EUROX 18 (2023) 100195

Contents lists available at ScienceDirect

European Journal of Obstetrics & Gynecology and

Reproductive Biology: X
journal homepage: www.journals.elsevier.com/european-journal-of-obstetrics-and-gynecology-and-
reproductive-biology

Furosemide for postpartum blood pressure control in patients with

hypertensive disorders
Megan Pagan a, Songthip T. Ounprpaseuth b, Taylor Ghahremani a, Tucker Doiron a,
Everett F. Magann a, *
a
Department of Obstetrics & Gynecology, University of Arkansas for Medical Sciences, Little Rock, AR 72205, USA
b
Department of Biostatistics, University of Arkansas for Medical Sciences, Little Rock, AR 72205, USA

A R T I C L E I N F O A B S T R A C T

Keywords: Objective: diuretics have the potential to reduce intravascular volume, decrease blood pressure The aim of our
Pregnancy study is to evaluate the effectiveness of furosemide in postpartum patients with pre-eclampsia and chronic hy­
Chronic hypertension pertension with superimposed pre-eclampsia.
Postpartum
Methods: This is a retrospective cohort study. Data was extracted from the record of patients who delivered
Blood pressure control
between 2017 and 2020 and had chronic hypertension or, chronic hypertension with superimposed pre-
Pre-eclampsia
Furosemide eclampsia, gestational hypertension, or pre-eclampsia. Patients who received intravenous furosemide in the
postpartum period were compared to those who did not. The groups were also analyzed for fetal growth re­
striction, and pregnancy outcomes comparing those who did receive furosemide and those who did not.
Results: The furosemide group had a statistically significant longer postpartum length of stay (p < 0.0001),
required more antihypertensive medications (p < 0.0001), medication increases (p < 0.0001), and emergent
blood pressure treatment (p < 0.0001), than the group who did not. There was no difference between groups in
hospital readmission, or fetal growth restriction.
Conclusion: The postpartum length of stay and rates of readmission were not decreased in the group treated with
intravenous furosemide. Future prospective studies that control for pregnancy comorbidities and severity of
preeclampsia are needed to determine furosemide’s effect on the volume status of the postpartum pre-eclamptic
patient and determine its role in the treatment of these women.

Introduction diuretic, may be a potential therapy to reduce intravascular volume in

the postpartum period and assist with blood pressure control and
Hypertension affects approximately 10 % of pregnancies and causes readmission rates [8,9]. A randomized control trial from 2005 found
a significant proportion of maternal morbidity and mortality [1,2]. benefits in patients with pre-eclampsia with severe features who
Hypertension in the postpartum period requiring hospital readmission received 5 days of furosemide postpartum, but no studies specifically
comprises a considerable number of obstetrical readmissions and overall evaluated both superimposed pre-eclampsia and pre-eclampsia with or
hospital readmission rates [3,4]. Hypertension and hypertensive ur­ without severe features [8–10].
gency can increase in the postpartum period due to postpartum fluid The aim of our study is to determine the effectiveness of furosemide
dynamics and changes in sodium balance in the setting of pre-eclampsia. in postpartum patients with pre-eclampsia and chronic hypertension
Following delivery, an influx of volume into the intravascular space with superimposed pre-eclampsia. We hypothesized that treatment with
occurs as the pathophysiology of pre-eclampsia reverses [5,6]. These furosemide would reduce oral antihypertensive medications, reduce
changes in fluid dynamics can take days to weeks to completely resolve. length of postpartum admission, and readmission rates.
In the postpartum period, blood pressure may improve in the first
few days only to increase sometime later in the first postpartum week Methods
[7]. This shift can affect blood pressure and hinder successful and effi­
cient blood pressure control during postpartum. Furosemide, a loop The study design was a retrospective cohort study approved by

* Correspondence to: 4301 West Markham St., #518, Little Rock, AR 72205, USA.
E-mail address: efmagann@uams.edu (E.F. Magann).

