Stress Pathways to Spontaneous Preterm Birth: The Role of Stressors, Psychological Distress, and Stress Hormones
Stress Pathways to Spontaneous Preterm Birth: The Role of Stressors, Psychological Distress, and Stress Hormones
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DOI：
10.1093/aje/kwp061
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发表时间：
2009-06-01
影响因子：
5
通讯作者：
Platt, Robert W.
中科院分区：
文献类型：
--
作者：
Kramer, Michael S.;Lydon, John;Platt, Robert W.
作者在一项多中心前瞻性队列研究中调查了大量的压力源和心理困扰的测量方法，该研究对1999年10月至2004年4月期间在蒙特利尔（加拿大）地区分娩的5，337名自发性早产妇女进行了研究。此外，巢式病例对照分析（207例，444例对照），通过分析母体血浆促肾上腺皮质激素释放激素（CRH），胎盘组织病理学，和（在一个子集）母体头发皮质醇，探索潜在的生物学途径。在研究的大量压力和痛苦测量中，只有妊娠相关焦虑与自发性早产一致且独立相关（对于高于中位数的值，调整后的比值比= 1.8（95%置信区间：1.3，2.4）），在四分位数之间存在剂量反应关系。在粗分析中，母体血浆CRH浓度在病例中显著高于对照组，但在校正后并非如此（对于高于中位数的浓度，校正比值比= 1.1（95%置信区间：0.8，1.6））。在有足够母体头发样本的参与者亚组（n = 117）中，头发皮质醇与胎龄呈正相关。母体血浆CRH、毛发皮质醇、感染/炎症、梗死或母体血管病变的胎盘组织病理学特征均与妊娠相关焦虑或任何其他压力或痛苦指标无显著相关性。压力诱导早产的生物学途径仍然知之甚少。
The authors investigated a large number of stressors and measures of psychological distress in a multicenter, prospective cohort study of spontaneous preterm birth among 5,337 Montreal (Canada)-area women who delivered from October 1999 to April 2004. In addition, a nested case-control analysis (207 cases, 444 controls) was used to explore potential biologic pathways by analyzing maternal plasma corticotrophin-releasing hormone (CRH), placental histopathology, and (in a subset) maternal hair cortisol. Among the large number of stress and distress measures studied, only pregnancy-related anxiety was consistently and independently associated with spontaneous preterm birth (for values above the median, adjusted odds ratio = 1.8 (95% confidence interval: 1.3, 2.4)), with a dose-response relation across quartiles. The maternal plasma CRH concentration was significantly higher in cases than in controls in crude analyses but not after adjustment (for concentrations above the median, adjusted odds ratio = 1.1 (95% confidence interval: 0.8, 1.6)). In the subgroup (n = 117) of participants with a sufficient maternal hair sample, hair cortisol was positively associated with gestational age. Neither maternal plasma CRH, hair cortisol, nor placental histopathologic features of infection/inflammation, infarction, or maternal vasculopathy were significantly associated with pregnancy-related anxiety or any other stress or distress measure. The biologic pathways underlying stress-induced preterm birth remain poorly understood.