Prenatal stress and hemodynamics in pregnancy: a systematic review

Terri A. Levine, Fiona A. Alderdice, Ruth E. Grunau, Fionnuala M. McAuliffe*

*Corresponding author for this work

Research output: Contribution to journalReview articlepeer-review

15 Citations (Scopus)
317 Downloads (Pure)


Maternal prenatal stress is associated with preterm birth, intrauterine growth restriction, and developmental delay. However, the impact of prenatal stress on hemodynamics during pregnancy remains unclear. This systematic review was conducted in order to assess the quality of the evidence available to date regarding the relationship between prenatal stress and maternal–fetal hemodynamics. The PubMed/Medline, EMBASE, PsycINFO, Maternity and Infant Care, Trip, Cochrane Library, and CINAHL databases were searched using the search terms pregnancy; stress; fetus; blood; Doppler; ultrasound. Studies were eligible for inclusion if prenatal stress was assessed with standardized measures, hemodynamics was measured with Doppler ultrasound, and methods were adequately described. A specifically designed data extraction form was used. The methodological quality of included studies was assessed using well-accepted quality appraisal guidelines. Of 2532 studies reviewed, 12 met the criteria for inclusion. Six reported that prenatal stress significantly affects maternal or fetal hemodynamics; six found no significant association between maternal stress and circulation. Significant relationships between prenatal stress and uterine artery resistance (RI) and pulsatility (PI) indices, umbilical artery RI, PI, and systolic/diastolic ratio, fetal middle cerebral artery PI, cerebroplacental ratio, and umbilical vein volume blood flow were found. To date, there is limited evidence that prenatal stress is associated with changes in circulation. More carefully designed studies with larger sample sizes, repeated assessments across gestation, tighter control for confounding factors, and measures of pregnancy-specific stress will clarify this relationship.

Original languageEnglish
Pages (from-to)721-739
Number of pages19
JournalArchives of Women's Mental Health
Issue number5
Early online date21 Jun 2016
Publication statusPublished - 01 Oct 2016


  • Blood flow
  • Doppler ultrasound
  • Fetal well-being
  • Hemodynamics
  • Middle cerebral artery
  • Pregnancy
  • Pregnancy-specific stress
  • Psychological distress
  • Stress
  • Umbilical artery
  • Uterine artery

ASJC Scopus subject areas

  • Medicine(all)
  • Obstetrics and Gynaecology
  • Psychiatry and Mental health

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