Biomedical subjects

E J H Mulder

Publications and source records attributed to E J H Mulder.

6 recordsLinked to original sources

PubMed2005

Long-term psychological consequences of pregnancy termination for fetal abnormality: a cross-sectional study.

OBJECTIVE: We examined women's long-term psychological well-being after termination of pregnancy (TOP) for fetal anomaly in order to identify risk factors for psychological morbidity. METHODS: A cross-sectional study was performed in 254 women, 2 to 7 years after TOP for fetal anomaly before 24 weeks of gestation. We used standardised questionnaires to investigate grief, posttraumatic symptoms, and psychological and somatic complaints. RESULTS: Women generally adapted well to grief. However, a substantial number of the participants (17.3%) showed pathological scores for posttraumatic stress. Low-educated women and women who had experienced little support from their partners had the most unfavourable psychological outcome. Advanced gestational age at TOP was associated with higher levels of grief, and posttraumatic stress symptoms and long-term psychological morbidity was rare in TOP before 14 completed weeks of gestation. Higher levels of grief and doubt were found if the fetal anomaly was presumably compatible with life. CONCLUSION: Termination of pregnancy for fetal anomaly is associated with long-lasting consequences for a substantial number of women. Clinically relevant determinants are gestational age, perceived partner support, and educational level.

Abortion, Induced↗

PubMed2004

The effects of antenatal betamethasone administration on fetal heart rate and behaviour depend on gestational age.

OBJECTIVE: We previously reported decreases in fetal heart rate (FHR) variability and body and breathing movements after maternal betamethasone administration. We now test the hypothesis that fetal responsiveness to betamethasone depends on the gestational age at which glucocorticoid therapy is started. DESIGN OF THE STUDY: 1-h recordings of FHR (n=350) and fetal movements (n=310) made during a 5-day period (days 0-4) were available for analysis. The recordings had been obtained from 63 pregnant women at high risk for preterm delivery who received betamethasone (two doses of 12 mg 24 h apart) between 26 and 34 weeks' gestational age (wGA). The response to betamethasone, i.e. the direction and magnitude of change in FHR and movement parameters compared with baseline (day 0), was studied in relation to gestational age at drug administration. RESULTS: Fetuses exposed to betamethasone at 29-34 wGA showed a decrease in FHR on day 1 (indicative of baroreceptor reflex), and reduced breathing activity and prolonged episodes of quiescence with a concomitant decrease in body movements on days 1 and 2. However, these changes were not observed if betamethasone administration occurred at 26-28 wGA. Betamethasone-induced reductions in FHR variability were similar in young and older fetuses. CONCLUSIONS: Age-related differential responsiveness to betamethasone was found for all studied fetal processes (body and breathing movements, FHR, and quiescence), except FHR variability. Our results suggest ontogenic changes in the mechanisms presumed to underlie these processes (glucocorticoid receptor (GR) maturation, cardiovascular and neuro-endocrine development).

Betamethasone↗

PubMed2003

Fetal behaviour does not differ between boys and girls.

INTRODUCTION: Little is known about sex differences in human fetal heart and behaviour. PATIENTS AND METHODS: One hundred twenty-three nulliparous healthy women carrying a male (n=56) or female (n=67) fetus participated in this study. All pregnancies remained uncomplicated and delivery was uneventful. Ultrasound observation of fetal general movements (GM) was performed for 1 h at 15-17 (T1) and 27-28 (T2) weeks of gestation and for 2 h at 37-39 weeks (T3). Fetal heart rate (FHR) monitoring occurred simultaneously with fetal ultrasound observations at T2 and T3. The incidence of GM (percentage of time), FHR and its variability, and the incidences of fetal heart rate patterns (HRP) A-D and behavioural states 1F-4F were compared between boys and girls. RESULTS: There were no significant differences between males and females in the distribution of HRP A-D, overall behavioural state distribution, and basal FHR, FHR variability or the presence of GM during quiet and active sleep (or during HRP A and HRP B, respectively). A TimeXSex interaction effect for GM assessed for total record length and a higher %GM in male fetuses at term age were the only significant findings. However, these observations lost statistical significance after adjustment for the effects of fetal wakefulness, which occurred to a higher extent in male than in female fetuses. CONCLUSION: Our data do not provide evidence for a difference in fetal functional development or maturation between the two sexes.