https://doi.org/10.1016/j.eurox.2023.100195
Received 11 April 2023; Accepted 2 May 2023
Available online 3 May 2023
2590-1613/© 2023 The Authors. Published by Elsevier B.V. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-
nc-nd/4.0/).
 EUROX 19 (2023) 100213

Contents lists available at ScienceDirect

European Journal of Obstetrics & Gynecology and

Reproductive Biology: X
journal homepage: www.journals.elsevier.com/european-journal-of-obstetrics-and-gynecology-and-
reproductive-biology

Evaluation of primary caesarean section and neonatal outcomes in a

tertiary care hospital and impact on current obstetric practice
Amey Chugh, Swati Lal *, Tanvi Nijhawan, Pooja Biradar
Department of Obstetrics and Gynecology, Dr D Y Patil Medical College, Hospital and Research Centre, D. Y. Patil Vidyapeeth, Pune, India

A R T I C L E I N F O A B S T R A C T

Keywords: Objective: To evaluate the rising rates of primary caesarean section, its indications and neonatal outcomes.
Caesarean section Study design: This was a prospective observational study of 1000 deliveries after 28 weeks gestation. The 312
Indications primary caesarean section (CS) cases were studied with respect to their antepartum and postpartum outcomes.
Foetal distress
Results: The primary caesarean section (PCS) rate was 31.2% which had risen from 17% in 2018–2019 at the
Respiratory distress
NICU admission
institute of study. The most common indication of PCS was found to be foetal distress (34.2%). Out of all PCS
25.64% were preterm deliveries. 57.05% of PCS born babies required NICU admission after birth and 59.93%
had 1 min APGAR score < 7. The most common indication for NICU admission was respiratory distress (55.13%).
Conclusion: The rising trend of CS can be attributed to rising PCS rate. Also the indications should be medically
justified whenever a CS is attempted as it has significant adverse maternal as well as neonatal implications and
also affects the subsequent pregnancy outcomes. CS delivered babies are more prone for respiratory distress
syndrome (RDS) and NICU admissions.

Introduction resulting in significant medical, social and financial impacts, which

could have been avoided, in the involved families and health care fa­
Childbirth is a one of the most important milestones in ones life. It is cilities.[4] The increase in primary caesarean section (PCS) leads to
a natural and at the same time a potentially risky procedure for the increase in repeat CS and thus becomes a vicious cycle of perpetuating
mother as well as the foetus, regardless of mode of delivery. Over the rise in overall caesarean deliveries.
years, vaginal delivery procedures and techniques have kept evolving Safe reduction of the rate of CS would require deep analysis of in­
and constant attempts have been made to make it even more safer. dications being advocated as well as practically practised, so as to find a
However, in few obstetrical emergencies, vaginal deliveries are strongly feasible and practical way to reduce it.
contraindicated and Caesarean section (CS) plays a vital role in deter­
mining fetomaternal outcomes. With every passing year, CS rate has Materials and methods
been on constant rise. WHO has recommended a threshold of 15% for CS
rate, which has already been crossed by India and was 21.5% according This prospective observational study was carried out at a tertiary
to NFHS-5 (2019–2021).[1] This rapid increase in the rate of caesarean care teaching hospital over a period of two years (October 2020 to
births without evidence of simultaneous decrease in maternal or August 2022). The sample size was 1000 patients and they were selected
neonatal morbidity and mortality raises concern about the justification in continuous manner. The sample size was calculated using Winpepi
of the indications.[2] Also to be borne in mind, the new statement issued software. Among these 1000 patients, 312 PCS cases were selected.
by WHO in 2015 “Every effort should be made to provide CS to women Written informed consent was obtained. Those willing were included
in need, rather than striving to achieve a specific rate”.[3]. after screening for inclusion and exclusion criteria.
Despite recommendation from WHO regarding the preferred rate of
CS, it is seen to be continuously rising. Multiple studies and researches
have been carried out to analyse various reasons for this emerging Inclusion criteria
epidemic. This has also contributed to the increase in NICU admissions
Any pregnant patient who delivered by undergoing PCS at our

