Jacobs Marni B, Boynton-Jarrett Renee D, Harville Emily W
Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine , New Orleans, LA , USA and.
J Psychosom Obstet Gynaecol. 2015;36(2):46-57. doi: 10.3109/0167482X.2015.1026892. Epub 2015 Mar 31.
Increased childhood adversity may be affect adult fertility, however, the mechanism through which this occurs is unclear. Menstrual cycle abnormalities are predictive of fertility difficulties, and stress influences menstrual cycle characteristics. Here, we assess whether adverse childhood experiences (ACEs) are associated with fertility difficulties and menstrual cycle dysregulation, offering a plausible mechanism for the link between lifetime stress and fertility.
From April 2012 to February 2014, 742 pregnant and non-pregnant women aged 18-45 years residing in southeastern Louisiana provided information on childhood adversity and reproductive history. Associations between ACEs and fertility difficulties and menstrual cycle patterns were evaluated.
As the number of ACEs increased, risk of fertility difficulties and amenorrhea increased (RR = 1.09, 95% CI 1.05-1.13 and RR = 1.07, 95% CI 1.04-1.10, respectively), while fecundability decreased [fecundability ratio (FR) = 0.97, 95% CI 0.95-1.00]. Compared to women with no adversity, women in the high adversity group were more likely to experience both infertility and amenorrhea (RR = 2.75, 95% CI 1.45-5.21 and RR = 2.54, 95% CI 1.52-4.25, respectively), and reduced fecundability (FR = 0.75, 95% CI 0.56-1.00). Although similar patterns were seen for menstrual cycle irregularity, associations were diminished. Associations did not materially change following adjustment for age, body mass index, race, education, smoking and income. Results are constrained by the self-report nature of the study and the limited generalizability of the study population.
To our knowledge, this is the first study to present evidence of a link between childhood stressors, menstrual cycle disruption and fertility difficulties. The effect of childhood stress on fertility may be mediated through altered functioning of the HPA axis, acting to suppress fertility in response to less than optimal reproductive circumstances.
童年逆境增加可能会影响成年后的生育能力，然而，其发生机制尚不清楚。月经周期异常可预测生育困难，且压力会影响月经周期特征。在此，我们评估童年不良经历（ACEs）是否与生育困难及月经周期失调相关，为终生压力与生育能力之间的联系提供一种合理机制。
2012年4月至2014年2月，居住在路易斯安那州东南部的742名年龄在18 - 45岁的孕妇和非孕妇提供了童年逆境及生殖史信息。评估了ACEs与生育困难及月经周期模式之间的关联。
随着ACEs数量增加，生育困难和闭经的风险增加（相对风险分别为RR = 1.09，95%置信区间1.05 - 1.13和RR = 1.07，95%置信区间1.04 - 1.10），而受孕能力下降[受孕能力比率（FR）= 0.97，95%置信区间0.95 - 1.00]。与无逆境的女性相比，高逆境组女性更有可能经历不孕和闭经（相对风险分别为RR = 2.75，95%置信区间1.45 - 5.21和RR = 2.54，95%置信区间1.52 - 4.25），且受孕能力降低（FR = 0.75，95%置信区间0.56 - 1.00）。尽管月经周期不规律也呈现类似模式，但关联减弱。在对年龄、体重指数、种族、教育程度、吸烟和收入进行调整后，关联没有实质性变化。研究结果受研究的自我报告性质以及研究人群有限的普遍性限制。
据我们所知，这是第一项提供童年应激源、月经周期紊乱与生育困难之间存在联系证据的研究。童年压力对生育能力的影响可能是通过下丘脑 - 垂体 - 肾上腺（HPA）轴功能改变介导的，在生殖环境不理想时抑制生育能力。
