Pregnancy

Maternal neuroendocrine function during pregnancy has been related to a number of pregnancy outcomes including less optimal fetal growth patterns. Animal models have consistently demonstrated that glucocorticoid infusions to the mother result in fetal growth restriction and norepinephrine infusions in reduced blood flow to the fetus. Similarly, human studies reveal that elevated maternal HPA axis and adrenal function (associated with stress anxiety and depression) during pregnancy is related to prematurity and low birthweight. The present study examined the relationship between maternal cortisol and norepinephrine and fetal growth measures during mid-gestation. Correlation analyses revealed that both maternal psychological (daily hassles, depression and anxiety) and biochemical (cortisol and norepinephrine) variables were negatively related to fetal growth measures. Hierarchical multiple regression analyses further revealed that maternal cortisol was the best single maternal predictor of fetal growth accounting for a significant portion of the variance even after controlling for gestational age and fetal gender. Results from the structural equation model indicate that the effects of maternal psychological distress on fetal growth are mediated by maternal cortisol. Potential mechanisms of action are discussed.

The purpose of this hermeneutic phenomenological study was to understand the essence of the lived experience of women after having an abnormal prenatal ultrasound. One hundred years ago, health disciplines had limited therapies for prenatal and neonatal disorders. During this period, the eugenics movement influenced leaders to involuntarily sterilize individuals who were sought to be "unfit" to prevent disorders in offspring. ... One of these contemporary reproductive genetic technologies is the use of ultrasound and serum bio-medical markers for detection of congenital, chromosome, and genetic disorders. When ultrasounds reveal abnormal findings, the perceived perfect pregnancy vanishes and gives way to feelings of shock, disbelief, fear, guilt, loss, and threats to self and their unborn baby. Twelve women who had an abnormal ultrasound were interviewed within the context of their cultural values and beliefs. The method of van Manen's hermeneutic phenomenology illuminated the meaning for these women in their life worlds. ... They endured this experience through their own coping mechanisms, but often felt uncertainty and emotional turmoil until the birth. The women also sought comfort through their cultural values, beliefs, and traditions. In coping with the risks found on this abnormal ultrasound, women often selected silence or blocking perceived threats. With these coping methods, they were alone in their suffering. ... Health providers, in not recognizing these women's misunderstandings and emotional fears, abandoned them in their psychosocial and cultural needs. The significance reveals that nurses and health providers need to infuse human caring ways of being, knowing, and doing within advanced technological environments.