Furthermore, prenatal stress decreases expression of placental 11β-HSD-2 in preclinical and clinical studies 20, 70, 71, particularly when stress is chronic rather than acute 72, and some preliminary evidence in humans suggests that this effect may differ by sex 73. Thus, maternal adversity may affect placental barriers, which may in turn impact the extent to which male fetuses may be exposed to glucocorticoids. We observed a significant impact of high maternal ACE history on waFAV, a proxy for fetal adrenal development, but only in males. Our observation that the waFAV in males of mothers with a high ACE history did not differ from the waFAV of females extends preclinical research demonstrating a dysmasculinizing effect of gestational stress on a range of offspring outcomes.
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Ultrasonographic identification and measurement of the human fetal adrenal gland in utero: clinical application.
Even in animal models, only one study has tested for a relationship between maternal stress and fetal adrenal gland size, but that study only examined effects of prenatal stress in male fetuses. Our finding of sex-specific effects of maternal ACEs on waFAV emphasize the importance of considering maternal early life stress as well as offspring sex in biomedical research. Our significant findings would have been obscured if we had excluded either as a factor in our statistical analyses. In humans, ACEs impact maternal glucocorticoids in complex ways during pregnancy 17 and increase placental corticotropin releasing hormone (pCRH) 16. In turn, higher maternal cortisol and placental pCRH levels during gestation have been linked to fetal growth restriction 21, earlier birth 22, lower birthweight 23, and enhanced offspring stress response 24, 25.
Within this larger model, we tested for pairwise comparisons of the offspring sex/maternal ACE subgroups at ultrasounds 1 and 2 as these were our primary outcomes of interest. In the present study, we observed decreased adrenal artery PI, increased adrenal blood flow, and increased fetal adrenal volume in fetuses diagnosed with fetal growth restriction, most likely in response to placental insufficiency and chronic hypoxia. This study aims to evaluate sonographic measurements of fetal adrenal gland size and middle adrenal artery Doppler in pregnancies with fetal growth restriction (FGR) and in a healthy control group. Although we recently published data from this cohort showing that women’s acoustic startle response did not differ by ACE during pregnancy but did in the postpartum 76, we did not measure any maternal factors that allowed us to understand the physiological impact of ACEs on the mother during pregnancy.
Although maternal cortisol is largely inactivated by placental 11β-hydroxysteroid dehydrogenase type 2 (11β-HSD-2), maternal cortisol levels still explain a third of the variation in fetal cortisol levels 26. In an animal model of prenatal stress focusing exclusively on male offspring, male rats of stress exposed mothers exhibited decreased weight of the fetal adrenal glands relative to control males 20. To our knowledge, the current study is the first to examine the volume of the human fetal adrenal gland as a proxy for the impact of maternal ACEs on fetal HPA axis development.
Ultrasonographic identification and measurement of the human fetal adrenal gland in utero
We chose to focus on the fetal adrenal for three reasons. First, the adrenals are an essential stress-responsive organ of the HPA axis and the earliest and fastest growing organ in the fetal HPA axis 27. Second, in animal models, its volume varies based on gestational stress exposure, at least in males 20, suggesting that high maternal ACEs and their potential to disrupt maternal HPA axis function during gestation could impact fetal adrenal development. Third, technological advances in three-dimensional (3-D) ultrasound have made it possible to measure fetal adrenal volume (FAV) noninvasively in humans 28, 29, with good intra- and interrater reliability 30. One possible mechanism is that males may be more susceptible to maternal ACE effects. Mothers carrying male fetuses already exhibit higher cortisol 68, at least during mid-gestation 69.
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When trying to do so, it said “currently closed” and provided the Mon-Fri business hours. This section collects any data citations, data availability statements, or supplementary materials included in this article. At initial screening, participants completed the Adverse Childhood Experiences Questionnaire (ACE-Q) 49, the Edinburgh Postnatal Depression Scale (EPDS) 50, and a questionnaire assessing demographics as well as medical/obstetrics history. At full screening, participants were administered the Structured Clinical Interview for limefx forex broker DSM-IV-TR (SCID) 51 to rule out current psychiatric illness and the Hamilton Depression Rating Scale (HAM-D) 52 to assess subclinical depressive symptoms.
Future studies investigating intergenerational transmission of stress should consider the influence of maternal preconception stress on offspring outcomes. Currently, there is little data to guide the timing of when to study preconception stress effects on human fetal development. However, our study showed that findings at the second ultrasound were less robust than at the first ultrasound—although the pattern of results was the same and trended towards significance. The signal may be stronger and/or easier to detect earlier in development. One possible explanation for our significant effects at the first but not the second ultrasound is that fetal organs may become more difficult to accurately visualize using 3-D ultrasound later in gestation as the fetal bones become more ossified. This is because ossified fetal bones create more acoustic shadowing, potentially limiting the borders of fetal organs.
Antenatal Fetal Adrenal Measurements at 22 to 30 Weeks’ Gestation, Fetal Growth Restriction, and Perinatal Morbidity
- We observed a significant impact of high maternal ACE history on waFAV, a proxy for fetal adrenal development, but only in males.
- TurboTax customer service thinks I entered 17 X’s for the account number.
- In the present study, we observed decreased adrenal artery PI, increased adrenal blood flow, and increased fetal adrenal volume in fetuses diagnosed with fetal growth restriction, most likely in response to placental insufficiency and chronic hypoxia.
- This crossover effect, if it occurred in our sample, could have diminished the magnitude of our effects later in gestation.
