Antenatal maternal stress and long-term effects on child neurodevelopment: how and why?
Antenatal maternal stress and long-term effects on child neurodevelopment: how and why?
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DOI：
10.1111/j.1469-7610.2006.01714.x
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发表时间：
2007-03-01
影响因子：
7.6
通讯作者：
Glover, Vivette
中科院分区：
文献类型：
--
作者：
Talge, Nicole M.;Neal, Charles;Glover, Vivette
我们回顾了来自独立前瞻性研究的大量证据，这些证据表明，如果母亲在怀孕期间受到压力，她的孩子更有可能出现情绪或认知问题，包括注意力缺陷/多动，焦虑和语言延迟的风险增加。这些发现是独立的影响，由于产妇产后抑郁症和焦虑。我们仍然不知道什么形式的焦虑或压力是最有害的，但研究表明，在这方面，与伴侣的关系可能很重要。这些影响的程度在临床上是显著的，因为由于产前压力和/或焦虑引起的情绪/行为问题的可归因负荷约为15%。动物模型表明，应激反应下丘脑-垂体-肾上腺（HPA）轴的活动及其激素终产物皮质醇参与了母亲和后代的这些影响。如果母亲的压力改变了她的激素水平，胎儿的环境就会改变，在人类中，母亲和胎儿的皮质醇水平之间存在很强的相关性。然而，在理解这种相互作用所涉及的机制方面仍然存在许多问题。例如，母体皮质醇对压力的反应在怀孕过程中会下降，在怀孕早期，母体和胎儿皮质醇之间的联系就不那么牢固了。母亲的焦虑和压力对发育中的胎儿和儿童的影响可能受到其他因素的调节，如母亲的饮食（例如，蛋白质负荷）。这表明，额外的警惕或焦虑，容易分心的注意力，或高度反应HPA轴可能已经适应在进化过程中的压力环境，但今天存在的代价是脆弱的神经发育障碍。
We review a significant body of evidence from independent prospective studies that if a mother is stressed while pregnant, her child is substantially more likely to have emotional or cognitive problems, including an increased risk of attentional deficit/hyperactivity, anxiety, and language delay. These findings are independent of effects due to maternal postnatal depression and anxiety. We still do not know what forms of anxiety or stress are most detrimental, but research suggests that the relationship with the partner can be important in this respect. The magnitude of these effects is clinically significant, as the attributable load of emotional/behavioral problems due to antenatal stress and/or anxiety is approximately 15%. Animal models suggest that activity of the stress-responsive hypothalamic-pituitary-adrenal (HPA) axis and its hormonal end-product cortisol are involved in these effects in both mother and offspring. The fetal environment can be altered if stress in the mother changes her hormonal profile, and in humans, there is a strong correlation between maternal and fetal cortisol levels. However, many problems remain in understanding the mechanisms involved in this interaction. For example, maternal cortisol responses to stress decline over the course of pregnancy, and earlier in pregnancy, the link between maternal and fetal cortisol is less robust. It is possible that the effects of maternal anxiety and stress on the developing fetus and child are moderated by other factors such as a maternal diet (e.g., protein load). It is suggested that extra vigilance or anxiety, readily distracted attention, or a hyper-responsive HPA axis may have been adaptive in a stressful environment during evolution, but exists today at the cost of vulnerability to neurodevelopmental disorders.