Adolescent↗

PubMed2002

Prenatal maternal stress: effects on pregnancy and the (unborn) child.

BACKGROUND: Animal experiments have convincingly demonstrated that prenatal maternal stress affects pregnancy outcome and results in early programming of brain functions with permanent changes in neuroendocrine regulation and behaviour in offspring. AIM: To evaluate the existing evidence of comparable effects of prenatal stress on human pregnancy and child development. STUDY DESIGN: Data sources used included a computerized literature search of PUBMED (1966-2001); Psychlit (1987-2001); and manual search of bibliographies of pertinent articles. RESULTS: Recent well-controlled human studies indicate that pregnant women with high stress and anxiety levels are at increased risk for spontaneous abortion and preterm labour and for having a malformed or growth-retarded baby (reduced head circumference in particular). Evidence of long-term functional disorders after prenatal exposure to stress is limited, but retrospective studies and two prospective studies support the possibility of such effects. A comprehensive model of putative interrelationships between maternal, placental, and fetal factors is presented. CONCLUSIONS: Apart from the well-known negative effects of biomedical risks, maternal psychological factors may significantly contribute to pregnancy complications and unfavourable development of the (unborn) child. These problems might be reduced by specific stress reduction in high anxious pregnant women, although much more research is needed.

Adult↗

PubMed2002

Fetal and maternal cardiovascular diurnal rhythms in pregnancies complicated by pre-eclampsia and intrauterine growth restriction.

OBJECTIVES: To determine whether the diurnal blood pressure profiles in pregnant women with pre-eclampsia and/or intrauterine growth restriction (IUGR) differ from those in normal pregnant controls, and, if so, to establish whether such a difference is accompanied by altered diurnal rhythms of fetal heart rate (FHR) and its variation. METHODS: Twenty-two women in the third trimester of pregnancy with pre-eclampsia, IUGR, or both, entered the study. Eleven healthy pregnant women served as controls. Maternal systolic and diastolic blood pressures and heart rate (MHR) were determined automatically at 30-min intervals during a period of 26 h starting at 09.00. During the study period, nine 1-h recordings of FHR were made at predetermined timepoints. FHR was analyzed numerically. RESULTS: Systolic and diastolic blood pressures and MHR showed diurnal patterns, with the highest values during the day and a trough during the night in all women. Daytime and night-time blood pressures were higher in pre-eclamptic women (p < 0.001), and the day-night difference was smaller than in controls (p < 0.001). Diurnal patterns of FHR and its variation did not differ qualitatively between the three study groups. However, FHR was affected by the maternal blood pressure profile, and all FHR parameters and their diurnal ranges were quantitatively different in IUGR fetuses (p < 0.05). CONCLUSION: In pre-eclamptic women, there was blunting of the diurnal blood pressure profile. This altered maternal hemodynamics was associated with a similar reduction in FHR amplitude during the 26-h period but not with FHR variation. Although diurnal rhythms of FHR and its variation persisted qualitatively in the IUGR fetuses, they seemed to have been reset quantitatively, leading to a flattened diurnal pattern.

Adult↗

PubMed2002

The amniotic fluid index in late pregnancy.

OBJECTIVE: Our purpose was to examine changes in the amniotic fluid index (AFI) in accurately dated term pregnancies both in relation to gestational age and in relation to the onset of spontaneous labor. STUDY DESIGN: This was a prospective observational study in 137 women with uneventful term pregnancies, in whom 220 AFI measurements were performed. More than one AFI value was available from 51 individuals. RESULTS: The AFI did not change significantly between 37 and 42 weeks' gestation, but a significant reduction was seen during the last 11 days before the spontaneous onset of labor (R = -0.37, n = 83, p < 0.001). The AFI (corrected for gestational age) within individuals remained stable over periods of up to 2 weeks. Meconium staining of the amniotic fluid was related to gestational age, but not to the AFI or fetal distress at birth. No significant correlation was found between fetal distress and the AFI, or between fetal distress and the reduction in AFI during the last two measurements before labor. CONCLUSIONS: The reduction of the AFI in pregnancies progressing beyond term is related to the labor process itself rather than to the exact gestational age.

Amniotic Fluid↗