孕期特异性焦虑与妊娠持续时间：日间皮质醇指数的中介作用。
Pregnancy-specific anxiety and gestational length: The mediating role of diurnal cortisol indices.
机构信息
Psychology Department, Athabasca University, Athabasca, AB, Canada; Psychology Department, University of Calgary, Calgary, AB, Canada.
Psychology Department, University of Calgary, Calgary, AB, Canada.
出版信息
Psychoneuroendocrinology. 2023 Jul;153:106114. doi: 10.1016/j.psyneuen.2023.106114. Epub 2023 Apr 17.
BACKGROUND
Preterm birth or shorter gestation is a common adverse pregnancy outcome. Pregnancy-specific anxiety is robustly associated with risk for shorter gestation. Hypothalamic-pituitary-adrenal (HPA) dysregulation, indicated by diurnal cortisol index variability [slope, area-under-the-curve (AUC) or cortisol awakening response (CAR)], could mediate associations between pregnancy-specific anxiety and shorter gestation. The purpose of this study was to explore whether diurnal cortisol index variability mediates associations between pregnancy-specific anxiety and gestational length.
METHODS
A sample of 149 women from the Healthy Babies Before Birth study reported pregnancy-specific anxiety in early pregnancy. Saliva samples were taken at three times during pregnancy, for two days each, at wake, 30 min post wake, noon, and evening. Diurnal cortisol indices were calculated using standard approaches. Pregnancy cortisol index variability was calculated across pregnancy timepoints. Gestational length was derived from medical charts. Covariates were sociodemographics, parity and obstetric risk. Mediation models were tested using SPSS PROCESS.
RESULTS
There was a significant indirect effect of pregnancy-specific anxiety on gestational length via CAR variability, b(SE)= -0.102(0.057), .95CI [- 0.227,- 0.008]. Higher pregnancy-specific anxiety was associated with lower CAR variability, b(SE)= -0.019(0.008), p = .022, and lower CAR variability was associated with shorter gestation, b(SE)= 5.29(2.64), p = .047. Neither AUC or slope variability mediated associations between pregnancy-specific anxiety and gestational length.
CONCLUSION
Lower CAR variability during pregnancy mediated the association between higher pregnancy-specific anxiety and shorter gestational length. Pregnancy-specific anxiety could dysregulate HPA axis activity, as indicated by lower CAR variability, demonstrating the importance of the HPA axis system in regulating pregnancy outcomes.
背景
早产或妊娠时间较短是一种常见的不良妊娠结局。妊娠特异性焦虑与妊娠时间较短的风险密切相关。下丘脑-垂体-肾上腺（HPA）轴功能失调，表现为日间皮质醇指数变异性[斜率、曲线下面积（AUC）或皮质醇觉醒反应（CAR）]，可能在妊娠特异性焦虑与妊娠时间较短之间起中介作用。本研究旨在探讨日间皮质醇指数变异性是否在妊娠特异性焦虑与妊娠时间之间起中介作用。
方法
来自“健康婴儿出生前研究”的 149 名女性在孕早期报告了妊娠特异性焦虑。在妊娠期间，3 次采集唾液样本，每次采集 2 天，时间分别为醒来时、醒来后 30 分钟、中午和晚上。采用标准方法计算日间皮质醇指数。计算了整个妊娠时间点的妊娠皮质醇指数变异性。妊娠时间从病历中得出。协变量为社会人口统计学、产次和产科风险。采用 SPSS PROCESS 检验中介模型。
结果
妊娠特异性焦虑通过 CAR 变异性对妊娠时间有显著的间接影响，b（SE）= -0.102（0.057），95%CI [-0.227，-0.008]。妊娠特异性焦虑越高，CAR 变异性越低，b（SE）= -0.019（0.008），p=0.022；CAR 变异性越低，妊娠时间越短，b（SE）= 5.29（2.64），p=0.047。AUC 或斜率变异性均不能介导妊娠特异性焦虑与妊娠时间之间的关联。
结论
妊娠期间 CAR 变异性降低介导了较高妊娠特异性焦虑与较短妊娠时间之间的关联。妊娠特异性焦虑可能会使 HPA 轴功能失调，表现为 CAR 变异性降低，这表明 HPA 轴系统在调节妊娠结局方面的重要性。
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