Suarez Lucina, Cardarelli Kathryn, Hendricks Kate
Texas Department of Health, Austin, TX 78756, USA.
Epidemiology. 2003 Sep;14(5):612-6. doi: 10.1097/01.ede.0000073270.39780.e9.
Studies suggest that maternal psychologic stress can increase the risk of congenital malformations, including neural tube defects (NTDs). We examined whether maternal stress and lack of social support contribute to NTD risk in a population living along the Texas-Mexico border.
Case mothers (N = 184) were Mexican-American women with NTD-affected pregnancies who delivered during 1995 to 2000 in one of the 14 Texas counties bordering on Mexico. Control mothers (N = 225) were randomly selected from Mexican-American women residing in the same area and delivering normal live births. We measured maternal stress by tallying the number of job changes, residential moves, and major injuries occurring during the year before conception. Social support was measured using social integration and perceived emotional support scales.
Mothers who experienced one or more stressful life events during the year before conception had increased risks for NTDs (odds ratio [OR] = 2.9; 95% confidence interval [CI] = 1.8-4.7) compared with mothers experiencing no events. Mothers who scored low on emotional support had an elevated risk compared with those who scored high (OR = 4.6; CI = 2.2-9.7). Social support measures, such as network size and satisfaction, group interactions, and church attendance, were unrelated to NTD risk. The estimated effects were not modified or confounded by age, education, country of birth, income, obesity, vitamin supplements, dietary folate, cigarette smoking, or alcohol consumption.
In this Mexican-American population, the occurrence of stressful life events was associated with NTD risk. These findings suggest that stress may exacerbate risk in populations with poor nutritional status and meager economic resources.
研究表明，母亲的心理压力会增加先天性畸形的风险，包括神经管缺陷（NTDs）。我们研究了母亲的压力和缺乏社会支持是否会增加德克萨斯 - 墨西哥边境地区人群患NTDs的风险。
病例组母亲（N = 184）为1995年至2000年期间在德克萨斯州与墨西哥接壤的14个县之一分娩的患有NTDs妊娠的墨西哥裔美国妇女。对照组母亲（N = 225）是从居住在同一地区并分娩正常活产的墨西哥裔美国妇女中随机选取的。我们通过统计受孕前一年发生的工作变动、居住迁移和重大伤害的数量来衡量母亲的压力。使用社会融合和感知情感支持量表来衡量社会支持。
与未经历任何事件的母亲相比，受孕前一年经历一次或多次压力性生活事件的母亲患NTDs的风险增加（优势比[OR] = 2.9；95%置信区间[CI] = 1.8 - 4.7）。情感支持得分低的母亲与得分高的母亲相比，风险升高（OR = 4.6；CI = 2.2 - 9.7）。社会支持措施，如社交网络规模和满意度、群体互动和参加教堂活动，与NTDs风险无关。估计的影响未因年龄、教育程度、出生国家、收入、肥胖、维生素补充剂、膳食叶酸、吸烟或饮酒而改变或混淆。
在这个墨西哥裔美国人群体中，压力性生活事件的发生与NTDs风险相关。这些发现表明，压力可能会加剧营养状况差和经济资源匮乏人群的风险。
