Seravalli Laura, Patterson Freda, Nelson Deborah B
J Midwifery Womens Health. 2014 Jul-Aug;59(4):374-9. doi: 10.1111/jmwh.12088. Epub 2014 May 29.
This study examined whether prenatal perceived stress levels during pregnancy were associated with preterm labor or preterm birth.
Perceived stress levels were measured at 16 weeks' gestation or less and between 20 and 24 weeks' gestation in a sample of 1069 low-income pregnant women attending Temple University prenatal care clinics. Scores were averaged to create a single measure of prenatal stress. Preterm birth was defined as the occurrence of a spontaneous birth prior to 37 weeks' gestation. Preterm labor was defined as the occurrence of regular contractions between 20 and 37 weeks' gestation that were associated with changes in the cervix.
Independent of potential confounding factors, prenatal perceived stress was not associated with preterm labor (odds ratio [OR], 1.10; 95% confidence interval [CI], 0.69-1.78; P = .66); however, prenatal stress trended toward an association with preterm birth (OR, 1.49; 95% CI, 1.00-2.23; P = .05). The strongest predictor of preterm labor was a history of preterm labor in a prior pregnancy. Women with a history of preterm labor were 2 times more likely to experience preterm labor in the current pregnancy than women who did not have a preterm labor history (OR, 2.16; 95% CI, 1.05-4.41; P = .04). Historical risk factors for preterm birth, such as African American race, a history of abortion, or a history of preterm birth, were not related to preterm labor. The strongest predictor of preterm birth was having a history of preterm birth in a prior pregnancy (OR, 2.55; 95% CI, 1.54-4.24; P < .001).
Prenatal perceived stress levels may be a risk factor for preterm birth independent of preterm labor; however, prenatal stress was not associated with preterm labor. Risk factors for preterm labor may be different from those of preterm birth.
本研究探讨孕期产前感知应激水平是否与早产或早产分娩相关。
在1069名前往天普大学产前护理诊所就诊的低收入孕妇样本中，于妊娠16周及以内和妊娠20至24周时测量感知应激水平。将得分进行平均以创建产前应激的单一测量指标。早产定义为妊娠37周前发生的自然分娩。先兆早产定义为妊娠20至37周期间发生的与宫颈变化相关的规律宫缩。
排除潜在混杂因素后，产前感知应激与先兆早产无关（优势比[OR]为1.10；95%置信区间[CI]为0.69 - 1.78；P = 0.66）；然而，产前应激与早产分娩呈趋势性关联（OR为1.49；95% CI为1.00 - 2.23；P = 0.05）。先兆早产的最强预测因素是既往妊娠有先兆早产史。有先兆早产史的女性当前妊娠发生先兆早产的可能性是无先兆早产史女性的2倍（OR为2.16；95% CI为1.05 - 4.41；P = 0.04）。早产分娩的既往风险因素，如非裔美国人种族、流产史或早产史，与先兆早产无关。早产分娩的最强预测因素是既往妊娠有早产史（OR为2.55；95% CI为1.54 - 4.24；P < 0.001）。
产前感知应激水平可能是独立于先兆早产的早产分娩风险因素；然而，产前应激与先兆早产无关。先兆早产的风险因素可能与早产分娩的不同。