* Corresponding author.
E-mail address: swatilal21@gmail.com (S. Lal).

https://doi.org/10.1016/j.eurox.2023.100213
Received 13 March 2023; Received in revised form 22 June 2023; Accepted 4 July 2023
Available online 4 July 2023
2590-1613/© 2023 The Authors. Published by Elsevier B.V. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-
nc-nd/4.0/).
 Revista Clínica Española 224 (2024) 337---345

Revista Clínica
Española
www.elsevier.es/rce

ORIGINAL ARTICLE

Adverse cardiovascular, obstetric and perinatal events

during pregnancy and puerperium in patients with
heart disease
N.E. Guzmán-Delgado a,d , C.E. Velázquez-Sotelo b,d,∗ , M.J. Fernández-Gómez a ,
L.G. González-Barrera b , A. Muñiz-García b,d , V.M. Sánchez-Sotelo c , P. Carranza-Rosales e ,
A. Hernández-Juárez b,d , J. Morán-Martínez f , V. Martínez-Gaytan g

a
División de Investigación en Salud, Unidad Médica de Alta Especialidad, Hospital de Cardiología No. 34, ‘‘Dr. Alfonso J. Treviño’’
del Centro Médico Nacional del Noreste, Instituto Mexicano del Seguro Social, Monterrey, Nuevo León, Mexico
b
Departamento de Cardiología, Unidad Médica de Alta Especialidad, Hospital de Cardiología No. 34, ‘‘Dr. Alfonso J. Treviño
Treviño’’ del Centro Médico Nacional del Noreste, Instituto Mexicano del Seguro Social, Monterrey, Nuevo León, Mexico
c
Departamento de Cirugía Cardiotorácica, Unidad Médica de Alta Especialidad, Hospital de Cardiología No. 34, ‘‘Dr. Alfonso J.
Treviño Treviño’’ del Centro Médico Nacional del Noreste, Instituto Mexicano del Seguro Social, Monterrey, Nuevo León, Mexico
d
Programa de Posgrado en Especialidades Médicas, Universidad de Monterrey. San Pedro Garza, García, Nuevo León, Mexico
e
Centro de investigación Biomédica del Noreste. Instituto Mexicano del Seguro Social. Monterrey, Nuevo León, Mexico
f
Departamento de Biología Celular y Ultraestructura, Facultad de Medicina, Universidad Autónoma de Coahuila unidad Torreón,
Torreón, Coahuila, Mexico
g
División de Investigación en Salud, Unidad Médica de Alta Especialidad de Gineco Obstetricia No.23, Dr. Ignacio Morones Prieto,
Instituto Mexicano del Seguro Social, Monterrey, Nuevo León, Mexico

Received 12 February 2024; accepted 5 April 2024

Available online 30 April 2024

KEYWORDS Abstract
Pregnancy; Background and objectives: cardiovascular changes during pregnancy carry greater risk in heart
Puerperium; disease. We analyze cardiovascular, obstetric and perinatal adverse effects associated with
Congenital/acquired congenital and acquired heart disease during pregnancy and postpartum.
heart disease; Materials and methods: Cross-sectional and retrospective study, which included the 2017---2023
Cardiovascular/obstetric registry of pregnant or postpartum patients hospitalised with diagnosis of congenital or acquired
adverse event; heart disease. Adverse events (heart failure, stroke, acute pulmonary edema, maternal death,
Maternal death obstetric haemorrhage, prematurity and perinatal death) were compared with the clinical
variables and the implemented treatment.
Results: 112 patients with a median age of 28 years (range 15−44) were included. Short circuits
predominated 28 (25%). Thirty-six patients (32%) were classified in class IV of the modified WHO
scale for maternal cardiovascular risk.

