Maternal stress and obstetric and infant outcomes: epidemiological findings and neuroendocrine mechanisms
Maternal stress and obstetric and infant outcomes: epidemiological findings and neuroendocrine mechanisms
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DOI：
10.1111/j.1479-828x.2000.tb03344.x
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发表时间：
2000-08-01
影响因子：
1.7
通讯作者：
Leader, L
中科院分区：
文献类型：
--
作者：
Austin, MP;Leader, L
本综述以早产作为关键结局指标，探讨了产前母亲压力与产科和婴儿结局之间的关联。这是通过 Medline 搜索完成的，该研究主要关注前瞻性对照研究，这些研究调查了相关的流行病学因素和假定的神经内分泌机制。美国对经济贫困的非洲裔美国妇女进行的多项研究表明，感知到的孕产妇生活事件 (LE) 压力与早产之间存在关联。欧洲研究的结果是相互矛盾的，部分原因是它们结合了结果指标，即。早产和低出生体重。然而，三项最大的斯堪的纳维亚流行病学研究检查了早产并控制了吸烟、年龄和产科史等混杂因素，证实了这种关联。这些研究综合起来表明，这可能是一个强有力的发现，不仅限于社会经济贫困的非裔美国人样本，而且独立于其他重要的危险因素。两项小型前瞻性研究检查了下丘脑-垂体-肾上腺（HPA）轴、心理社会状态和早产之间的关系，报告了一系列不良心理社会因素与促肾上腺皮质激素（ACTH）、促肾上腺皮质激素释放激素（CRH）和皮质醇水平之间的显着关联。另一方面，CRH 水平与早产之间存在显着相关性。显然，这些发现仍然是初步的，表明怀孕期间的感知压力、HPA 轴和早产之间存在复杂的关系。产前母亲压力对婴儿气质和精神病理学的影响仍有待在前瞻性对照试验中进行更全面的研究。
This review examines the associations between antenatal maternal stress and obstetric and infant outcomes using preterm delivery as the key outcome indicator. This was done by means of a Medline search focusing predominantly on prospective, controlled studies which investigated both the associated epidemiological factors and putative neuroendocrine mechanisms.There is evidence from a number of United States studies in economically deprived African American women for an association between perceived maternal life event (LE) stress and preterm delivery. The findings from the European studies are conflicting, partly because they combine outcome measures ie. preterm delivery and low birth weight. However the three largest Scandinavian epidemiological studies examining preterm delivery and controlling for confounders such as smoking, age and obstetric history, have confirmed this association. These studies taken together suggest that this may be a robust finding not limited to socioeconomically deprived African American samples and independent of other significant risk factors.Two small prospective studies examining the relationship between the hypothalamic-pituitary-adrenal (HPA) axis, psychosocial status and premature delivery have reported a significant association between a set of adverse psychosocial factors on the one hand, and levels of adrenocorticcotrophic hormone (ACTH), corticotrophin releasing hormone (CRH) and cortisol levels, and on the other hand, a significant correlation between CRH levels and premature delivery Clearly these findings remain preliminary and indicate a complex relationship between perceived stress in pregnancy, the HPA axis and premature delivery The impact of antenatal maternal stress on infant temperament and psychopathology remains to be examined more fully in prospective controlled trials.