DYSFUNCTION OF THE PLACENTA IN PREGNANT WOMEN WITH POST-TRAUMATIC STRESS DISORDER

Authors

DOI:

https://doi.org/10.11603/24116-4944.2023.1.13939

Keywords:

pregnancy, placental dysfunction, post-traumatic stress disorder

Abstract

The aim of the study – to assess the prevalence of post-traumatic stress disorder (pTSD) among pregnant women with signs of placental dysfunction.

Material and Methods. The study was conducted on the basis of the clinical units of the Department of Obstetrics and Gynecology of the Odessa National Medical University (Odesa) in 2022. 35 pregnant women aged 20–35 with signs of placental dysfunction (main group) and 30 pregnant women of the same age with the physiological course of pregnancy (control group) were examined. The following criteria were used to verify placental dysfunction: the presence of changes in fetoplacental blood flow, the presence of symmetric or asymmetric fetal hypotrophy, signs of fetal distress, hormonal imbalance (increased blood concentration of placental hormones with a simultaneous decrease in fetal hormones, including high levels of placental lactogen, chorionic gonadotropin, low levels of estrogens, progesterone, alpha-fetoprotein), changes in the activity of enzymes (alkaline phosphatase, oxytocinase). A structured clinical diagnostic interview and the CAPS-5 clinical diagnostic scale were used to determine the signs of PTSD. Statistical processing was carried out by methods of dispersion and correlation analysis using Statistica 14.0 software (TIBCO, USA)

Results and Discussion. The average age of pregnant women in the main group was 28.1±0.3 years, the control group was 27.3±0.4 years old (p>0.05). In both groups, first-time pregnant women predominated (54.3 % and 63.3 %, respectively). Signs of ZVUR were identified in 91.4 % of cases in pregnant women of the main group, violations of fetoplacental blood flow – in 100 % of cases, changes in cerebral blood flow of the fetus after the 32nd week of gestation – in 17.1 % of cases.In all cases of PD, changes in the hormonal profile were noted. When assessing the prevalence of PTSD in women of both clinical groups, a significant prevalence of such cases was determined in the main group (8 or 25.7 % versus 2 (6.7 %) in the control group, χ2=4.17 df=1 p=0.04). In all pregnant women, the manifestations of post-traumatic stress disorder lasted more than a month, their intensity corresponded to 62.2±1.1 points in the main group and 63.5±5.8 points in the control group. The most frequent causes of PTSD in pregnant women are the presence of obstetric or perinatal complications during previous pregnancies, the status of a refugee/displaced person from temporarily occupied territories, and the loss of a loved one (husband, brother, father, mother, etc.) as a result of military operations or for other reasons.

Conclusions. The frequency of detection of PTSD symptoms in pregnant women with compensated placental dysfunction is 3.5 times higher than during the physiological course of pregnancy. The most frequent causes of PTSD in pregnant women are the presence of obstetric or perinatal complications during previous pregnancies, the status of a refugee/displaced person from temporarily occupied territories and the loss of a loved one (husband, brother, father, mother, etc.) as a result of military operations or for other reasons

Author Biographies

N. M. Rozhkovska, Odesa National Medical University

Doctor of Medical Sciences, Professorof the Department of Obstetrics and Gynecology of Odesa NationalMedical University

O. M. Nadvorna, Odesa National Medical University

Candidate of Medical Sciences, AssociateProfessor of the Department of Obstetrics and Gynecology of OdesaNational Medical University

D. M. Zhelezov, Odesa National Medical University

Doctor of Medical Sciences, DeputyDirector of the KNP "Maternity Home No. 5", Odesa

References

Burton, G.J., & Jauniaux, E. (2018). Pathophysiology of placental-derived fetal growth restriction. American Journal of Obstetrics and Gynecology, 218(2), S745-S761. DOI: https://doi.org/10.1016/j.ajog.2017.11.577

Aplin, J.D., Myers, J.E., Timms, K., & Westwood, M. (2020). Tracking placental development in health and disease. Nature Reviews Endocrinology, 16(9), 479-494. DOI: https://doi.org/10.1038/s41574-020-0372-6

Brosens, I., Puttemans, P., & Benagiano, G. (2019). Placental bed research: I. The placental bed: from spiral arteries remodeling to the great obstetrical syndromes. American Journal of Obstetrics and Gynecology, 221(5), 437-456. DOI: https://doi.org/10.1016/j.ajog.2019.05.044

Nardozza, L.M.M., Caetano, A.C.R., Zamarian, A.C.P., Mazzola, J.B., Silva, C.P., Marçal, V. M.G., ... Araujo Júnior, E. (2017). Fetal growth restriction: current knowledge. Archives of Gynecology and Obstetrics, 295, 1061-1077. DOI: https://doi.org/10.1007/s00404-017-4341-9

