Karakash S D, Tschankoshvili N, Weedon J, Schwartz R M, Kirschbaum C, Minkoff H
Department of Obstetrics and Gynecology, Maimonides Medical Center, Brooklyn, NY, USA.
Department of Obstetrics and Gynecology, Maimonides Medical Center, Orange Park, FL, USA.
J Neonatal Perinatal Med. 2016;9(4):333-339. doi: 10.3233/NPM-161640.
We sought to determine whether hypocortisolism is associated with preterm birth, using hair cortisol as a marker of long term hypothalamic-pituitary-adrenal axis activity.
In a prospective, matched, case-control study, 29 women who had a preterm birth at 24-36w5d gestation were compared to 29 women who delivered at term, matched for maternal age, gestational age, and ethnicity. Cases' samples were collected within 72 h of preterm birth and controls at the same gestational age as the corresponding case. Participants completed validated questionnaires regarding general stress and childhood trauma. The Wilcoxon signed-rank test was used to compare the distribution of mean hair cortisol scores between cases and controls. Conditional logistic regression was used to predict case vs. control by hair cortisol score, controlling for relevant covariates.
Baseline characteristics of cases and controls did not differ. Hair cortisol levels were significantly lower among cases in the adjusted analysis. Hair cortisol level was a predictor of case versus control. Each 10-pg.mg-1 increase in hair cortisol level was associated with an estimated 33% decreased odds of being a case. The only significant difference in the validated questionnaires was an increased measure of emotional neglect in the preterm group.
Our study suggests that women who deliver prematurely may have lower hair cortisol levels than women who deliver at term. Normal hypothalamic-pituitary-adrenal axis activation is a physiologic, adaptive response to stress. One hypothesis to explain our results are that women who are stressed, but unable to mount an adequate stress response could be at particular risk for preterm birth.
我们试图通过使用头发皮质醇作为下丘脑 - 垂体 - 肾上腺轴长期活动的标志物，来确定低皮质醇血症是否与早产相关。
在一项前瞻性、匹配的病例对照研究中，将29名在妊娠24 - 36周5天早产的女性与29名足月分娩的女性进行比较，根据产妇年龄、孕周和种族进行匹配。病例样本在早产72小时内收集，对照样本在与相应病例相同的孕周收集。参与者完成了关于一般压力和童年创伤的有效问卷。采用Wilcoxon符号秩检验比较病例组和对照组之间平均头发皮质醇得分的分布。使用条件逻辑回归通过头发皮质醇得分预测病例与对照，并控制相关协变量。
病例组和对照组的基线特征无差异。在调整分析中，病例组的头发皮质醇水平显著较低。头发皮质醇水平是病例与对照的预测指标。头发皮质醇水平每增加10 pg·mg-1，作为病例的估计几率降低33%。有效问卷中唯一显著的差异是早产组情感忽视的测量值增加。
我们的研究表明，早产女性的头发皮质醇水平可能低于足月分娩女性。正常的下丘脑 - 垂体 - 肾上腺轴激活是对压力的一种生理适应性反应。一种解释我们结果的假说是，处于压力下但无法产生足够应激反应的女性可能特别容易早产。