∗ Corresponding author.
E-mail addresses: claudia.velazquez.391@gmail.com, claudia.velazquez@udem.edu (C.E. Velázquez-Sotelo).

https://doi.org/10.1016/j.rceng.2024.04.016
2254-8874/© 2024 The Authors. Published by Elsevier España, S.L.U. This is an open access article under the CC BY-NC license
(http://creativecommons.org/licenses/by-nc/4.0/).
 N.E. Guzmán-Delgado, C.E. Velázquez-Sotelo, M.J. Fernández-Gómez et al.

Heart failure occurred in 39 (34.8%), acute lung edema 12 (10.7%), stroke 2 (1.8%), maternal
death 5 (4.5%), obstetric haemorrhage 4 (3.6%), prematurity 50 (44.5%) and perinatal death
6 (5.4%). Shunts were associated with prematurity (adjusted odds ratio 4; 95% CI: 1.5−10,
p = 0.006). Peripartum cardiomyopathy represented higher risk of pulmonary edema (adjusted
OR 34; 95% CI: 6−194, p = 0.001) and heart failure (adjusted OR 16; 95% CI: 3−84, p = 0.001).
An increased risk of obstetric haemorrhage was observed in patients with prosthetic valves
(adjusted OR 30; 95% CI: 1.5−616, p = 0.025) and with the use of acetylsalicylic acid (adjusted
OR 14; 95% CI: 1.2---16, p = 0.030). Furthermore, the latter was associated with perinatal death
(adjusted OR 9; 95% CI: 1.4−68, p = 0.021).
Conclusions: severe complications were found during pregnancy and postpartum in patients
with heart disease, which is why preconception evaluation and close surveillance are vital.
© 2024 The Authors. Published by Elsevier España, S.L.U. This is an open access article under
the CC BY-NC license (http://creativecommons.org/licenses/by-nc/4.0/).

PALABRAS CLAVE Eventos adversos cardiovasculares, obstétricos y perinatales en el embarazo y

Embarazo; puerperio en pacientes cardiópatas
Puerperio;
Resumen
Cardiopatía
Antecedentes y objetivos: los cambios cardiovasculares del embarazo conllevan mayor riesgo
congénita/adquirida;
en cardiópatas. El objetivo fue analizar los efectos adversos cardiovasculares, obstétricos y
Evento cardiovascu-
perinatales asociados a cardiopatía congénita y adquirida durante el embarazo y puerperio.
lar/obstétrico
Materiales y métodos: Estudio transversal y retrospectivo, que incluyó el registro de 2017---2023
adverso;
de pacientes embarazadas o puérperas hospitalizadas con diagnóstico de cardiopatía congénita
Muerte materna
o adquirida. Se compararon los eventos adversos (falla cardiaca, evento vascular cerebral
(EVC), edema agudo pulmonar, muerte materna, hemorragia obstétrica, prematuridad y muerte
perinatal) con las variables clínicas y el tratamiento implementado.
Resultados: Se incluyeron 112 pacientes con mediana de edad de 28 años (rango 15−44). Pre-
dominaron los cortocircuitos 28 (25%). Treinta y seis pacientes (32%) se clasificaron en clase IV
de la escala modificada de la OMS para riesgo cardiovascular materno.
Presentaron falla cardiaca 39 (34,8%), edema agudo de pulmón 12 (10,7%), EVC 2 (1,8%),
muerte materna 5 (4,5%), hemorragia obstétrica 4 (3,6%), prematuridad 50 (44,5%) y muerte
perinatal 6 (5,4%).
Los cortocircuitos se asociaron con prematuridad (odds ratio ajustado 4; IC 95%: 1,5-10,
p = 0,006). La miocardiopatía periparto tuvo un mayor riesgo de edema agudo pulmonar (OR
ajustado 34; IC 95%: 6---194, p = 0,001) y falla cardiaca (OR ajustado 16; IC: 95%: 3---84, p = 0,001).
Se observó un aumento del riesgo a hemorragia obstétrica en pacientes con prótesis valvulares
(OR ajustado 30; IC 95%: 1,5---616, p = 0,025) y al uso de ácido acetil salicílico (OR ajustado 14;
IC 95%: 1,2---167, p = 0,030). Además, este último se asoció a muerte perinatal (OR ajustado 9;
IC 95%: 1,4---68, p = 0,021).
Conclusiones: Se encontraron complicaciones severas durante el embarazo y puerperio en
cardiópatas, por ello es vital la evaluación preconcepcional y vigilancia estrecha.
© 2024 Los Autores. Publicado por Elsevier España, S.L.U. Este es un artículo Open Access bajo
la licencia CC BY-NC (http://creativecommons.org/licenses/by-nc/4.0/).

