Sandman C A, Wadhwa P D, Chicz-DeMet A, Dunkel-Schetter C, Porto M
Department of Psychiatry, University of California, Irvine, USA.
Ann N Y Acad Sci. 1997 Apr 24;814:266-75. doi: 10.1111/j.1749-6632.1997.tb46162.x.
Preliminary conclusions from our research include the possibility that each of the HPA products evaluated, even though correlated (e.g., ACTH and beta E), may be linked to unique and specific outcomes. Maternal stress during the 28-30 weeks of gestation is associated with birth outcome. Increased levels of psychosocial stress were significantly related to gestational age at birth and infant birth weight. Maternal stress during the third trimester was associated with increased maternal plasma levels of ACTH and cortisol. This finding is consistent with possible mechanisms whereby psychosocial stress influences birth outcome. CRH controls the timing of labor and delivery. Precocious elevation of CRH is related to the risk of preterm delivery. This system may be "stress-sensitive." Even though pregnant women may be immunized from stress, the stress signal that is transmitted (release of ACTH and cortisol) is amplified by the placental release of CRH. This possibility has at least two consequences: (1) influencing the timing of delivery and (2) desensitization of hypophyseal corticotrophs and further "protection" of the pregnant women from the results of stress (i.e., release of ACTH and beta E). Beta E appears to influence fetal learning and perhaps the developing nervous system.
我们研究的初步结论包括，所评估的每种下丘脑-垂体-肾上腺（HPA）产物，即使相互关联（例如促肾上腺皮质激素和β-内啡肽），也可能与独特且特定的结果相关。妊娠28至30周时的母体应激与出生结局相关。心理社会应激水平升高与出生时的胎龄和婴儿出生体重显著相关。孕晚期的母体应激与母体血浆中促肾上腺皮质激素和皮质醇水平升高有关。这一发现与心理社会应激影响出生结局的可能机制相一致。促肾上腺皮质激素释放激素（CRH）控制分娩的时间。CRH的过早升高与早产风险相关。该系统可能是“应激敏感的”。尽管孕妇可能免受应激影响，但所传递的应激信号（促肾上腺皮质激素和皮质醇的释放）会因胎盘释放CRH而放大。这种可能性至少有两个后果：（1）影响分娩时间；（2）垂体促肾上腺皮质细胞脱敏，并进一步使孕妇免受应激结果的影响（即促肾上腺皮质激素和β-内啡肽的释放）。β-内啡肽似乎会影响胎儿学习，或许还会影响发育中的神经系统。
