Department of Population Health Sciences, School of Medicine and Public Health, University of Wisconsin, Madison, 610 North Walnut Street, Office 503, Madison, WI, 53726, USA.
Department of Population Health Sciences, School of Medicine and Public Health, University of Wisconsin, Madison, 610 North Walnut Street, Office 707, Madison, WI, 53726, USA.
Matern Child Health J. 2014 Jan;18(1):52-63. doi: 10.1007/s10995-013-1233-x.
Mounting evidence from clinic and convenience samples suggests that stress is an important predictor of adverse obstetric outcomes. Using a proposed theoretical framework, this review identified and synthesized the population-based literature on the measurement of stress prior to and during pregnancy in relation to obstetric outcomes. Population-based, peer-reviewed empirical articles that examined stress prior to or during pregnancy in relation to obstetric outcomes were identified in the PubMed and PsycInfo databases. Articles were evaluated to determine the domain(s) of stress (environmental, psychological, and/or biological), period(s) of stress (preconception and/or pregnancy), and strength of the association between stress and obstetric outcomes. Thirteen studies were evaluated. The identified studies were all conducted in developed countries. The majority of studies examined stress only during pregnancy (n = 10); three examined stress during both the preconception and pregnancy periods (n = 3). Most studies examined the environmental domain (e.g. life events) only (n = 9), two studies examined the psychological domain only, and two studies examined both. No study incorporated a biological measure of stress. Environmental stressors before and during pregnancy were associated with worse obstetric outcomes, although some conflicting findings exist. Few population-based studies have examined stress before or during pregnancy in relation to obstetric outcomes. Although considerable variation exists in the measurement of stress across studies, environmental stress increased the risk for poor obstetric outcomes. Additional work using a lifecourse approach is needed to fill the existing gaps in the literature and to develop a more comprehensive understanding of the mechanisms by which stress impacts obstetric outcomes.
越来越多的临床和便利样本证据表明，压力是不良产科结局的重要预测因素。本综述使用提出的理论框架，确定并综合了与产科结局相关的妊娠前后人群中压力测量的文献。在 PubMed 和 PsycInfo 数据库中，确定了在妊娠前或妊娠期间检查压力与产科结局之间关系的基于人群、同行评审的实证文章。评估文章以确定压力的域（环境、心理和/或生物）、压力的时期（受孕前和/或妊娠期间）以及压力与产科结局之间的关联强度。评估了 13 项研究。确定的研究均在发达国家进行。大多数研究仅在妊娠期间检查压力（n=10）；有 3 项研究检查了受孕前和妊娠期间的压力（n=3）。大多数研究仅检查了环境域（例如生活事件）（n=9），2 项研究仅检查了心理域，2 项研究检查了两者。没有研究纳入压力的生物学测量。妊娠前后的环境压力源与较差的产科结局相关，尽管存在一些相互矛盾的发现。很少有基于人群的研究检查过妊娠前后的压力与产科结局之间的关系。尽管研究之间在压力测量方面存在相当大的差异，但环境压力增加了不良产科结局的风险。需要使用生命历程方法开展更多工作，以填补文献中的现有空白，并更全面地了解压力影响产科结局的机制。