Introduction In Western studies, congenital heart disease represents

75---82% of heart disease during pregnancy, while in non-
The association between pregnancy and pre-existing heart Western countries rheumatic heart disease is the main
disease or its onset during pregnancy is the leading cause of cause.5,6
indirect maternal mortality.1 This is due to the fact that 85% In our country, in 2005, congenital and acquired heart
of paediatric patients with congenital heart disease survive disease was responsible for almost one fifth of all maternal
to adulthood, thereby increasing the incidence of pregnan- deaths.7
cies complicated by cardiovascular diseases2,3 ; this is also in Pregnancy induces multiple changes in the cardiovascu-
part due to the increase in age of first-time mothers, with lar system. A significant increase in cardiac output of up to
an age range ranging between 28.8 and 31.2 years.4 45% occurs by 24 weeks’ gestation (WG). A 5−10 mmHg drop

338
 Journal of Reproductive Immunology 163 (2024) 104221

Contents lists available at ScienceDirect

Journal of Reproductive Immunology

journal homepage: www.elsevier.com/locate/jri

Angiogenic factors and the lectin pathway of complement in women with

secondary recurrent pregnancy loss
M.C. Krog a, b, c, *, E.M. Flachs d, A.M. Kolte a, W. de Jager e, L. Meyaard e, O.B. Christiansen f, g,
R. Steffensen h, K. Vomstein a, j, P. Garred b, c, i, H.S. Nielsen a, c, j
a
The Recurrent Pregnancy Loss Unit, the Capital Region, Copenhagen University Hospitals, Rigshospitalet and Hvidovre Hospital, Kettegård Alle 30, Hvidovre 2650,
Denmark
b
The Department of Clinical Immunology, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, Copenhagen 2100, Denmark
c
Department of Clinical Medicine, Faculty of Health and Medical Sciences, Copenhagen University, Blegdamsvej 3B, Copenhagen 2200, Denmark
d
The Department of Occupational and Environmental Medicine, Copenhagen University Hospital, Bispebjerg Hospital, Bispebjerg Bakke 23F, Copenhagen 2400, Denmark
e
Multiplex Core Facility, Laboratory of Translational Immunology, University Medical Center Utrecht, Heidelberglaan 100, Utrecht 3584 CX, the Netherlands
f
Centre for Recurrent Pregnancy Loss of Western Denmark, Department of Obstetrics and Gynecology, Aalborg University Hospital, Reberbansgade 15, Aalborg 9000,
Denmark
g
Department of Clinical Medicine, Aalborg University, Søndre Skovvej 15, Aalborg 9000, Denmark
h
Department of Clinical Immunology, Aalborg University Hospital, Urbansgade 32, Aalborg 9000, Denmark
i
The Laboratory of Molecular Medicine, Department of Clinical Immunology, Section 7631, Copenhagen University Hospital, Rigshospitalet, Ole Maaløesvej 26,
Copenhagen 2200, Denmark
j
Department of Obstetrics and Gynecology, Copenhagen University Hospital, Hvidovre Hospital, Kettegård Alle 30, Hvidovre 2650, Denmark

