Hogue Carol J Rowland, Bremner J Douglas
Department of Epidemiology, Rollins School of Public Health, Emory University School of Medicine, Atlanta, GA 30322, USA.
Am J Obstet Gynecol. 2005 May;192(5 Suppl):S47-55. doi: 10.1016/j.ajog.2005.01.073.
The disparity between black and white infant mortality rates increased over the last decade, despite overall improvement in infant survival. Because most black infant deaths are related to preterm delivery, the discovery of the cause of premature birth in general and excess premature birth for black infants in particular is of paramount importance for reproductive health research. Substantial theoretic support exists for maternal stress as a risk factor for preterm birth. Traumatic events early in life may sensitize the adult to contemporary stresses and increase her vulnerability to stress-induced neuroendocrine or infection/inflammatory pathways to early parturition. In addition, an individual may prematurely age as a result of cumulative stress or a major traumatic event. This "stress age," which is synonymous with the concept of weathering and similar to the concept of allostatic load, may affect parturition through chronic conditions (such as hypertension) and in poorly understood pathophysiologic mechanisms that are related to increased chronologic age. One potential measure of stress age is maternal serum dehydroepiandrosterone sulfate. Maternal stress is a potential explanatory factor for excess preterm delivery among black women because of their exposure to racism-associated stress. However, few studies have addressed this question, and results are mixed. Future etiologic research must take into account the complexities of the measurement of stress age and past and current exposures to stress, which includes internalized racism and interpersonal racism.
尽管婴儿存活率总体有所提高，但过去十年间黑人和白人婴儿死亡率之间的差距仍在扩大。由于大多数黑人婴儿死亡与早产有关，因此找出一般早产的原因，尤其是黑人婴儿过度早产的原因，对生殖健康研究至关重要。有大量理论支持将母亲压力作为早产的一个风险因素。早年的创伤事件可能会使成年人对当代压力更加敏感，并增加其因压力诱发的神经内分泌或感染/炎症途径而早产的易感性。此外，个体可能会因累积压力或重大创伤事件而过早衰老。这种“压力年龄”与“风化”概念同义，类似于“应变负荷”概念，可能通过慢性疾病（如高血压）以及与实际年龄增加相关的、尚未完全了解的病理生理机制影响分娩。压力年龄的一个潜在衡量指标是母亲血清硫酸脱氢表雄酮。由于黑人女性面临与种族主义相关的压力，母亲压力是黑人女性早产过多的一个潜在解释因素。然而，很少有研究探讨这个问题，结果也参差不齐。未来的病因学研究必须考虑到压力年龄测量的复杂性以及过去和当前所面临的压力，其中包括内化种族主义和人际种族主义。
