Richard G. Künzel , Merna Elgazzar , Paul A. Bain , Clemens Kirschbaum , Stefania Papatheodorou , Bizu Gelaye
{"title":"母体产前毛发皮质醇浓度与早产之间的关系:系统回顾和荟萃分析","authors":"Richard G. Künzel , Merna Elgazzar , Paul A. Bain , Clemens Kirschbaum , Stefania Papatheodorou , Bizu Gelaye","doi":"10.1016/j.psyneuen.2024.107041","DOIUrl":null,"url":null,"abstract":"<div><h3>Background</h3><p>The risk of preterm birth (PTB) increases when experiencing stress during pregnancy. Chronic stress has been associated with a dysregulation of the hypothalamic-pituitary-adrenal axis, for which hair cortisol concentration (HCC) is a promising biomarker. However, previous studies on the association between HCC and PTB yielded inconsistent results. This systematic review and meta-analysis synthesized previous studies on the association between maternal HCC before and during pregnancy and spontaneous PTB.</p></div><div><h3>Methods</h3><p>Data was extracted from <em>N</em> = 11 studies with <em>k</em> = 19 effect sizes retrieved from PubMed, Embase, Web of Science, CINAHL and citation searching by hand in June 2023 and updated in October 2023. Standardized mean differences were calculated, and a random-effects three-level meta-analysis was conducted. Effect heterogeneity was assessed using Q and I<sup>2</sup>.</p></div><div><h3>Results</h3><p>HCC during pregnancy was higher among PTB than term groups, but effects were not statistically significant (<em>z</em> = 0.11, 95% CI: − 0.28, 0.51, <em>p</em> = .54) and total heterogeneity was high (Q<sub>16</sub> = 60.01, <em>p</em> < .001, I<sup>2</sup><sub>Total</sub> = 92.30%). After leaving out two possible outlier studies in sensitivity analyses, HCC was lower among preterm compared to term delivering groups, although not statistically significant (<em>z</em> = − 0.06, 95% CI: − 0.20, 0.08, <em>p</em> = .39) but with a substantially reduced total heterogeneity (Q<sub>12</sub> = 16.45, <em>p</em> = .17, I<sup>2</sup><sub>Total</sub> = 42.15%). No moderators affected the estimates significantly, but an effect of trimester and gestational age at delivery is likely.</p></div><div><h3>Conclusion</h3><p>There is currently no evidence of prenatal HCC differences between PTB and term groups as effects were small, imprecise, and not significant. Low statistical power and methodological weaknesses of the small-scale studies challenge possible biological inferences from the small effects, but further research on HCC during pregnancy is highly encouraged.</p></div>","PeriodicalId":20836,"journal":{"name":"Psychoneuroendocrinology","volume":null,"pages":null},"PeriodicalIF":3.4000,"publicationDate":"2024-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"The association between maternal prenatal hair cortisol concentration and preterm birth: A systematic review and meta-analysis\",\"authors\":\"Richard G. Künzel , Merna Elgazzar , Paul A. Bain , Clemens Kirschbaum , Stefania Papatheodorou , Bizu Gelaye\",\"doi\":\"10.1016/j.psyneuen.2024.107041\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div><h3>Background</h3><p>The risk of preterm birth (PTB) increases when experiencing stress during pregnancy. Chronic stress has been associated with a dysregulation of the hypothalamic-pituitary-adrenal axis, for which hair cortisol concentration (HCC) is a promising biomarker. However, previous studies on the association between HCC and PTB yielded inconsistent results. This systematic review and meta-analysis synthesized previous studies on the association between maternal HCC before and during pregnancy and spontaneous PTB.</p></div><div><h3>Methods</h3><p>Data was extracted from <em>N</em> = 11 studies with <em>k</em> = 19 effect sizes retrieved from PubMed, Embase, Web of Science, CINAHL and citation searching by hand in June 2023 and updated in October 2023. Standardized mean differences were calculated, and a random-effects three-level meta-analysis was conducted. Effect heterogeneity was assessed using Q and I<sup>2</sup>.