A R T I C L E I N F O A B S T R A C T

Keywords: The poor remodeling of placental spiral arteries seen in preeclampsia is also discussed to contribute to recurrent
Recurrent pregnancy loss pregnancy loss (RPL) preceded by abnormal angiogenesis and excessive complement activation. Low levels of
Poor placentation Mannose-binding-lectin (MBL), a pattern recognition molecule (PRM) of the lectin pathway, have been found in
Angiogenesis
women with RPL. We propose that pregnancy loss is connected to defective angiogenesis with reperfusion
Complement system
The lectin pathway
damage in the placenta and decreased levels of PRM in the lectin pathway in women with RPL. In this cohort
study, we investigate the angiogenic factors and the lectin complement pathway in early pregnancy and their
time-dependent relationship with pregnancy outcomes in 76 women with secondary RPL (sRPL) who have at
least four prior pregnancy losses and a live birth. We evaluated levels of Angiopoietin-1 (Ang-1), Angiopoietin-2
(Ang-2), Vascular Endothelial Growth Factor (VEGF), soluble fms-like tyrosine kinase-1 (sFlt-1), and the PRMs,
MBL, ficolin-1, − 2, − 3 and an additional soluble PRM, Pentraxin-3, during the 5th, 6th, and 7th gestational
weeks. Our results showed that, compared to live births, pregnancies that ended in loss were associated with
elevated VEGF levels and decreased levels of the Ang-2/Ang-1 ratio. Also, increasing levels of ficolin-2 were
significantly associated with pregnancy loss, with MBL showing no association. Our research suggests that
women with sRPL may have inadequate placentation with impaired angiogenesis in pregnancies ending in a loss.

1. Introduction (Brosens et al., 2019). Women who deliver their first child and later
experience recurrent pregnancy losses (secondary recurrent pregnancy
Placentation remains one of the critical factors in the establishment loss, sRPL) show a higher prevalence of these complications during their
of a successful pregnancy. An altered placentation has been linked to first pregnancy, indicating altered placentation in these patients (Niel­
obstetric complications, such as preeclampsia, placental abruption, in­ sen, 2011; Nielsen et al., 2010; Svarre Nielsen et al., 2008). According to
trauterine growth restriction, stillbirth, and post-partum bleeding the European Society of Human Reproduction and Embryology

Abbreviations: RPL, Recurrent Pregnancy Loss; SRPL, secondary RPL; PRPL;, primary RPL; EVT;, extravillous trophoblast; Ang-1, Angiopoietin-1; Ang-2,
Angiopoietin-2; VEGF, Vascular Endothelial Growth Factor; SFlt-1;, soluble fms-like tyrosine kinase-1; MBL;, Mannose-binding-lectin; PTX3;, Pentraxin 3.
* Corresponding author at: The Recurrent Pregnancy Loss Unit, the Capital Region, Copenhagen University Hospitals, Rigshospitalet and Hvidovre Hospital,
Kettegård Alle 30, Hvidovre 2650, Denmark.
E-mail address: maria.christine.krog@regionh.dk (M.C. Krog).

https://doi.org/10.1016/j.jri.2024.104221
Received 6 July 2023; Received in revised form 20 February 2024; Accepted 23 February 2024
Available online 27 February 2024
0165-0378/© 2024 The Author(s). Published by Elsevier B.V. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).
 Psychoneuroendocrinology 166 (2024) 107073

Contents lists available at ScienceDirect

Psychoneuroendocrinology
journal homepage: www.elsevier.com/locate/psyneuen

Stress-related eating in pregnancy? An RCT examining links between

prenatal stress and food choices
H. Lustermans a, *, R. Beijers a, b, V. Vis a, E. Aarts c, C. de Weerth a
a
Radboud University Medical Center, Donders Institute for Brain, Cognition and Behaviour, Department of Cognitive Neuroscience, P.O. Box 9010, Nijmegen 6500 GL,
the Netherlands
b
Department of Social Development, Behavioural Science Institute, Radboud University, P.O. Box 9104, Nijmegen 6500 HE, the Netherlands
c
Donders Institute for Brain, Cognition and Behaviour, Centre for Cognitive Neuroimaging, Radboud University, Nijmegen 6525 EN, the Netherlands

