Adverse obstetric and neonatal outcomes in women with mental disorders.

The brain and the placenta synthesize identical peptides and proteins, such as brain-derived neurotrophic factor, oxytocin, vascular endothelial growth factor, cortisol, and matrix metalloproteinases. Given the promiscuity between neurochemistry and the mechanism of placentation, it would be expected that mental disorders occurring during pregnancy would increase the risk of adverse obstetric and neonatal outcomes. Indeed, expectant mothers with anxiety disorders, post-traumatic stress disorder, schizophrenia, or depressive disorders are at higher risk of preterm birth, low-birth-weight and small-for-gestational-age infants than controls. These mental illnesses are accompanied by a procoagulant phenotype and low activity of tissue plasminogen activator, which may contribute to placental insufficiency. Another risk factor for pregnancy complications is hyperemesis gravidarum, more common among women with eating disorders or anxiety disorders than in controls. Severe hyperemesis gravidarum is associated with dehydration, electrolyte imbalance and malnutrition, all of which may increase the risk of miscarriages, of low-birth-weight babies and preterm birth. This paper reviews some aspects of mental disorders that may influence pregnancy and neonatal outcomes.

Predictors of poor perinatal outcome following maternal perception of reduced fetal movements--a prospective cohort study.

BACKGROUND: Maternal perception of reduced fetal movement (RFM) is associated with increased risk of stillbirth and fetal growth restriction (FGR). RFM is thought to represent fetal compensation to conserve energy due to insufficient oxygen and nutrient transfer resulting from placental insufficiency. OBJECTIVE: To identify predictors of poor perinatal outcome after maternal perception of reduced fetal movements (RFM). DESIGN: Prospective cohort study. METHODS: 305 women presenting with RFM after 28 weeks of gestation were recruited. Demographic factors and clinical history were recorded and ultrasound performed to assess fetal biometry, liquor volume and umbilical artery Doppler. A maternal serum sample was obtained for measurement of placentally-derived or modified proteins including: alpha fetoprotein (AFP), human chorionic gonadotrophin (hCG), human placental lactogen (hPL), ischaemia-modified albumin (IMA), pregnancy associated plasma protein A (PAPP-A) and progesterone. Factors related to poor perinatal outcome were determined by logistic regression. RESULTS: 22.1% of pregnancies ended in a poor perinatal outcome after RFM. The most common complication was small-for-gestational age infants. Pregnancy outcome after maternal perception of RFM was related to amount of fetal activity while being monitored, abnormal fetal heart rate trace, diastolic blood pressure, estimated fetal weight, liquor volume, serum hCG and hPL. Following multiple logistic regression abnormal fetal heart rate trace (Odds ratio 7.08, 95% Confidence Interval 1.31-38.18), (OR) diastolic blood pressure (OR 1.04 (95% CI 1.01-1.09), estimated fetal weight centile (OR 0.95, 95% CI 0.94-0.97) and log maternal serum hPL (OR 0.13, 95% CI 0.02-0.99) were independently related to pregnancy outcome. hPL was related to placental mass. CONCLUSION: Poor perinatal outcome after maternal perception of RFM is closely related to factors which are connected to placental dysfunction. Novel tests of placental function and associated fetal response may provide improved means to detect fetuses at greatest risk of poor perinatal outcome after RFM.

Prenatal protein malnutrition enhances stimulus control by CDP, but not a CDP/THIP combination in rats.

In the present study, the effects of prenatal protein malnutrition on stimulus control exerted by the benzodiazepine (BZ), chlordiazepoxide (CDP) and the GABA-A receptor agonist 4,5,6,7-tetrahydroisoxazolo[5,4-c]pyridin-3-ol (THIP) were characterized. The adult, male offspring of female Sprague-Dawley rats fed either low (6% casein) or adequate (25% casein) protein diets 5 weeks prior to mating and throughout pregnancy served as subjects. Subjects were first trained to discriminate CDP (8.0 mg/kg ip) from saline using drug discrimination procedures. Once a criterion level of performance was achieved, generalization tests were performed to lower doses of CDP (4.0, 2.0, 1.0, 0.5 and 0.25 mg/kg) and then to several doses of THIP (10.0, 7.5, 5.6 and 3.2 mg/kg). Lastly, the ability of a single dose of THIP (3.0 mg/kg) to enhance discriminative control by several low doses of CDP (4.0, 2.0, 1.0 and 0.5 mg/kg) was assessed. Although both diet groups acquired the original CDP/saline discrimination at the same rate, malnourished rats exhibited significantly more generalization to low doses of CDP than their well-nourished counterparts. Neither diet group exhibited significant generalization to THIP nor a difference in THIP's ability to enhance the CDP cue. These results suggest that a subject's sensitivity to the stimulus properties of drugs can be selectively modified by prenatal malnutrition.

[Psychosomatic aspects of females with placental insufficiency]. / Zur Psychosomatik von Frauen mit Plazentainsuffizienz.

Significant differences occurred on various scales by comparing 30 pregnant women who suffered from dysfunction of placenta chosen at random. Comparison was made by means t-tests and cross tables in GT, FPI, SSG sociological and medical data. Additionally a controlled experiment was performed. Dominating parts on a body level are the masochistic and the rigid one, both high charged structures. They seem to be more frequent than schizoid, oral and psychopathic parts. Looking to psychosomatics of dysfunction of placenta aggressive wishes against the child could be found.