Institute for Psychology, Department of Clinical Child and Adolescent Psychology, University of Basel, Missionsstrasse 64a, Basel, Switzerland.
Arch Womens Ment Health. 2011 Feb;14(1):33-41. doi: 10.1007/s00737-010-0183-1. Epub 2010 Sep 25.
Antenatal maternal stress is thought to negatively affect fetal development, birth outcomes, and infant's development. Glucocorticoids are suggested to be a common link between prenatal stressors and infant's health. However, data on these mechanisms are rare and sometimes conflicting. The objective of this study was to examine the effects of maternal distress during pregnancy on fetal development and birth weight in humans prospectively. This study focuses on cortisol as one mediating the mechanism of the association between maternal distress and birth outcomes. Pregnancy-related and general distress was measured in 81 women with uncomplicated, singleton pregnancies. The rise of salivary cortisol on awakening (CAR) was assessed in weeks 13-18 and 35-37 postmenstrual age of pregnancy. Mothers completed a structured interview, the perceived stress scale, a widely used psychological instrument that provided a global measure of perceived stress, as well as the Prenatal Distress Questionnaire, a self-report questionnaire designed to assess worries and anxiety in pregnancy. Pre-, peri-, and postnatal medical risk factors as well as birth characteristics were extracted from medical records routinely kept by the attending obstetricians. Hierarchical multiple regressions indicate that maternal cortisol levels explained 19.8% of the variance in birth weight and 9% of the variance in body length at birth, even after controlling for gestational age, parity, pre-pregnancy BMI, smoking, and infant's sex. Newborns of mothers with higher cortisol levels in pregnancy had lower birth weights and were shorter at birth. An ANCOVA for repeated measures indicated that, after controlling for covariates, pregnancy-related as well as general distress in pregnancy did not influence cortisol levels after awakening (area under the curve). No significant associations between perceived stress and anthrometric measures at birth were found. In conclusion, maternal cortisol levels in pregnancy influence intrauterine growth and may be a better predictor for birth outcome than perceived stress.
产前母体应激被认为会对胎儿发育、分娩结局和婴儿发育产生负面影响。糖皮质激素被认为是产前应激源与婴儿健康之间的共同联系。然而，关于这些机制的数据很少，有时还存在冲突。本研究旨在前瞻性地研究孕妇在怀孕期间的焦虑对胎儿发育和出生体重的影响。本研究重点关注皮质醇作为母体焦虑与出生结局之间关联的一种中介机制。在 81 名无并发症、单胎妊娠的女性中测量了与妊娠相关的和一般的压力。在妊娠 13-18 周和 35-37 周时评估唾液皮质醇的清晨升高 (CAR)。母亲完成了一项结构访谈、感知压力量表，这是一种广泛使用的心理工具，提供了感知压力的总体衡量标准，以及产前焦虑问卷，这是一种自我报告问卷，旨在评估怀孕时的担忧和焦虑。产前、围产期和产后的医学危险因素以及出生特征从主治产科医生常规保存的医疗记录中提取。层次多元回归表明，即使在控制了胎龄、产次、孕前 BMI、吸烟和婴儿性别后，母体皮质醇水平仍解释了出生体重 19.8%的变异性和出生时身长 9%的变异性。怀孕期间皮质醇水平较高的母亲所生的新生儿出生体重较低，出生时身长较短。重复测量的 ANCOVA 表明，在控制了协变量后，妊娠相关和一般妊娠压力并不会影响觉醒后 (曲线下面积) 的皮质醇水平。未发现感知压力与出生时人体测量指标之间存在显著关联。总之，孕妇怀孕期间的皮质醇水平会影响宫内生长，并且可能比感知压力更能预测出生结局。
