School of Life Sciences, University of Skövde, Skövde, Sweden.
Breastfeed Med. 2009 Dec;4(4):207-20. doi: 10.1089/bfm.2009.0001.
In this study we made a detailed analysis of the mothers' release pattern of adrenocorticotropic hormone (ACTH) and cortisol during a breastfeeding session during the second day postpartum and related these patterns to maternal oxytocin levels as well to the duration of sucking and the duration of skin-to-skin contact before sucking the breast. Furthermore, we investigated if epidural analgesia and oxytocin administration during and after labor influenced the release pattern of ACTH and cortisol.
Sixty-three primiparae were included in the study. Fourteen received oxytocin intramuscularly postpartum, nine received oxytocin infusion, 14 received epidural analgesia combined with oxytocin infusion, and six received epidural analgesia alone. Twenty mothers did not receive any of these medical interventions. Blood samples were analyzed for ACTH and cortisol by enzyme-linked immunoassay.
Both ACTH and cortisol levels fell significantly during the breastfeeding session. A significant negative relationship was found between oxytocin and ACTH levels, but not between oxytocin and cortisol levels. A positive and significant relationship was found between ACTH and cortisol levels. The duration of skin-to-skin contact before onset of sucking was significantly and negatively associated with lower cortisol levels, but not with ACTH levels. Cortisol levels differed significantly between mothers having received epidural analgesia with and without oxytocin.
Breastfeeding is associated with a decrease of ACTH and cortisol levels. Skin-to-skin contact contributes to this effect. ACTH correlated negatively with the duration of sucking and with median oxytocin levels, whereas cortisol levels correlated inversely with the duration of skin-to-skin contact preceding sucking, suggesting a partial dissociation between the mechanisms regulating ACTH and cortisol release. In addition, medical interventions in connection with birth influence the activity of the hypothalamic-pituitary-adrenal axis 2 days after birth.
本研究详细分析了产后第 2 天母乳喂养过程中产妇促肾上腺皮质激素（ACTH）和皮质醇的释放模式，并将这些模式与产妇催产素水平以及吸吮持续时间和吸吮前皮肤接触持续时间相关联。此外，我们还研究了分娩期间和之后硬膜外镇痛和催产素给药是否会影响 ACTH 和皮质醇的释放模式。
本研究纳入了 63 名初产妇。14 名产妇产后接受肌肉内催产素注射，9 名产妇接受催产素输注，14 名产妇接受硬膜外镇痛联合催产素输注，6 名产妇接受单纯硬膜外镇痛。20 名产妇未接受任何这些医疗干预。通过酶联免疫吸附试验分析血液样本中的 ACTH 和皮质醇。
母乳喂养过程中 ACTH 和皮质醇水平均显著下降。催产素与 ACTH 水平呈显著负相关，但与皮质醇水平无关。ACTH 与皮质醇水平呈正相关。吸吮开始前皮肤接触时间与较低的皮质醇水平呈显著负相关，但与 ACTH 水平无关。接受硬膜外镇痛加或不加催产素的产妇皮质醇水平存在显著差异。
母乳喂养与 ACTH 和皮质醇水平下降有关。皮肤接触有助于这种效应。ACTH 与吸吮持续时间和中位数催产素水平呈负相关，而皮质醇水平与吸吮前皮肤接触持续时间呈负相关，提示调节 ACTH 和皮质醇释放的机制部分分离。此外，与分娩相关的医疗干预会影响产后第 2 天下丘脑-垂体-肾上腺轴的活性。