A R T I C L E I N F O A B S T R A C T

Keywords: Background: Diet quality during pregnancy is important for maternal health and offspring development. How­
Prenatal stress ever, national dietary recommendations are not always met. A potential barrier for healthy food choices might be
TSST the experience of stress. Previous literature in non-pregnant populations suggests a negative effect of acute stress
Food choice
on diet quality. This preregistered study is the first to test whether an acute stressor leads to unhealthy food
choices in pregnancy and examine the moderating role of stress, depressive and anxiety complaints in daily life.
Method: Pregnant women (N = 110, 3rd trimester) completed online self-reported surveys measuring stress,
depressive and anxiety complaints in daily life. Hereafter, participants were invited for a laboratory visit, in
which they were exposed to the Trier Social Stress Test or a control task. After this manipulation, self-reported
and actual food choices and food intake were assessed. At the end of the visit, a hair sample was collected.
Throughout the visit, visual analogue scales on negative affect were completed and saliva samples were
collected.
Results: The stress group experienced significantly more psychological stress than the control group during the
experimental manipulation. Main regression analyses showed that the acute laboratory stressor did not cause
unhealthy food choices in the third trimester of pregnancy. In fact, the stress group chose fewer unhealthy foods
and consumed fewer kilocalories compared to the control group. Additionally, the findings point at a moderating
role of depressive and stress complaints in daily life on food choices within the control group: higher scores were
related to more unhealthy food choices and more kilocalories consumed.
Discussion: As this was the first study to test the effect of an acute stressor on food choices in pregnant women,
more research is needed to obtain a better understanding of stress-related eating in pregnancy. This knowledge
may inform future interventions to support pregnant women in improving their diet quality.

1. Introduction neurodevelopment (de Lauzon-Guillain et al., 2022) and better health,

such as lower chances of insulin resistance in newborns or obesity in
Despite the importance of diet quality for both the mother and her childhood (Biagi et al., 2019). Lifestyle interventions supporting a
unborn offspring, pregnant women often do not meet national dietary healthy diet to prevent excessive gestational weight gain have had small
recommendations (Bodnar et al., 2017; Hinkle et al., 2021; Jardí et al., or even no effects (Aung et al., 2022; Fair and Soltani, 2021). One
2019; Stråvik et al., 2019; Wen et al., 2010). For the mother, a healthy explanation of this lack of success to improve prenatal dietary quality
diet is associated with a reduced risk of gestational diabetes (Mijato­ might be that psychosocial stress was not addressed as a potential bar­
vic-Vukas et al., 2018), better sleep quality (Zaragoza-Martí et al., rier for healthy eating (Fair and Soltani, 2021; Skouteris et al., 2010).
2022), less gestational weight gain and hypertension disorder (Abdol­ Previous research speculates about a causal influence of stress on diet
lahi et al., 2021). Regarding the offspring, a healthy maternal pregnancy quality during pregnancy, however, experimental studies are lacking (de
diet is associated with a reduced risk of low birth weight and preterm Weerth, 2018). This study aims to obtain a better causal understanding
birth (Abdollahi et al., 2021; Zaragoza-Martí et al., 2022), improved of the association between prenatal stress and food choices.

* Corresponding author.
E-mail address: hellen.lustermans@radboudumc.nl (H. Lustermans).

https://doi.org/10.1016/j.psyneuen.2024.107073
Received 27 October 2023; Received in revised form 2 May 2024; Accepted 5 May 2024
Available online 9 May 2024
0306-4530/© 2024 The Authors. Published by Elsevier Ltd. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).