Wadhwa P D, Dunkel-Schetter C, Chicz-DeMet A, Porto M, Sandman C A
Department of Obstetrics and Gynecology, University of California, Irvine, USA.
Psychosom Med. 1996 Sep-Oct;58(5):432-46. doi: 10.1097/00006842-199609000-00006.
Physiological processes including neuroendocrine function have been proposed as mediators of the relationship between prenatal psychological state and pregnancy outcome; however, there are virtually no human studies that have systematically assessed such mechanisms. Neuroendocrine processes are significantly altered during pregnancy, and are characterized by the evolution of a transient neuroendocrine system, the placenta, and modifications in endocrine control mechanisms. Because these alterations have implications for neuroendocrine responsivity to exogenous conditions, the aim of the present study was to examine the cross-sectional association between prenatal psychosocial factors and stress-related neuroendocrine parameters during human pregnancy.
Fifty-four adult women with a singleton, intrauterine pregnancy were recruited before 28 weeks of gestation. Maternal antecubital venous blood samples were withdrawn at 28 weeks of gestation for bioassays of adrenocorticotropin hormone (ACTH), beta-endorphin (beta E), and cortisol. Measures of prenatal stress, social support, and personality were collected using a two-part, self-report questionnaire administered at 28 and 30 weeks of gestation. Biomedical data were obtained from the medical record. Factors known to influence neuropeptide and hormone levels during pregnancy were controlled, including gestational age, circadian variation, and obstetric risk.
In the present sample, prenatal psychosocial stress, social support, and personality variables were associated with neuroendocrine parameters in two primary ways. First, certain psychosocial factors were significantly associated with plasma levels of ACTH, beta E, and cortisol, and second, psychosocial factors were associated with a measure of disregulation of the normal relationship between two pro-opiomelanocortin (POMC) derivatives, ACTH and beta E. Furthermore, a combination of the maternal psychosocial and sociodemographic factors during pregnancy accounted for 36% of the variance in ACTH, 22% of the variance in the ACTH-beta E disregulation index, 13% of the variance in cortisol, and 3% of the variance in beta E.
The present findings are consistent with the premise that maternal-placental-fetal neuroendocrine parameters are significantly associated, both in magnitude and specificity, with features of maternal psychosocial functioning in pregnancy despite the systemic alterations associated with the endocrinology of pregnancy. These findings provide a basis for further investigations of the role of the neuroendocrine system as a putative mediating pathway between prenatal psychosocial factors and birth outcome, and possibly also as a mechanism linking features of the maternal psychosocial environment to fetal/infant brain development.
包括神经内分泌功能在内的生理过程被认为是产前心理状态与妊娠结局之间关系的调节因素；然而，几乎没有人类研究系统地评估过此类机制。妊娠期间神经内分泌过程会发生显著改变，其特征是短暂的神经内分泌系统——胎盘的演变以及内分泌控制机制的变化。由于这些改变对外源性条件下的神经内分泌反应性有影响，本研究的目的是探讨人类妊娠期间产前心理社会因素与应激相关神经内分泌参数之间的横断面关联。
招募了54名单胎、宫内妊娠的成年女性，她们在妊娠28周前入组。在妊娠28周时采集孕妇肘前静脉血样，用于促肾上腺皮质激素（ACTH）、β-内啡肽（βE）和皮质醇的生物测定。产前应激、社会支持和个性的测量采用在妊娠28周和30周时进行的两部分自填问卷收集。生物医学数据从病历中获取。对已知影响妊娠期间神经肽和激素水平的因素进行了控制，包括孕周、昼夜变化和产科风险。
在本样本中，产前心理社会应激、社会支持和个性变量与神经内分泌参数主要有两种关联方式。首先，某些心理社会因素与ACTH、βE和皮质醇的血浆水平显著相关；其次，心理社会因素与促阿片黑素皮质激素（POMC）的两种衍生物ACTH和βE之间正常关系的失调程度有关。此外，孕期母亲心理社会因素和社会人口学因素的组合占ACTH变异的36%、ACTH-βE失调指数变异的22%、皮质醇变异的13%和βE变异的3%。
目前的研究结果与以下前提一致，即尽管妊娠内分泌存在系统性改变，但母胎神经内分泌参数在大小和特异性上均与孕期母亲心理社会功能特征显著相关。这些发现为进一步研究神经内分泌系统作为产前心理社会因素与出生结局之间可能的中介途径的作用提供了基础，也可能为将母亲心理社会环境特征与胎儿/婴儿脑发育联系起来的机制提供依据。
