Austin M P, Leader L
School of Psychiatry, University of New South Wales, Sydney, Australia.
Aust N Z J Obstet Gynaecol. 2000 Aug;40(3):331-7. doi: 10.1111/j.1479-828x.2000.tb03344.x.
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 adrenocorticotrophic 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.
本综述以早产作为关键结局指标，研究产前母亲压力与产科及婴儿结局之间的关联。这是通过对Medline数据库进行检索来完成的，检索主要聚焦于前瞻性对照研究，这些研究调查了相关的流行病学因素及假定的神经内分泌机制。美国一些针对经济贫困非裔美国女性的研究有证据表明，母亲感知到的生活事件（LE）压力与早产之间存在关联。欧洲研究的结果相互矛盾，部分原因是它们合并了结局指标，即早产和低出生体重。然而，斯堪的纳维亚三项最大规模的流行病学研究，在考察早产并控制了如吸烟、年龄和产科病史等混杂因素后，证实了这种关联。综合这些研究表明，这可能是一个确凿的发现，不限于社会经济贫困的非裔美国样本，且独立于其他重要风险因素。两项小型前瞻性研究考察了下丘脑 - 垂体 - 肾上腺（HPA）轴、心理社会状态与早产之间的关系，报告了一方面一组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）及皮质醇水平之间存在显著关联，另一方面CRH水平与早产之间存在显著相关性。显然，这些发现仍属初步，表明孕期感知压力、HPA轴与早产之间存在复杂关系。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。
