Physiological reactivity to acute stress during pregnancy

怀孕期间对急性应激的生理反应

• 批准号: 7708094
• 负责人: Lisa Michelle Christian
• 金额: $ 18.12万
• 依托单位: OHIO STATE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2009
• 资助国家: 美国
• 起止时间: 2009-08-15 至 2011-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7708094
• 关键词: Acute; Address; African American; Animals; Anxiety; Attenuated; Australia; Biological Assay; Birth Rate; Blood Pressure; Blood Vessels; Canada; Cardiac Output; Cardiovascular Physiology; Cardiovascular system; Catecholamines; Caucasians; Caucasoid Race; Characteristics; Chronic stress; Developed Countries; Developing Countries; Discrimination; Distress; Employee Strikes; Endocrine; Europe; Exhibits; Family; Fetal Development; Fetus; Genes; Gestational Age; Glucocorticoid Receptor; Glucocorticoids; Health; Health Services; Health behavior; Hostility; Human; Hydrocortisone; Immune; Immune response; Immune system; Impedance Cardiography; Infection; Inflammation; Inflammatory; Inflammatory Response; Investigation; Knowledge; Lead; Length; Link; Literature; Measurement; Measures; Mediating; Methodology; Minority; Monitor; Mothers; Neurosecretory Systems; Not Hispanic or Latino; Outcome; Participant; Perinatal; Peripheral Resistance; Physiological; Physiological Adaptation; Pregnancy; Pregnant Women; Premature Birth; Psychosocial Stress; Race; Reaction; Receptor Signaling; Recovery; Reporting; Research; Risk; Social support; Socioeconomic Status; Stress; Treatment/Psychosocial Effects; United States; Vascular resistance; Woman; acute stress; base; biological adaptation to stress; cost; depressive symptoms; design; experience; immune function; novel; prevent; psychological stressor; psychosocial; public health relevance; racial difference; receptor function; response; stressor; therapy design

DESCRIPTION (provided by applicant): Preterm delivery, an increasingly frequent occurrence in the United States, is associated with significant family burden and an estimated societal cost of at least $26 billion per year. In the U.S., the preterm birth rate is 12-13% as compared to 5-9% in other developed countries. Persistent racial disparities contribute to this discrepancy. Psychosocial stress and related physiological sequelae may contribute to preterm birth overall, as well as to racial disparities in preterm birth. The experience of chronic stress, such as that conferred by racial minority status, may sensitize physiological stress responses. Indeed, as compared to Caucasians, African-Americans exhibit greater cardiovascular reactivity to a variety of acute stressors. Importantly, blood pressure, glucocorticoid, and catecholamine responses to acute stress are attenuated during healthy pregnancy as compared to nonpregnancy. This adaptation may protect the mother and fetus from potentially detrimental effects of maternal physiological activation. Thus, women who exhibit greater and more extended physiological reactions to everyday stressors may be at increased risk for negative perinatal outcomes. Notably, no studies of acute stress during pregnancy have examined inflammatory immune responses or mechanisms underlying blood pressure change (i.e., cardiac output, total peripheral resistance). Moreover, limited information is available regarding effects of race on physiological adaptation to pregnancy. The current study will address important gaps in the literature by examining cardiovascular, endocrine, and immune reactivity to acute stress among 40 healthy pregnant women (20 Caucasian, 20 African-American) and 40 demographically matched nonpregnant control women. This research is designed to ultimately lead to the identification of women at greater risk for negative perinatal outcomes and elucidation of mechanisms underlying increased risk, providing a basis for individualized health care services. Specific Aim #1: To utilize more comprehensive and advanced methodology to assess physiological reactivity during pregnancy versus nonpregnancy, including measures of inflammation, impedance cardiography, and glucocorticoid receptor function. Hypothesis #1: Pregnant women will show attenuated physiological responses to acute stress as compared to nonpregnant women. Specific Aim #2: To examine racial differences in physiological reactivity during pregnancy versus nonpregnancy. Hypothesis #2: As compared to Caucasian women, African-American women will exhibit greater physiological reactivity to stress during pregnancy and nonpregnancy. Specific Aim #3: To examine psychosocial correlates of physiological reactivity during pregnancy and nonpregnancy. Hypothesis #3: Women reporting greater distress will exhibit greater physiological reactivity during pregnancy and nonpregnancy. Specific Aim #4: To examine associations between physiological reactivity and length of gestation. Hypothesis #4: Greater physiological reactivity to acute stress will predict shorter gestational length. PUBLIC HEALTH RELEVANCE: This study will fill important gaps in our knowledge regarding physiological adaption during pregnancy and effects of race on such adaptation. Information gained from this study will provide the groundwork for the following: 1) identification of women at greater risk of negative perinatal outcomes; 2) describing physiological mechanisms underlying the link between stress and risk of preterm delivery; and 3) providing interventions designed to reduce the effects of stress and promote healthy pregnancy and fetal development.

描述（由申请人提供）：在美国越来越频繁地发生早产，与巨大的家庭负担有关，估计每年至少260亿美元的社会成本。在美国，早产率为12-13％，而其他发达国家为5-9％。持续的种族差异有助于这种差异。社会心理压力和相关的生理后遗症可能会导致早产总体以及早产的种族差异。慢性压力的经验，例如由种族少数群体赋予的经验，可能会使生理压力反应敏感。确实，与高加索人相比，非裔美国人对各种急性应激源的心血管反应性更大。重要的是，与未怀孕相比，在健康怀孕期间，血压，糖皮质激素和儿茶酚胺对急性应激的反应会减弱。这种适应可以保护母亲和胎儿免受母体生理激活的潜在有害作用。因此，表现出对日常压力源的生理反应越来越大的妇女可能会增加阴性围产期结局的风险。值得注意的是，怀孕期间没有对急性应激的研究研究了血压变化的炎症免疫反应或机制（即心输出量，总周围耐药性）。此外，关于种族对妊娠生理适应的影响的信息有限。当前的研究将通过检查40名健康孕妇（20名高加索人，20名非裔美国人）和40位人口统计学匹配的非孕妇对急性应激的心血管，内分泌和免疫反应性来解决文献中的重要差距。这项研究旨在最终导致识别妇女面临着更大风险的负面围产期结果的风险，并阐明风险增加的机制，从而为个性化的医疗服务提供了基础。具体目的1：利用更全面和先进的方法来评估怀孕期间的生理反应性与未怀孕，包括炎症，阻抗心脏造影和糖皮质激素受体功能的测量。假设1：与未怀孕的妇女相比，孕妇将表现出对急性应激的减弱生理反应。特定目的＃2：检查怀孕与未怀孕期间生理反应性的种族差异。假设2：与高加索妇女相比，非洲裔美国妇女在怀孕和未怀孕期间对压力的生理反应更大。特定目的＃3：检查怀孕和未怀孕期间生理反应性的社会心理相关性。假设3：报告遇到更大的妇女在怀孕和未怀孕期间将表现出更大的生理反应性。特定目的＃4：检查生理反应性与妊娠长度之间的关联。假设4：对急性应激的生理反应性更大将预测妊娠长度较短。公共卫生相关性：这项研究将填补我们关于怀孕期间生理适应的重要空白以及种族对这种适应的影响。从这项研究中获得的信息将为以下方面提供基础：1）识别妇女面临负面影响更大的风险； 2）描述压力与早产风险之间联系的生理机制； 3）提供旨在减少压力影响并促进健康怀孕和胎儿发育的干预措施。