Qu, H., & Khalil, R.A. (2020). Integrative Cardiovascular Physiology and Pathophysiology: Vascular mechanisms and molecular targets in hypertensive pregnancy and preeclampsia. American Journal of Physiology-Heart and Circulatory Physiology, 319(3), H661. DOI: https://doi.org/10.1152/ajpheart.00202.2020

Zou, Z., Forbes, K., Harris, L.K., & Heazell, A.E. (2021). The potential role of the E SRRG pathway in placental dysfunction. Reproduction, 161(3), R45-R60. DOI: https://doi.org/10.1530/REP-20-0272

How Common is PTSD in Women? Retrieved from: https://www.ptsd.va.gov/understand/common/common_women.asp.

Forray, A., Mayes, L.C., Magriples, U., & Epperson, C.N. (2009). Prevalence of post-traumatic stress disorder in pregnant women with prior pregnancy complications. The Journal of Maternal-Fetal & Neonatal Medicine, 22(6), 522-527. DOI: https://doi.org/10.1080/14767050902801686

Johnson, R.J., Antonaccio, O., Botchkovar, E., & Hobfoll, S.E. (2021). War trauma and PTSD in Ukraine’s civilian population: comparing urban-dwelling to internally displaced persons. Social Psychiatry and Psychiatric Epidemiology, 1-10. DOI: 10.1007/s00127-021-02176-9. Epub 2021 Oct 1. PMID: 34596712. DOI: https://doi.org/10.1007/s00127-021-02176-9

Rieder, J.K., Kleshchova, O., & Weierich, M.R. (2022). Estradiol, stress reactivity, and daily affective experiences in trauma-exposed women. Psychological Trauma: Theory, Research, Practice, and Policy, 14(5), 738. DOI: 10.1037/tra0001113. Epub 2021 Oct 28. PMID: 34726450; PMCID: PMC9046469. DOI: https://doi.org/10.1037/tra0001113

Yehuda, R., Hoge, C.W., McFarlane, A.C., Vermetten, E., Lanius, R.A., Nievergelt, C.M., ... Hyman, S.E. (2015). Post-traumatic stress disorder. Nature Reviews Disease Primers, 1(1), 1-22. DOI: 10.1038/nrdp.2015.57. PMID: 27189040. DOI: https://doi.org/10.1038/nrdp.2015.57

Howard, J.T., Sosnov, J.A., Janak, J.C., Gundlapalli, A.V., Pettey, W.B., Walker, L.E., & Stewart, I. (2018). Associations of initial injury severity and posttraumatic stress disorder diagnoses with long-term hypertension risk after combat injury. Hypertension, 71(5), 824-832. DOI: 10.1161/HYPERTENSIONAHA.117.10496. Epub 2018 Mar 19. PMID: 29555664. DOI: https://doi.org/10.1161/HYPERTENSIONAHA.117.10496

Solovei, V.M. (2020). Diahnostyka placentarnoyi dysfunktsii ta prohnozuvannia perynatalnykh uskladnen u zhinok iz nevynoshuvanniam u ranni terminy hestacii (ohliad literatury) [Diagnosis of placental dysfunction and prediction of perinatal complications in women with miscarriage in early gestation (literature review)]. Klinichna ta eksperymentalna patolohiya – Clinical and Experimental Pathology, 19, 2(72), 91-97 [in Ukrainian].

Wardinger, J.E., & Ambati, S. (2022). Placental Insufficiency. Treasure Island (FL): StatPearls Publishing. Retrieved from: https://www.ncbi.nlm.nih.gov/books/NBK563171/.

Structured Clinical Interview for the DSM-5 (SCID PTSD Module). Retrieved from: https://www.ptsd.va.gov/professional/assessment/adult-int/scid-ptsd-module.asp.

Clinician-Administered PTSD Scale for DSM-5 (CAPS-5). Retrieved from: https://www.ptsd.va.gov/professional/assessment/adult-int/caps.asp.

Fetіsov, V.S. (2018). Paket statistichnogo analіzu danih STATISTICA [Package of statistical data analysis STATISTICA]. Nіzhуn : NDU іm. M. Hoholia [in Ukrainian].

Published

2023-07-04

How to Cite

Rozhkovska, N. M., Nadvorna, O. M., & Zhelezov, D. M. (2023). DYSFUNCTION OF THE PLACENTA IN PREGNANT WOMEN WITH POST-TRAUMATIC STRESS DISORDER. Actual Problems of Pediatrics, Obstetrics and Gynecology, (1), 44–47. https://doi.org/10.11603/24116-4944.2023.1.13939

Issue

Section

OBSTETRICS AND GYNECOLOGY