Stress matters! Psychophysiological and emotional loadings of pregnant women undergoing fetal magnetic resonance imaging

Abstract

Background: While the application of fetal MRI in high-risk pregnant women is steadily rising, little is known about the psychological consequences of this procedure. The aim of the present study was to investigate emotional and psychophysiological reactions of females undergoing fetal MRI.

Methods: Sixty women (17-44 ys), assigned for fetal MRI, were included. Affective state was assessed by standardized measures of anxiety, emotional states and depressive symptoms. Stress coping strategies were assessed using a self-report questionnaire. Stress responses were determined using skin conductance levels (SCL) during fetal MRI as well as measurement of salivary cortisol levels immediately before and after fetal MRI.

Results: Analysis of fast and slow physiological stress measures revealed significant differences between women with and without a supporting person accompanying them to the examination. For SCLs, lower levels of stress during MRI emerged in accompanied women. Women with well-marked stress-coping-strategies experienced lower levels of stress during the examination. Although fast and slow stress measures before and after MRI did not show significant correlations, a significant difference of SCLs pre and post examination was clearly detectable, as well as a trend of decreased cortisol levels for both time points.

Conclusions: The results imply that the elevation of SCLs is an accurate instrument to assess fast stress alterations in patients during fetal MRI. Stress coping strategies and whether women are accompanied or not play an important role in the experience of anxiety and depressive symptoms. These factors should be considered especially in patients with high-risk-pregnancies to improve patient care.

Figure 1

Non-polarizing MR compatible electrode with an eight meter twisted pair cable used for recording skin conductance levels of subjects while lying in the scanner.

Figure 2

Graphic representation of the experimental design for all subjects. Measurements for each subject took place on the same day (between 7 and 9 am) and included three different subprocedures. Immediately before fetal MRI (1) patients were informed about the whole experiment, gave their written informed consent and completed two questionnaires. Subsequently saliva samples were taken. During fetal MRI (2) skin conductance levels were monitored and recorded. Immediately after fetal MRI (3) saliva samples were taken, and several questionnaires were completed.

Figure 3

Stress measures cortisol and skin conductance measures before and after fetal MRI depending on accompanying person. a) All subjects showed higher cortisol levels before compared to post examination. b) Skin conductance levels (SCL, in μs) of the first 5 minutes (t1) and last 5 minutes (t2) of fetal MRI examination of women with (yes) and without (no) support by an accompanying person. Accompanied women showed a significant reduction of SCL-levels at the last 5 minutes of the examination.

Figure 4

Mean scores of positive and negative affect scale showing higher positive as well as negative scores immediately before compared to post fetal MRI examination for all subjects. Significant differences are marked with an asterisk.

Figure 5

Stress measures cortisol and skin conductance measures before and after fetal MRI depending on severity of diagnosis. a) Cortisol levels immediately before (pre) and after (post) fetal MRI examination for women grouped by severity of diagnosis. All cortisol levels were reduced after MRI examination, with the best effect for the subgroup in which the fetal pathology was probably not compatible with survival. b) Skin conductance levels (SCL, in μs) of the first 5 minutes (t1) and last 5 minutes (t2) of fetal MRI examination of women grouped by severity of diagnosis. All SCL levels were reduced after MRI examination, with the best effect for the subgroup with no fetal malformation.

Figure 6

Stress measures cortisol and skin conductance measures before and after fetal MRI depending on stress management strategies. a) Cortisol levels immediately before (pre) and after (post) fetal MRI examination for women grouped by characteristics of their stress management strategies. All cortisol levels were reduced after MRI examination. b) Skin conductance levels (SCL, in μs) of the first 5 minutes (t1) and last 5 minutes (t2) of fetal MRI examination of women grouped by characteristics of their stress management strategies. Women with above average strategies were able to relax the most during the MRI examination.