Vlenterie Richelle, Roeleveld Nel, van Gelder Marleen M H J
Department for Health Evidence, Radboud Institute for Health Sciences, Radboud University Medical Center, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands.
Department for Health Evidence, Radboud Institute for Health Sciences, Radboud University Medical Center, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands; Department of Pediatrics, Radboudumc Amalia Children's Hospital, Radboud University Medical Center, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands.
Psychoneuroendocrinology. 2016 Dec;74:295-301. doi: 10.1016/j.psyneuen.2016.09.009. Epub 2016 Sep 16.
Mood disorders during pregnancy have been associated with adverse effects on maternal as well as fetal health. Since mood, anxiety, and stress disorders are related with elevated cortisol levels, salivary cortisol may be a useful biomarker. Although multiple samples are generally recommended, a single measurement of awakening salivary cortisol could be a simpler and more cost-effective method to determine whether women have elevated morning cortisol levels during a specific period of pregnancy. Therefore, the aim of this validation study among 177 women in the PRIDE Study was to examine whether one awakening salivary cortisol measurement will suffice to classify pregnant women as having normal or elevated cortisol levels compared to awakening salivary cortisol measurements on three consecutive working days. We calculated intraclass correlation coefficients (ICC) and Cohen's kappa statistics (κ) overall as well as in sub-analyses within strata based on maternal age, level of education, net household income, pre-pregnancy BMI, parity, complications during pregnancy, caffeine consumption, gestational week of sampling, and awakening time. The mean cortisol concentrations were 8.98ng/ml (SD 5.32) for day one, 8.62ng/ml (SD 4.55) for day two, and 8.39ng/ml (SD 4.58) for day three. The overall ICC was 0.86 (95% CI 0.82-0.89) while the κ was 0.75 (95% CI 0.64-0.86). For the ICCs calculated within sub-analyses, a maximum difference of 0.11 was observed between the strata. For the κ statistics, most strata did not differ more than 0.12, except for pre-pregnancy BMI, severe nausea, and extreme fatigue with differences up to 0.22. In conclusion, one awakening salivary cortisol measurement is as reliable for the classification of pregnant women into normal and elevated morning cortisol levels as salivary cortisol measurements on three consecutive working days.
孕期情绪障碍与对母体及胎儿健康的不良影响有关。由于情绪、焦虑和应激障碍与皮质醇水平升高有关，唾液皮质醇可能是一种有用的生物标志物。尽管通常建议采集多个样本，但单次测量觉醒时唾液皮质醇可能是一种更简单且成本效益更高的方法，用于确定女性在孕期特定阶段早晨的皮质醇水平是否升高。因此，本验证研究在PRIDE研究中的177名女性中开展，目的是检验与连续三个工作日的觉醒时唾液皮质醇测量相比，单次觉醒时唾液皮质醇测量是否足以将孕妇归类为皮质醇水平正常或升高。我们计算了总体以及基于产妇年龄、教育程度、家庭净收入、孕前体重指数、产次、孕期并发症、咖啡因摄入量、采样孕周和觉醒时间分层的亚分析中的组内相关系数（ICC）和科恩kappa统计量（κ）。第一天的平均皮质醇浓度为8.98ng/ml（标准差5.32），第二天为8.62ng/ml（标准差4.55），第三天为8.39ng/ml（标准差4.58）。总体ICC为0.86（95%置信区间0.82 - 0.89），而κ为0.75（95%置信区间0.64 - 0.86）。在亚分析中计算的ICC中，各层之间的最大差异为0.11。对于κ统计量，除了孕前体重指数、严重恶心和极度疲劳，差异高达0.22外，大多数层的差异不超过0.12。总之，单次觉醒时唾液皮质醇测量对于将孕妇分为早晨皮质醇水平正常和升高的类别，与连续三个工作日的唾液皮质醇测量一样可靠。
