Li Zhiwen, Zhang Le, Li Hongtian, Ye Rongwei, Liu Jianmeng, Ren Aiguo
Institute of Reproductive and Child Health/Ministry of Health Key Laboratory of Reproductive Health, Peking University, Beijing 100191, China.
Birth Defects Res A Clin Mol Teratol. 2013 Feb;97(2):109-14. doi: 10.1002/bdra.23108. Epub 2013 Jan 11.
Several human studies suggested an association between maternal stressful life events and increased risk of neural tube defects (NTDs). All of these studies, however, are from the United States; little was known among populations in developing countries that have different social and economic status.
We examined the association between occurrence of maternal severe stressful life events during the periconceptional period and risk of NTDs in a population-based case-control study in Shanxi Province, China. Participants included 631 NTD cases (285 with anencephaly, 297 with spina bifida, and 49 with encephalocele) and 862 normal controls born between 2002 and 2007. Exposure information was collected within 1 week after delivery. The multivariable logistic regression model was used to estimate the adjusted odds ratio (OR) and its 95% confidence interval (95% CI) controlling for potential confounding variables.
Occurrence of maternal severe stressful life events was associated with a crude OR of 6.3 (95% CI, 2.8-14.4) for NTDs. After adjustment for all potential variables, the adjusted OR for NTDs remain significant (adjusted OR, 4.2; 95% CI, 1.4-12.6), and stronger for anencephaly (adjusted OR, 4.4; 95% CI, 1.2-15.9) than for spina bifida (adjusted OR, 3.4; 95% CI, 0.9-12.7). Adjustment for lifestyle variables greatly reduced the risk by 32%. A significant difference was found for some lifestyle characteristics between women with and without severe life events.
This study confirmed the association between maternal stress and risk of NTDs that has been consistently reported in the United States. The effect may be the combined results of maternal physiologic changes and lifestyle changes.
多项人体研究表明，母亲生活中的应激事件与神经管缺陷（NTDs）风险增加之间存在关联。然而，所有这些研究均来自美国；对于社会经济地位不同的发展中国家人群，这方面了解甚少。
在中国山西省开展的一项基于人群的病例对照研究中，我们考察了受孕前后母亲发生严重应激生活事件与NTDs风险之间的关联。参与者包括2002年至2007年期间出生的631例NTDs病例（285例无脑儿、297例脊柱裂和49例脑膨出）和862例正常对照。在分娩后1周内收集暴露信息。采用多变量逻辑回归模型估计调整后的优势比（OR）及其95%置信区间（95%CI），同时控制潜在的混杂变量。
母亲发生严重应激生活事件与NTDs的粗OR为6.3（95%CI，2.8 - 14.4）。在对所有潜在变量进行调整后，NTDs的调整后OR仍然显著（调整后OR，4.2；95%CI，1.4 - 12.6），且无脑儿的关联强度（调整后OR，4.4；95%CI，1.2 - 15.9）强于脊柱裂（调整后OR，3.4；95%CI，0.9 - 12.7）。对生活方式变量进行调整后，风险大幅降低了32%。有无严重生活事件的女性在一些生活方式特征方面存在显著差异。
本研究证实了美国一直报道的母亲应激与NTDs风险之间的关联。这种影响可能是母亲生理变化和生活方式变化共同作用的结果。
