Second- and third-trimester termination of pregnancy: physiological, neurobiological and psychological adaptation and long-term consequences

• Applicants: Professorin Dr. Natalya Chechko; Professor Dr. Christian Enzensberger; Dr. Susanne Nehls
• Subject Area: Clinical Psychiatry, Psychotherapy, Child and Adolescent Psychiatry ; Gynaecology and Obstetrics
• Term: since 2024
• Project identifier: Deutsche Forschungsgemeinschaft (DFG) - Project number 549905821

The revised proposal of Natalia Chechko, Susanne Nehls and first-time applicant Christian Enzensberger involves a multimodal longitudinal study of physical, neurobiological and psychological adaptation after late termination of pregnancy (TOP) required for medical reasons. Although fine diagnosis is possible from the 11th-13th week of pregnancy, most examinations take place after the 20th week of pregnancy due to cost reasons. With this study we pursue three objectives: First, we characterize the adaptation processes from pregnancy to 6 weeks post-TOP to understand the interaction of factors such as steroid fluctuation, neuroplasticity, and neural impact of emotional and physiological pain and explore their contribution to the development of psychopathology. Second, we analyze adaptation until 6 months post-TOP, assessing the modulating effects of stress, grief and trauma as well as protective factors for long-term adaptation. Third, we control for the effects of late TOP by comparing changes in neuroplasticity in participants with TOP in the 1st trimester of pregnancy, in postpartum women with uncomplicated pregnancies, and in nulliparous women during both ovulation and menstruation. To answer these questions, women with indications for late TOP (2nd/3rd trimester) are recruited during pregnancy, and closely monitored until 24 weeks after TOP using ecological momentary assessments (bi-daily mood and stress, baby blues symptoms in the first 14 days, weekly depressive symptoms, coping mechanisms, anxiety, posttraumatic stress, and grief symptoms). MRI measurements are performed before the TOP and 1, 2, 4, 6 and 24 weeks afterwards. Hormone levels (oestradiol, progesterone and allopregnanolone) are measured during pregnancy, daily in the first 14 days after TOP and at each MRI measurement time. In addition, cumulative cortisol concentrations in the hair are determined during the last 4 weeks of pregnancy and in the first 4 weeks after TOP. In order to compare adaptive patterns of late TOP with control groups, women with TOP in the 1st trimester will also be recruited. Data of healthy postpartum women from another DFG project of the applicants Chechko and Nehls, as well as data of nulliparous participants from a DFG project of applicant Chechko will also be included. We believe that with this interdisciplinary project (psychiatry and gynecology) we can present a model of physical, neurobiological, and psychological adjustment after late TOP and important evidence that late TOP is not a mere termination of pregnancy but also sets in motion massive biological and psychological processes.

• DFG Programme: Research Grants