Maternal anxiety and ultrasound markers for aneuploidy in a multiethnic population

OBJECTIVE

Discussion of isolated ultrasound (US) markers for fetal aneuploidy can provoke significant patient anxiety. The objective of this study is to quantify maternal anxiety associated with the detection of these markers.

METHODS

All patients undergoing routine second-trimester US examination for fetal anatomical survey over a one-year period were administered the State-Trait Anxiety Inventory (STAI) for Adults before and after the procedure. Women with isolated fetal markers for aneuploidy were notified of the findings but discouraged from pursuing amniocentesis. Rates of normal US examination, aneuploidy markers, anomalies, amniocentesis, and pregnancy outcomes were assessed across the ethnic groups. Pre- and post-ultrasound STAI surveys were scored and standardized with previously established norms. Student t-tests, Chi-square, and analysis of variance (ANOVA) were used where appropriate.

RESULTS

Among the 798 patients tested, 57% were Hispanic, 30% were Asian, 6% were Black, and 7% were White. Maternal anxiety level was decreased in women after a normal US. The anxiety level increased with aneuploidy markers and was the highest with anomalies. Aneuploidy markers were more common among Hispanic and Asian fetuses, without any associated aneuploidy. Women with isolated aneuploidy markers underwent amniocentesis as often as women with advanced maternal age.

CONCLUSION

The detection and communication of isolated aneuploidy markers is associated with increased maternal anxiety and unnecessary amniocentesis.

Regulation of plasminogen activator inhibitor (PAI)-1 expression in a human trophoblast cell line by glucocorticoid (GC) and transforming growth factor (TGF)-beta

Plasminogen activator inhibitor (PAI)-1 plays a key role in the regulation of fibrinolysis and cellular invasion by virtue of suppression of plasminogen activator function. Excessive production of placental PAI-1 has been associated with aberrant periplacental fibrin deposition in pregnancies complicated by pre-eclampsia (PE) and intrauterine growth restriction (IUGR). In the current study we used HTR-8/SVneo cells and primary cultures of cytotrophoblasts as models for study of PAI-1 regulation by transforming growth factor (TGF)-beta, and dexamethasone (DEX), a synthetic glucocorticoid (GC). ELISA and Northern blotting assays revealed that DEX treatment significantly enhanced TGF-beta effects on PAI-1 protein and mRNA expression in HTR-8/SVneo cells and cytotrophoblasts. These effects were GC-specific in that DEX and cortisol, but not estradiol, progesterone or testosterone, augmented PAI-1 levels in TGF-beta-treated cells. Conversely, DEX and TGF-beta treatment suppressed PAI-2 levels in HTR-8/SVneo cells and did not affect PAI-2 levels in cytotrophoblasts. PAI-1 promoter assays revealed that TGF-beta, but not DEX, enhanced PAI-1 expression in HTR-8/SVneo cells through a transcriptional mechanism. These results suggest that GC and TGF-beta may alter fibrinolytic and invasive properties of trophoblasts through their effects on PAI-1 expression.