Medicine with Specialization in Internal Medicine and General Medicine, Hochschule Fulda-University of Applied Sciences, Fulda, Germany.
PLoS One. 2021 Jan 22;16(1):e0245386. doi: 10.1371/journal.pone.0245386. eCollection 2021.
"Stress" is an emerging problem in our society, health care system as well as patient care, worldwide. Especially by focusing on pre-gestational, gestational but also lactation phases "stress" is to be considered as an own trans-generational risk factor which is associated with adverse metabolic as well cardiovascular outcomes in mothers and their children. Hence, the maternal hypothalamic-pituitary-adrenotrophic (HPA) axis may be stimulated by various "stress" mechanisms as well as risk factors leading to an adverse in utero environment, e.g. by excess exposure of glucocorticoids, contributing to cardio-metabolic disorders in mothers and their offspring.
To review the evidence of in utero programming by focusing on the impact of maternal "stress", on adverse cardio-metabolic outcomes on their offspring later in life, by identifying underlying (patho-) physiological mechanisms (1) as well as adverse short and long-term cardio-metabolic outcomes (2).
We conducted a systematic scoping review to identify publications systematically including reviews, interventional, observational, experimental studies as well as human and animal model studies. MEDLINE (PubMed) and EMBASE databases and reference lists were searched. Peer-reviewed articles from January 2000 until August 2020 were included.
Overall, n = 2.634 citations were identified, n = 45 eligible studies were included and synthesized according to their key findings. In brief, maternal hypothalamic-pituitary-adrenotrophic (HPA) axis might play a key role modifying in utero milieu leading to cardio-metabolic diseases in the offspring later in life. However, maternal risk factor "stress", is clearly linked to adverse cardio-metabolic offspring outcomes, postnatally, such as obesity, hyperglycemia, insulin resistance, diabetes mellitus (DM), Metabolic Syndrome (MetS), cardiovascular disease (CD), hypertension, restricted fetal growth as well as reduced birth, adrenal, and pancreas weights.
Women who experienced "stress" as risk factor, as well as their offspring, clearly have a higher risk of adverse short- as well as long-term cardio-metabolic outcomes. Future research work is needed to understand complex transgenerational mechanisms.
“压力”是一个在我们的社会、医疗保健系统以及患者护理中日益突出的问题，在全球范围内都是如此。特别是在关注孕前、孕期和哺乳期时，“压力”本身作为一种跨代风险因素，与母亲及其子女的不良代谢和心血管结局相关。因此，母体下丘脑-垂体-肾上腺轴（HPA）可能会受到各种“压力”机制和风险因素的刺激，导致宫内环境不良，例如糖皮质激素过度暴露，导致母亲及其后代出现心脏代谢紊乱。
通过关注母体“压力”对后代生命后期不良心脏代谢结局的影响，审查宫内编程的证据，确定潜在的（病理）生理机制（1）以及不良的短期和长期心脏代谢结局（2）。
我们进行了系统的范围界定综述，以系统地识别出版物，包括综述、干预、观察、实验研究以及人类和动物模型研究。检索了 MEDLINE（PubMed）和 EMBASE 数据库以及参考文献列表。纳入了 2000 年 1 月至 2020 年 8 月的同行评议文章。
总共确定了 2634 篇引文，纳入了 45 项符合条件的研究，并根据其主要发现进行了综合分析。简而言之，母体下丘脑-垂体-肾上腺轴（HPA）可能在调节宫内环境方面发挥关键作用，导致后代生命后期出现心脏代谢疾病。然而，母体风险因素“压力”与后代不良心脏代谢结局明显相关，如肥胖、高血糖、胰岛素抵抗、糖尿病（DM）、代谢综合征（MetS）、心血管疾病（CD）、高血压、胎儿生长受限以及出生体重、肾上腺和胰腺重量减轻。
经历过“压力”这一风险因素的女性及其后代，明显有更高的短期和长期不良心脏代谢结局风险。未来的研究工作需要深入了解复杂的跨代机制。
