孕期高皮质醇水平与胎儿生长改变的关联。来自班加罗尔一项前瞻性队列研究MAASTHI的结果。
Association of high cortisol levels in pregnancy and altered fetal growth. Results from the MAASTHI, a prospective cohort study, Bengaluru.
作者信息
Shriyan Prafulla, Sudhir Paulomi, van Schayck Onno C P, Babu Giridhara R
机构信息
Indian Institute of Public Health, Public Health Foundation of India, Bengaluru, Karnataka, 560023, India.
Clinical Psychology, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India.
出版信息
Lancet Reg Health Southeast Asia. 2023 Jul;14:100196. doi: 10.1016/j.lansea.2023.100196.
BACKGROUND
The role of maternal stress levels on mothers' mental health and fetal growth has been previously studied. However, the evidence linking cortisol exposure during pregnancy to growth outcomes in infants is sparsely available from lower and middle-income countries. We aim to investigate the association of serum cortisol levels in pregnancy with infant birth outcomes and postpartum depressive symptoms in a public health facility in India.
METHODS
The current study is a part of the maternal antecedents of adiposity and studying the transgenerational role of hyperglycemia and insulin (MAASTHI) prospective cohort. We assessed the relationship between maternal exposure to serum cortisol and adverse neonatal outcomes and postpartum depressive symptoms. Serum cortisol levels in stored blood samples were measured in 230 pregnant women as a biomarker for stress during pregnancy. Pregnant women between 18 and 45 years of age were recruited for the study, presenting at ≥14 weeks of gestation and providing voluntary written informed consent. The Edinburgh Postnatal Depression Scale assessed postpartum depressive symptoms, and detailed infant anthropometric measurements were carried out at birth.
FINDINGS
We found that higher levels (>17.66 μg/L) are significantly associated with low birth weight (OR = 2.28; 95% CI 1.21-4.32) and lower weight for length (OR = 2.16; 95% CI 1.07-4.35). The odds of developing postpartum depressive symptoms in pregnant women with higher mean cortisol cut-off levels is 2.3-fold [OR: 2.33, 95% CI (1.17, 4.64)] compared than women with lower cortisol levels. No significant association was found between serum cortisol and infants' birth weight for gestational age, head circumference, the sum of skinfold thickness, and crown-rump length.
INTERPRETATION
Our results support the hypothesis that higher maternal cortisol levels may adversely impact birth weight, weight for length in newborns, and postpartum depressive symptoms in mothers.
FUNDING
This study was supported by the India Alliance Senior Fellowship [Grant No. IA/CPHS/20/1/505278] awarded to Giridhara R. Babu.
背景
此前已有研究探讨母体应激水平对母亲心理健康及胎儿生长的作用。然而，在低收入和中等收入国家，关于孕期暴露于皮质醇与婴儿生长结局之间关联的证据尚少。我们旨在印度一家公共卫生机构中，调查孕期血清皮质醇水平与婴儿出生结局及产后抑郁症状之间的关联。
方法
本研究是肥胖的母体 antecedents 及研究高血糖和胰岛素的跨代作用（MAASTHI）前瞻性队列研究的一部分。我们评估了母体暴露于血清皮质醇与不良新生儿结局及产后抑郁症状之间的关系。对230名孕妇储存血样中的血清皮质醇水平进行测量，将其作为孕期应激的生物标志物。招募年龄在18至45岁之间、妊娠≥14周且提供自愿书面知情同意书的孕妇参与研究。采用爱丁堡产后抑郁量表评估产后抑郁症状，并在婴儿出生时进行详细的人体测量。
研究结果
我们发现，较高水平（>17.66μg/L）与低出生体重（比值比=2.28；95%置信区间1.21 - 4.32）及较低的身长体重比（比值比=2.16；95%置信区间1.07 - 4.35）显著相关。平均皮质醇临界值水平较高的孕妇出现产后抑郁症状的几率是皮质醇水平较低孕妇的2.3倍[比值比：2.33，95%置信区间（1.17，4.64）]。未发现血清皮质醇与婴儿的出生体重、胎龄、头围、皮褶厚度总和及顶臀长度之间存在显著关联。
解读
我们的研究结果支持以下假设，即较高的母体皮质醇水平可能对新生儿的出生体重、身长体重比及母亲的产后抑郁症状产生不利影响。
资金支持
本研究由授予吉里达拉·R·巴布的印度联盟高级奖学金[资助编号IA/CPHS/20/1/505278]资助。
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