Timing of prenatal maternal exposure to severe life events and adverse pregnancy outcomes: a population study of 2.6 million pregnancies.
Timing of prenatal maternal exposure to severe life events and adverse pregnancy outcomes: a population study of 2.6 million pregnancies.
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DOI：
10.1097/psy.0b013e31820a62ce
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发表时间：
2011-04
影响因子：
3.3
通讯作者：
D'Onofrio BM
中科院分区：
文献类型：
--
作者：
Class QA;Lichtenstein P;Långström N;D'Onofrio BM
使用基于人群的样本，确定产前应激暴露时间对后代缩短胎龄（GA）、早产（PTB）、低出生体重（LBW）和小于胎龄儿（SGA）风险的影响。瑞典纵向人口登记处与1973年至2004年在瑞典出生的所有人相关联。产前母亲压力暴露被定义为孩子的父亲或母亲的一级亲属死亡。使用线性和逻辑回归，压力暴露的时间进行了检查，整个怀孕，按月，并通过新的时期创建的基础上，压力暴露的调查结果。共有2，618，777名无先天性异常的活产单胎婴儿被纳入; 32，286名暴露于产前母亲压力。通过检查压力暴露与妊娠结果之间的关系，发现风险在妊娠中期增加，特别是在第5个月和第6个月之后。结合第1-4、5和6以及7-9个月作为不同脆弱性的潜在时期，发现第2时期的压力（5和6个月）与GA缩短的风险最大相关（-0.52天，SE=0.15，p=0.0006）、PTB（OR=1.24，99%CI =1.08-1.42）、LBW（OR=1.38，99%CI =1.19-1.61）和SGA（OR=1.25，99%CI =1.05-1.49）。缩短GA，PTB，LBW和SGA的风险在妊娠第5和/或第6个月的应激暴露后更大。将未来的分析细化到这几个月可能是有益的。可能的机制包括下丘脑-垂体-肾上腺轴和相关应激反应分子调节因子的改变。
To identify the impact of timing of prenatal stress exposure on offspring risk for shortened gestational age (GA), preterm birth (PTB), low birth weight (LBW), and small for gestational age (SGA) using a population-based sample. Swedish longitudinal population registries were linked to study all individuals born in Sweden 1973–2004. Prenatal maternal stress exposure was defined as death of the father of the child or first degree relative of the mother. Using linear and logistic regression, timing of stress exposure was examined across pregnancy, by month, and by novel periods created based on month of stress exposure findings. A total of 2,618,777 live-born, singleton infants without congenital anomalies were included; 32,286 exposed to prenatal maternal stress. Examining associations between stress exposure and outcome by the month revealed that risk increases mid-gestation, particularly following months 5 and 6. Combining months 1–4, 5 and 6, and 7–9 as potential periods of differing vulnerability, it was found that stress during period 2 (months 5 and 6) was associated with the greatest risk for shortened GA (−0.52 days, SE=0.15, p=0.0006), PTB (OR=1.24, 99% CI=1.08–1.42), LBW (OR=1.38, 99% CI=1.19–1.61), and SGA (OR=1.25, 99% CI=1.05–1.49). Risk for shortened GA, PTB, LBW, and SGA are greater following stress exposure during the 5th and/or 6th month of pregnancy. It may be beneficial to refine future analyses to these months. Possible mechanisms include alterations in the hypothalamic-pituitary-adrenal axis and associated stress-responsive molecular regulators.