Valsamakis Georgios, Papatheodorou Dimitrios C, Chalarakis Nikolaos, Vrachnis Nikolaos, Sidiropoulou Elpida J, Manolikaki Maria, Mantzou Aimilia, Margeli Alexandra, Papassotiriou Ioannis, Chrousos George P, Mastorakos George
Endocrine Unit, 2(nd) Department of Obstetrics and Gynecology, Aretaieion University Hospital, Athens Medical School, National and Kapodistrian University of Athens, Athens, Greece.
Department of Clinical Biochemistry, "Aghia Sophia" Children's Hospital, National and Kapodistrian University of Athens, Athens, Greece.
Psychoneuroendocrinology. 2017 Oct;84:11-16. doi: 10.1016/j.psyneuen.2017.06.008. Epub 2017 Jun 13.
Chronic or acute stressors influence maternal and fetal Hypothalamus-Pituitary-Adrenal Axes (HPA) during pregnancy. In this study, the effect of maternal stress into maternal insulin sensitivity was investigated during pregnancy.
Eighty-two pregnant women [aged 27.1±2.5 (mean±SD) yrs; BMI=25±2.2kg/m] had at the 2 and 3 trimesters anthropometry, fasting blood samples (cortisol, Corticotropin Releasing Hormone (CRH), active amylin, Interleukin (IL6)), Oral Glucose Tolerance Test (OGTT) for glucose and insulin, state-trait anxiety inventory (STAI) trait and state questionnaires (for stress assessment).
Maternal cortisol, CRH and STAI state score increased significantly from 2 to 3 trimester. At these trimesters women with STAI trait scores ≥40 had greater serum cortisol and CRH concentrations and lower insulin sensitivity index (ISI) values than those with scores <40 while STAI trait score predicted negatively ISI. At the 2 trimester maternal CRH concentrations correlated positively with maternal STAI state, Homeostatic Model Assessment Insulin Resistance (HOMAR), 1 and 2 phase insulin secretion and negatively with ISI. STAI trait correlated negatively with ISI. STAI state correlated positively with maternal systolic blood pressure and HOMAR. At the 3 trimester STAI trait correlated negatively and positively with ISI and STAI state, respectively, while STAI state correlated positively with HOMAR. In women with STAI state scores ≥40, these scores correlated positively with maternal CRH.
In normal pregnant women, enhanced long-term stress is associated with decreased insulin sensitivity. Both long- and short- term stress are associated with enhanced maternal HPA axis and increased placental CRH secretion.
慢性或急性应激源在孕期会影响母体和胎儿的下丘脑-垂体-肾上腺轴（HPA）。在本研究中，对孕期母体应激对母体胰岛素敏感性的影响进行了调查。
82名孕妇[年龄27.1±2.5（平均±标准差）岁；体重指数=25±2.2kg/m²]在孕中期和孕晚期进行了人体测量、空腹血样采集（皮质醇、促肾上腺皮质激素释放激素（CRH）、活性胰淀素、白细胞介素（IL6））、口服葡萄糖耐量试验（OGTT）以检测血糖和胰岛素、状态-特质焦虑量表（STAI）特质和状态问卷（用于应激评估）。
母体皮质醇、CRH和STAI状态评分从孕中期到孕晚期显著增加。在这些孕期，STAI特质评分≥40的女性比评分<40的女性具有更高的血清皮质醇和CRH浓度以及更低的胰岛素敏感性指数（ISI）值，而STAI特质评分与ISI呈负相关。在孕中期，母体CRH浓度与母体STAI状态、稳态模型评估胰岛素抵抗（HOMAR）、1期和2期胰岛素分泌呈正相关，与ISI呈负相关。STAI特质与ISI呈负相关。STAI状态与母体收缩压和HOMAR呈正相关。在孕晚期，STAI特质分别与ISI呈负相关和正相关，与STAI状态呈正相关，而STAI状态与HOMAR呈正相关。在STAI状态评分≥40的女性中，这些评分与母体CRH呈正相关。
在正常孕妇中，长期应激增强与胰岛素敏感性降低有关。长期和短期应激均与母体HPA轴增强和胎盘CRH分泌增加有关。
