Chronic HPA activity in mothers with preterm delivery: A pilot nested case-control study.
Chronic HPA activity in mothers with preterm delivery: A pilot nested case-control study.
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DOI：
10.3233/npm-180139
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发表时间：
2020-01-01
影响因子：
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通讯作者：
Williams, M A
中科院分区：
文献类型：
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作者：
Gelaye, B;Kirschbaum, C;Williams, M A
背景技术背景：慢性下丘脑-垂体-肾上腺（HPA）轴活动在早产（PTB）发病机制中的作用尚不清楚，因为长期监测皮质醇浓度的能力有限，测量方法不一致。我们探讨了这种关系，使用新的方法来评估皮质醇的头发，这是一个有效的和可靠的措施慢性HPA轴activity.METHODS：137名参与者（40例PTB病例和97名对照组从出生队列的孕妇在秘鲁）进行了采访，并邀请提供一个9厘米的头发样本，从头皮的后顶位置（平均= 13周妊娠）。 使用发光免疫测定法测定毛发皮质醇浓度（HCC），并将值进行自然对数转换。PTB病例定义为妊娠37周前分娩的妇女。病例对照差异进行了评估，使用多变量线性和逻辑回归。结果：总体而言，合并孕前和妊娠早期肝癌是13%，低于对照组（p值= 0.01）。 与对照组相比，妊娠前3-6个月、妊娠前0-3个月和妊娠早期，PTB病例中的母亲HCC分别低14%（p= 0.11）、10%（p = 0.22）和14%（p =0.08）。 校正假定的混杂因素后，HCC增加1个单位与PTB几率降低55%相关（aOR = 0.45; 95%CI：0.17-1.17）。 对于头皮中间段和头皮远端段的HCC增加1个单位（代表妊娠前0-3个月和妊娠早期的HCC浓度），PTB的相应比值为0.53（95% CI：0.19-1.48）和0.39（95%CI：0.13-1.13），分别。结论：妇女谁提供早产，与那些谁提供在任期内，有较低的孕前和头三个月肝癌。我们的研究结果表明，HPA轴激活，适应性应激反应系统的组成部分，可能是慢性失调的妇女在PTB的风险增加。
BACKGROUND: Chronic hypothalamic-pituitary-adrenal (HPA) axis activity role in the pathogenesis of preterm birth (PTB) remains unclear due to inconsistent measures with limited ability to monitor long-term cortisol concentrations. We explored this relationship using the novel method of assessing cortisol in hair, which is a valid and reliable measure of chronic HPA axis activity.METHODS: 137 participants (40 PTB cases and 97 controls from a birth cohort of pregnant women in Peru) were interviewed and invited to provide a 9-cm hair sample from the posterior vertex position of the scalp (mean = 13 weeks gestation). Hair cortisol concentration (HCC) was determined using luminescence immunoassay and values were natural-log transformed. PTB cases were defined as women who delivered before 37 gestational weeks. Case-control differences were assessed using multivariable linear and logistic regressions.RESULTS: Overall, combined pre-conception and first-trimester HCC was 13% lower among cases as compared with controls (p-value = 0.01). Compared with controls, maternal HCC among PTB cases were 14% (p = 0.11), 10% (p = 0.22) and 14% (p = 0.08) lower for 3-6 months pre-conception, 0-3 months pre-conception, and first trimester, respectively. After adjusting for putative confounders, a 1-unit increase in HCC was associated with 55% reduced odds of PTB (aOR = 0.45; 95% CI: 0.17-1.17). For a 1-unit increase in HCC in the scalp-intermediate and scalp-distal segments (representing HCC concentrations in 0-3 months pre-conception and first trimester), the corresponding odds for PTB were 0.53 (95% CI: 0.19-1.48) and 0.39 (95% CI: 0.13-1.13), respectively.CONCLUSIONS: Women who deliver preterm, as compared with those who deliver at term, have lower preconception and first trimester HCC. Our findings suggest that HPA axis activation, integral to the adaptive stress-response system, may be chronically dysregulated in women at increased risk of PTB.