If you are not receiving a federal tax refund then the boxes for routing and account numbers are all X’d out on the Form 1040 since there is no direct deposit for a refund. We’ve noticed that someone attempted to fill out a tax return using your information with a different account. We are holding the tax https://limefx.vip/ return for 48 hours to give you the opportunity to verify it’s yours or stop it. If we don’t hear from you within 48 hours, this return will be filed in accordance with IRS filing regulations. Given our focus on pregnant women and their offspring, ACEs could not be measured prospectively, nor did we rely on external records to confirm the occurrence of ACEs (e.g., court records). Although retrospective reporting is more susceptible to misclassification, a previous study assessing the test–retest reliability of an 8-item version of the ACE-Q 77 found its reliability to be “good” as defined by Fleiss 78 and “moderate to substantial” as defined by Landis and Koch 79.
Rationale for ACE as a dichotomous variable
CNE, MDS, and DRK contributed to the conception and design of the study. DRK, EYW, SLK, LH, RLJ, and GE contributed to the acquisition of the data. RLJ, MDS, EYW, and LH contributed to analysis of the data.
Humans
At this visit, they also completed the EPDS and the Spielberger State‐Trait Anxiety Inventory (STAI) 53. At the full screening and at each ultrasound visit, participants completed the Perceived Stress Scale (PSS) 54. Also, in the print center, you may choose to print all worksheets and schedules. This will show the detail of all calculations along with the routing and bank number entered for deposit or debit. I entered my routing number and account number and TurboTax recorded it as all X’s and sent it to the IRS. E.g. Routing number XXXXXXXXX, Account number XXXXXXXXXXXXXXXXX with no check in either Savings or Checking.
- At initial screening, participants completed the Adverse Childhood Experiences Questionnaire (ACE-Q) 49, the Edinburgh Postnatal Depression Scale (EPDS) 50, and a questionnaire assessing demographics as well as medical/obstetrics history.
- Given our focus on pregnant women and their offspring, ACEs could not be measured prospectively, nor did we rely on external records to confirm the occurrence of ACEs (e.g., court records).
- Furthermore, prenatal stress decreases expression of placental 11β-HSD-2 in preclinical and clinical studies 20, 70, 71, particularly when stress is chronic rather than acute 72, and some preliminary evidence in humans suggests that this effect may differ by sex 73.
- Although we recently published data from this cohort showing that women’s acoustic startle response did not differ by ACE during pregnancy but did in the postpartum 76, we did not measure any maternal factors that allowed us to understand the physiological impact of ACEs on the mother during pregnancy.
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The sex differences that we observed are consistent with the limited preclinical data investigating this 20. In males of mothers with a high ACE history, waFAV was significantly smaller than in males of mothers with a low ACE history but indistinguishable from the waFAV of females regardless of their mother’s ACE history. Importantly, our sample consisted of psychiatrically and medically healthy women, allowing us to isolate the impact of maternal ACEs on waFAV without the confounding impact of maternal mental and physical health problems during gestation.
Predicting Late-Term Pregnancy: The Role of Corrected Fetal Adrenal Gland Volume in Low-Risk Pregnants
The observed effects were presumably not due to maternal ACE effects on prenatal stress as perceived stress did not differ between maternal ACE groups at baseline or either of the two ultrasounds. Overall, our findings suggest male vulnerability to dysmasculinization of waFAV in response to maternal preconception stress. Research has long established that parental life experiences impact the offspring, with studies indicating effects across the lifespan, from the time of conception to adulthood 31, 59, 80–82. However, all previous human studies investigating outcomes in the fetus have focused on the effects of prenatal stress rather than preconception stress. To our knowledge, this study is the only one that has examined an association between a biological marker of risk in the fetus and maternal childhood adversity rather than adversity during pregnancy.
Thus, a next important step in this research is to study the mechanisms by which maternal ACEs become biologically embedded to influence offspring development. This prospective study included 107 singleton pregnancies with FGR between 24 and 42 weeks of gestation and 107 pregnancies with fetuses whose growth was appropriate for gestational age (AGA). Adrenal gland size and Doppler parameters of the adrenal artery were measured and the values and obstetric outcomes were compared between the study and control groups.
We designed this study (1) to evaluate the relationship between maternal ACEs and fetal body weight-adjusted FAV (waFAV) and (2) to consider fetal sex as a potential moderator. In animal models, the impact of gestational stress exposure on fetal adrenal gland development has not been studied in females and, in humans, prenatal stress exposure impacts offspring outcomes in a sex-dependent manner (e.g., 23, 31–38, 40, 42). Our sample included psychiatrically and medically healthy women, with the intention of isolating the effect of maternal ACEs on waFAV without the confounding impact of maternal mental health or medical problems during gestation. In a novel study testing for associations between maternal ACEs and waFAV as a marker of fetal HPA axis development, we demonstrate that maternal exposure to ACEs impacts the development of the fetal adrenal gland in a sex-specific manner.
If this is for a direct deposit of a tax refund, the routing and account numbers will be x’d out if you download the tax return before the tax return has been accepted by the IRS. The mechanisms by which parental early life stress can be transmitted to the next generation, in some cases in a sex-specific manner, are unclear. Maternal preconception stress may increase susceptibility to suboptimal health outcomes via in utero programming of the fetal hypothalamic–pituitary–adrenal (HPA) axis.
Another possible explanation is that maternal cortisol exposure may differ across gestation depending on offspring sex. One study found that maternal cortisol was higher in mid-gestation with male fetuses and higher in late gestation with female fetuses 69. This crossover effect, if it occurred in our sample, could have diminished the magnitude of our effects later in gestation. This allowed us to model data even if participants were missing one of the two ultrasounds.