母体内皮质醇水平对初产妇孕晚期胎儿心率模式的影响。

Effect of maternal cortisol levels on fetal heart rate patterns in primiparous pregnant women in the third trimester.

机构信息

Istanbul Medipol Üniversitesi, Faculty of Health Sciences, Department of Midwifery - Istanbul, Turkey.

Acıbadem Mehmet Ali Aydınlar Üniversitesi, Acıbadem Bakırköy Hospital, Department of Obstetrics and Gynecology - Istanbul, Turkey.

出版信息

Rev Assoc Med Bras (1992). 2023 May 19;69(5):e20221610. doi: 10.1590/1806-9282.20221610. eCollection 2023.

DOI:10.1590/1806-9282.20221610

PMID:37222328

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10204844/

Abstract

OBJECTIVE

This study aimed to determine whether maternal cortisol levels affect fetal heart rate patterns in primiparous pregnant women in the third trimester.

METHODS

This cross-sectional descriptive study included 400 primiparous pregnant women with uncomplicated pregnancies between November and December 2022. The study included primiparous pregnant women over 18 years old in the third trimester who had not exercised for at least 2 h before the fetal heart rate monitoring and had a healthy pregnancy without consuming any food or drink. Fetuses with decelerating heartbeats and pregnant women who showed uterine contraction and cervical dilation during the fetal heart rate monitoring were excluded from the study. Research data were collected with the data collection form. The fetal heart rate data were collected using a cardiotocograph. At least two accelerations during the 20-min nonstress test period were the basis for diagnosing a reactive nonstress test. About 5 mL of maternal saliva for cortisol measurements was collected before fetal heart rate monitoring. Research data were analyzed with IBM SPSS Statistics for Macintosh, Version 28.0. A p-value of <0.05 was considered significant.

RESULTS

There were no significant differences in the comparison of the groups in terms of education and income status, family type, fetal gender, pregnancy planning status, BMI and age averages, or gestational week averages (p>0.05). The number of at least two accelerations required for the diagnosis of reactive NST was also higher in Group 1 (maternal salivary cortisol level ≤24.20). A moderately positive relationship between fetal heart rate and maternal salivary cortisol was observed (r=0.448, p=0.000). In total, 11.9% of the total change in fetal heart rate level is explained by maternal cortisol (R2=0.119). Maternal cortisol increases fetal heart rate level (ß=0.349).

CONCLUSION

These findings suggest that stress in primiparous pregnant women with high cortisol levels may influence fetal heart rate patterns. It was revealed that the increase in cortisol level, considered a stress hormone, may be a harbinger of fetal tachycardia.

摘要

目的

本研究旨在探讨初产妇孕晚期皮质醇水平是否会影响胎儿心率模式。

方法

这是一项横断面描述性研究，纳入了 2022 年 11 月至 12 月间的 400 名初产妇。纳入标准为：年龄≥18 岁，孕 3 期，胎儿心率监测前至少 2 h 未运动，健康妊娠，未进食或饮水。排除标准为：胎儿心动过缓、胎儿心率监测期间出现宫缩和宫颈扩张的孕妇。采用数据收集表收集研究数据。使用胎儿监护仪采集胎儿心率数据。20 min 无应激试验期间至少有 2 次加速，作为反应性无应激试验的诊断依据。在胎儿心率监测前采集 5ml 左右的母体唾液进行皮质醇测量。采用 IBM SPSS Statistics for Macintosh，Version 28.0 对研究数据进行分析。p 值<0.05 认为差异有统计学意义。

结果

两组在教育和收入状况、家庭类型、胎儿性别、妊娠计划状况、BMI 和年龄均值、孕周均值等方面比较，差异均无统计学意义（p>0.05）。组 1（母体唾液皮质醇水平≤24.20）中，反应性 NST 诊断所需的至少 2 次加速的数量也更高。胎儿心率与母体唾液皮质醇之间呈中度正相关（r=0.448，p=0.000）。总的来说，母体皮质醇水平变化可解释胎儿心率水平变化的 11.9%（R2=0.119）。母体皮质醇增加胎儿心率水平（ß=0.349）。