Purpose: Explore the associations of prenatal maternal anxiety to placental histologic findings, and the pro-inflammatory, anti-inflammatory, and immunoregulatory cells found in the placenta and determine the effect of maternal anxiety on the association between placental molecular changes on pregnancy and birth and infant outcomes.~Subject Population: Prenatal patients receiving obstetrical care at the San Antonio Military Medical Center will be the focused population. Patients must be 18 years or older and planning to deliver at the San Antonio Military Medical Center.~Design: The study is a repeated measures longitudinal design in which patients will complete psychosocial measures of prenatal anxiety, depression, and resilience at multiple data points during their pregnancies (at 12, 16, 24, and 32 weeks gestation). Placental tissue collected after birth will be used to obtain histologic, microscopic, and molecular data. Pregnancy and neonoatal outcome data including gestational age at delivery, infant birthweight, mode of delivery, and pregnancy complications, including pre-eclampsia, gestational hypertension, gestational diabetes, and perinatal and neonatal infections will be collected from the maternal and infant medical records.~Procedures: Participants will complete multiple psychosocial measures at 12, 16, 24, and 32 weeks gestation. Placental tissue will be collected at delivery, gross and microscopic examinations will occur for all placentas of women consented to the study. Histopathological findings will be classified according to standard guidelines and coded into categories that identify vascular malperfusion or uteroplacental vascular insufficiency and maternal inflammatory disorders. Tissue biopsies will be frozen and maintained until they can be batch run. Each biopsy will be homogenized and divided into groups for analysis for RNA expression, protein expression, hormonal and oxidative stress biomarkers. Linear mixed models will be used for all normally distributed continuous data. Binary or dichotomized outcomes will be assessed through mixed model logistic regression. Measurement times, adjusting for age, employment status, prior deliveries, marital status, education, deployment of partner, and MOMS group will be included within the models. Each prenatal variable, anxiety, self-esteem, depression, and resilience will be longitudinally regressed on measurement time to obtain slopes through best linear unbiased predictor. The results slopes will be used to determine any significant effects for prenatal psychosocial scores to pregnancy complications, birth and infant outcomes, and to the physiologic data.
Explore the associations of prenatal maternal anxiety to placental histologic findings, and the pro-inflammatory, anti-inflammatory, and immunoregulatory cells found in the placenta and determine the effect of maternal anxiety on the association between placental molecular changes on pregnancy and birth and infant outcomes.