Subjects: Medicine, Pharmacy >> Clinical Medicine submitted time 2023-07-19 Cooperative journals: 《中国全科医学》
Abstract： Background As an objective index to evaluate chronic stress，allostatic load （AL） is associated with adverse pregnancy outcomes. At present，there are few longitudinal studies to analyze the influencing factors of AL among pregnant women. Objective To investigate the status of AL and its influencing factors in pregnant women at different trimesters. Methods This study was designed as a prospective study. Questionnaire survey，physical examination and laboratory examination were administered to 152 women in the first （≤ 14 weeks），second （23-27 weeks） and third （30-34 weeks） trimesters of pregnancy collected by using convenience sampling method. The Edinburgh Postpartum Depression Scale （EPDS） was used to assess the depression during pregnancy. Referring to previous studies，the relevant assessment indexes of metabolic system，cardiovascular system，and immune system were used to calculate the total score of AL，and AL ≥ 3 score was used as a criterion for determining high AL level at different trimesters of pregnancy. Multivariate logistic regression analysis was used to explore the influencing factors of AL in the first，second and third trimesters. Results Among 152 pregnant women，the mean total AL score was （2.06±1.68），（2.07±1.84） and （2.07±1.68） in the first，second and third trimesters；52 （34.0%），54 （35.3%） and 50 （32.7%） women were in high level of AL （total score of AL ≥ 3） in the first，seccond and third trimesters . The results of multivariate logistic regression analysis showed that occupations｛business service employees〔OR=0.229，95%CI（0.062，0.845），P=0.027〕，office staff〔OR=0.164，95%CI（0.051，0.528），P=0.002〕，professional and technical personnel〔OR=0.278，95%CI（0.099，0.784），P=0.015〕｝，unemployment〔OR=5.516，95%CI（1.044，29.144），P=0.044〕and depression〔OR=6.241，95%CI（1.403，27.757），P=0.016〕were the influencing factors of AL in the first trimester. Age〔OR=1.098，95%CI（1.002，1.202），P=0.045〕and AL in the first trimester〔OR=9.965，95%CI（4.402，22.561），P=0.000〕were the influencing factors of AL in the second trimester. Sleep duration in the third trimester〔≥ 9 h/d：OR=0.176，95%CI（0.044，0.703），P=0.014〕，AL in the first trimester〔OR=4.697，95%CI（1.852，11.908），P<0.001〕and AL in the second trimester〔OR=9.426，95%CI（3.728，23.834），P<0.001〕 were the influencing factors of AL in the third trimester. Conclusion More than 30% of women are at high levels of AL at different trimesters and the influencing factors of AL at different trimesters are different. Occupation，unemployment status，and depression are the influencing factors of AL in the first trimester；age and AL in the first trimester are the influencing factors of AL in the second trimester；sleep duration in the third trimester and AL in the first and second trimesters are the influencing factors of AL in the third trimester. Earlier attention and timely intervention of AL during pregnancy will help reduce the risk of high AL as pregnancy progresses.
Subjects: Medicine, Pharmacy >> Clinical Medicine submitted time 2023-07-18 Cooperative journals: 《中国全科医学》
Abstract： Background The incidence of adverse pregnancy outcomes has remained high in recent years，which poses a serious threat to maternal and neonatal life and health. Chronic stress is known to be a risk factor for adverse pregnancy outcomes，while the relationship between allostatic load （AL） as a composite physiological index of chronic stress，and adverse pregnancy outcomes has not been clarified. Objective To explore the effect of AL on adverse pregnancy outcomes inwomen in late pregnancy. Methods Women in late pregnancy who met the study requirements were recruited as study subjects by using the convenience sampling method from November 2021 to November 2022 in the obstetrics outpatient clinics of the 901 Hospital，Joint Logistic Support Force of the Chinese People's Liberation Army，Jin'an Maternal and Child Health Care Hospital. Basic information such as general and obstetric data were collected through questionnairs，biological indicators were collected through physical examination and laboratory tests，and AL scores of the study subjects were calculated by referring to AL-related literature; pregnancy outcome information was obtained by reviewing the hospital electronic medical record system. Multivariate Logistic regression analysis was used to explore the effect of AL on adverse pregnancy outcomes in women in late pregnancy. Results A total of 354 women in late pregnancy with an average age of （29.3±4.1） years and upper quartile of AL total score of 3 were included in this study. The upper quartile of the total AL score of the study subjects was used as the high#2;risk threshold，and they were divided into low-level AL （AL <3） and high-level AL （AL ≥ 3） according to their AL scores. High AL pregnant women accounted for 32.8% （116/354） and low AL pregnant women accounted for 67.2% （238/354）. The prevalence of adverse pregnancy outcomes was 15.5% （55/354），including 9.9% （35/354） of macrosomia，followed by preterm birth〔5.4% （19/354）〕and low birth weight〔2.3% （8/354）〕. The incidence of adverse pregnancy outcomes was higher in women in late pregnancy with high AL（56.4%，31/116） than in women in late pregnancy with low AL（43.6%，24/238） （P<0.05）; the incidence of preterm birth （63.2%，12/116） and delivery of macrosomia （51.4%，18/116） was higher in women in late pregnancy with high AL than in women in late pregnancy with low AL（36.8%，7/238; 48.6%，17/238） （P<0.05）. Multivariate Logistic regression analysis showed that women in late pregnancy with high AL had a 2.465-fold increased risk of adverse pregnancy outcomes compared to women in late pregnancy with low AL〔95%CI （1.315，4.622），P<0.05〕. High AL level was a risk factor for preterm birth〔OR=4.832，95%CI （1.545，15.114）〕and delivery of macrosomia〔OR=2.868，95%CI （1.392，5.909）〕in women in late pregnancy compared to low AL level（P<0.05）. Conclusion High levels of AL in women in late pregnancy increase the risk of adverse pregnancy outcomes，especially the risk of preterm birth and delivery of macrosomia. Attention to AL in women during pregnancy should be enhanced to provide a theoretical basis for preventing adverse pregnancy outcomes and promoting maternal and infant health.
Hits
Hits
Downloads
Comment