Maternal Stress/Distress, Hormonal Pathways and Spontaneous Preterm Birth

被引:44
作者
Kramer, Michael S. [1 ,2 ]
Lydon, John [3 ]
Goulet, Lise [6 ]
Kahn, Susan [4 ]
Dahhou, Mourad [1 ]
Platt, Robert W. [1 ,2 ]
Sharma, Shakti [5 ]
Meaney, Michael J. [5 ]
Seguin, Louise [6 ]
机构
[1] McGill Univ, Dept Pediat, Fac Med, Montreal, PQ H3A 2T5, Canada
[2] McGill Univ, Fac Med, Dept Epidemiol Biostat & Occupat Hlth, Montreal, PQ, Canada
[3] McGill Univ, Fac Med, Dept Psychol, Montreal, PQ, Canada
[4] McGill Univ, Fac Med, Dept Med, Montreal, PQ, Canada
[5] McGill Univ, Fac Med, Dept Psychiat, Montreal, PQ H3A 2T5, Canada
[6] Univ Montreal, Fac Med, Dept Med Sociale & Prevent, Montreal, PQ H3C 3J7, Canada
基金
加拿大健康研究院;
关键词
preterm birth; stress; stressors; anxiety; stress hormones; HPA axis; CORTICOTROPIN-RELEASING HORMONE; SOCIOECONOMIC DISPARITIES; CATECHOLAMINE LEVELS; PSYCHOSOCIAL STRESS; PREGNANCY; PROGESTERONE; RISK; NEUROENDOCRINE; ANXIETY; FETAL;
D O I
10.1111/ppe.12042
中图分类号
R1 [预防医学、卫生学];
学科分类号
1004 ; 120402 ;
摘要
Background Although second-trimester blood corticotrophin-releasing hormone (CRH) levels are robustly associated with preterm birth, the findings with respect to cortisol have been inconsistent, as have been those relating stress hormones to measured stressors and maternal distress. Methods We measured plasma CRH, adrenocorticotrophic hormone (ACTH), cortisol, cortisol-binding globulin, oestradiol and progesterone at 2426 weeks in a nested casecontrol study of 206 women who experienced spontaneous preterm birth and 442 term controls. We also related the hormonal levels to measures of environmental stressors, perceived stress and maternal distress (also assessed at 2426 weeks) and to placental histopathology. Results With the exception of an unexpectedly low oestradiol:progesterone ratio among cases (adjusted odds ratio=0.5 [95% confidence interval 0.3, 0.8] for ratios above the median in controls), none of the hormonal measures was independently associated with spontaneous preterm birth; placental histopathological evidence of infection/inflammation, infarction or decidual vasculopathy; or measures of maternal stress or distress. CRH levels were positively associated with cortisol, but not with ACTH, whereas ACTH was also positively associated with cortisol. Conclusions Our findings suggest an intact pituitaryadrenal axis and confirm the positive feedback effect of cortisol on (placental) CRH. Neither of these hormonal pathways, however, was strongly linked to maternal stress/distress or to the risk of spontaneous preterm birth.
引用
收藏
页码:237 / 246
页数:10
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