Maternal parity and perinatal cortisol adaptation: The role of pregnancy-specific distress and implications for postpartum mood.
Maternal parity and perinatal cortisol adaptation: The role of pregnancy-specific distress and implications for postpartum mood.
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DOI：
10.1016/j.psyneuen.2018.07.008
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发表时间：
2018-11
影响因子：
3.7
通讯作者：
Christian LM
中科院分区：
文献类型：
--
作者：
Gillespie SL;Mitchell AM;Kowalsky JM;Christian LM
与以前分娩的女性相比（即，第一次分娩的人（即，显示较高的皮质醇水平。心理因素可能起作用;下丘脑-垂体-肾上腺激活是一种众所周知的应激反应。初产也预示着产后抑郁症的风险更大，这可能与产前皮质醇升高后皮质醇和情绪之间的对应关系更大有关。目前的研究探讨了产次，围产期皮质醇适应，妊娠特定的困扰，产后情绪之间的关联。这项纵向研究测定了137名妇女在怀孕早期、中期、晚期和产后的血清皮质醇水平。对妊娠特有的痛苦和抑郁症状进行了评估。母亲的年龄，种族，体重指数，睡眠质量，抑郁症状，和采样时间的一天进行了统计控制。初产妇女在孕中期和孕晚期的皮质醇水平高于经产妇女（p <0.01），并且在整个妊娠期间的痛苦程度高于经产妇女（F1，126 = 22.1，p < 0.01）。中介分析表明，产次和产前皮质醇（每曲线下面积; AUC）之间的关联部分由痛苦解释（ab = 1.0，95%CI [0.05，2.9]）。产前皮质醇（根据AUC）不能预测产后抑郁症状（B* = 0.03，p = 0.81），经产次无差异（B* = 0.03，p = 0.91）。在产后，产次和皮质醇之间的显著相互作用（B* = 0.40，p = 0.03）显示，在多胎妊娠中皮质醇和情绪之间没有显著关联（B* =-0.11，p = 0.28），但在多胎妊娠中有正向关联的趋势（B* = 0.24，p = 0.06）。皮质醇水平和妊娠特异性痛苦在孕次和多胎中更高，妊娠特异性痛苦部分介导了产次和皮质醇水平之间的关联。皮质醇水平和情绪显示对应性在产后未经产妇，但不是经产妇。虽然观察性研究必须谨慎解释，由于潜在的不可测量的混杂因素，这些研究结果表明，未来的研究检查围产期和产后下丘脑-垂体-肾上腺扰动的机制和设计干预措施，旨在预防相关并发症应仔细考虑潜在的差异，通过奇偶校验。
Compared to women who have given birth before (i.e., multiparas), those giving birth for the first time (i.e., primiparas) show higher cortisol levels. Psychological factors may play a role; hypothalamic-pituitary-adrenal activation is a well-described stress response. Primiparity also predicts greater risk for postpartum depression, which may be related to greater correspondence between cortisol and mood following prenatal cortisol elevations. The current study examined associations among parity, perinatal cortisol adaptation, pregnancy-specific distress, and postpartum mood. This longitudinal study assayed serum cortisol levels among 137 women at early, mid-, and late pregnancy and postpartum. Pregnancy-specific distress and depressive symptoms were assessed. Maternal age, race, body mass index, sleep quality, depressive symptoms, and sampling time of day were statistically controlled. Primiparous women showed higher cortisol levels than multiparous women during mid- , p < 0.01) and late pregnancy , p < 0.01) and higher distress across pregnancy (F1,126 = 22.1, p < 0.01). Mediation analyses demonstrated that the association between parity and prenatal cortisol (per area under the curve; AUC) was partially accounted for by distress (ab = 1.0, 95%CI [0.05, 2.9]). Prenatal cortisol (per AUC) did not predict postpartum depressive symptoms (b* = 0.03, p = 0.81), with no difference by parity (b* = 0.03, p = 0.91). At postpartum, a significant interaction between parity and cortisol (b* = 0.40, p = 0.03) revealed no significant association between cortisol and mood among multiparas (b* = −0.11, p = 0.28) but a trend toward a positive association among primiparas (b* = 0.24, p = 0.06). Cortisol levels and pregnancy-specific distress are higher in primiparas versus multiparas, with pregnancy-specific distress partially mediating the association between parity and cortisol levels. Cortisol levels and mood display correspondence at postpartum in primiparous but not multiparous women. While observational studies must be interpreted with caution due to potential unmeasured confounders, these findings suggest that future studies examining mechanisms underlying perinatal and postpartum hypothalamic-pituitary-adrenal perturbations and designing interventions aimed at preventing related complications should carefully consider potential differences by parity.
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影响因子：
8.1
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