Stress responses at birth: determinants of cord arterial cortisol and links with cortisol response in infancy
Stress responses at birth: determinants of cord arterial cortisol and links with cortisol response in infancy
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DOI：
10.1111/j.1471-0528.2005.00620.x
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发表时间：
2005-07-01
影响因子：
5.8
通讯作者：
Glover, V
中科院分区：
文献类型：
--
作者：
Miller, NM;Fisk, NM;Glover, V
目的探讨分娩时婴儿应激反应的决定因素，检验出生时应激反应(脐动脉皮质醇反映)影响接种2个月后皮质醇反应的假设。设计前瞻性观察研究。设立第三转诊妇产医院。对172例单胎妊娠的初产妇女进行产前招募。出生时，收集脐动脉血和产科数据。分别在接种前和接种后两个月从婴儿身上采集唾液。用放射免疫法分析脐血和唾液中的皮质醇。主要结果是衡量出生时的应激反应，如脊髓动脉皮质醇所显示的，以及与接种两个月后唾液皮质醇反应的关系。结果脐动脉皮质醇的使用方式、脊髓/硬膜外联合使用和pH值不同。两个月后唾液皮质醇水平与脐动脉皮质醇水平呈正相关(r=0.24，P<；0.05)。脐动脉皮质醇最高和最低的婴儿在2个月时的皮质醇反应有显著差异(P=0.017)。这些组的分娩方式不同，高皮质醇反应组的剖宫产率为8%，低皮质醇反应组的剖宫产率为83%(P<；0.0001)。结论阴道分娩的婴儿出生时产生的皮质醇反应高于剖宫产。分娩时的压力可能会影响婴儿HPA轴的反应长达两个月。
Objective To investigate (A) the determinants of infant stress response at delivery and (B) test the hypothesis that stress at birth, as reflected by cord arterial cortisol, influences cortisol response to vaccination at two months.Design Prospective observational study.Setting Tertiary referral maternity hospital.Population One hundred and seventy-two primiparous women with uncomplicated singleton pregnancies.Methods Women were recruited antenatally. At birth, cord arterial blood and obstetric data were collected. Saliva was collected from infants immediately before and after vaccination at two months. Cortisol was analysed from cord blood and saliva by radio-immunoassay.Main outcome measures Stress response at birth, as demonstrated by cord arterial cortisol; association with saliva cortisol response to vaccination at two months.Results Cord arterial cortisol varied with mode of delivery, combined spinal/epidural use and pH. Salivary cortisol response at two months correlated with cord arterial cortisol (r= 0.24, P < 0.05). Infants with the highest and lowest cord arterial cortisol had markedly different cortisol responses at two months (P= 0.017). These groups had different modes of delivery with caesarean rates of < 8% in the high cortisol response group and 83% in the low cortisol response group (P < 0.0001).Conclusion Babies born vaginally mount greater cortisol responses at birth than those delivered by caesarean section. Stress at delivery may influence the infant HPA axis response for up to two months.