</p></div><div><h3>Results</h3><p>HCC during pregnancy was higher among PTB than term groups, but effects were not statistically significant (<em>z</em> = 0.11, 95% CI: − 0.28, 0.51, <em>p</em> = .54) and total heterogeneity was high (Q<sub>16</sub> = 60.01, <em>p</em> < .001, I<sup>2</sup><sub>Total</sub> = 92.30%). After leaving out two possible outlier studies in sensitivity analyses, HCC was lower among preterm compared to term delivering groups, although not statistically significant (<em>z</em> = − 0.06, 95% CI: − 0.20, 0.08, <em>p</em> = .39) but with a substantially reduced total heterogeneity (Q<sub>12</sub> = 16.45, <em>p</em> = .17, I<sup>2</sup><sub>Total</sub> = 42.15%). No moderators affected the estimates significantly, but an effect of trimester and gestational age at delivery is likely.</p></div><div><h3>Conclusion</h3><p>There is currently no evidence of prenatal HCC differences between PTB and term groups as effects were small, imprecise, and not significant. Low statistical power and methodological weaknesses of the small-scale studies challenge possible biological inferences from the small effects, but further research on HCC during pregnancy is highly encouraged.</p></div>\",\"PeriodicalId\":20836,\"journal\":{\"name\":\"Psychoneuroendocrinology\",\"volume\":null,\"pages\":null},\"PeriodicalIF\":3.4000,\"publicationDate\":\"2024-04-03\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Psychoneuroendocrinology\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://www.sciencedirect.com/science/article/pii/S0306453024000854\",\"RegionNum\":2,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q2\",\"JCRName\":\"ENDOCRINOLOGY & METABOLISM\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Psychoneuroendocrinology","FirstCategoryId":"3","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S0306453024000854","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"ENDOCRINOLOGY & METABOLISM","Score":null,"Total":0}
The association between maternal prenatal hair cortisol concentration and preterm birth: A systematic review and meta-analysis
Background
The risk of preterm birth (PTB) increases when experiencing stress during pregnancy. Chronic stress has been associated with a dysregulation of the hypothalamic-pituitary-adrenal axis, for which hair cortisol concentration (HCC) is a promising biomarker. However, previous studies on the association between HCC and PTB yielded inconsistent results. This systematic review and meta-analysis synthesized previous studies on the association between maternal HCC before and during pregnancy and spontaneous PTB.
Methods
Data was extracted from N = 11 studies with k = 19 effect sizes retrieved from PubMed, Embase, Web of Science, CINAHL and citation searching by hand in June 2023 and updated in October 2023. Standardized mean differences were calculated, and a random-effects three-level meta-analysis was conducted. Effect heterogeneity was assessed using Q and I2.
Results
HCC during pregnancy was higher among PTB than term groups, but effects were not statistically significant (z = 0.11, 95% CI: − 0.28, 0.51, p = .54) and total heterogeneity was high (Q16 = 60.01, p < .001, I2Total = 92.30%). After leaving out two possible outlier studies in sensitivity analyses, HCC was lower among preterm compared to term delivering groups, although not statistically significant (z = − 0.06, 95% CI: − 0.20, 0.08, p = .39) but with a substantially reduced total heterogeneity (Q12 = 16.45, p = .17, I2Total = 42.15%). No moderators affected the estimates significantly, but an effect of trimester and gestational age at delivery is likely.
Conclusion
There is currently no evidence of prenatal HCC differences between PTB and term groups as effects were small, imprecise, and not significant. Low statistical power and methodological weaknesses of the small-scale studies challenge possible biological inferences from the small effects, but further research on HCC during pregnancy is highly encouraged.
期刊介绍:
Psychoneuroendocrinology publishes papers dealing with the interrelated disciplines of psychology, neurobiology, endocrinology, immunology, neurology, and psychiatry, with an emphasis on multidisciplinary studies aiming at integrating these disciplines in terms of either basic research or clinical implications. One of the main goals is to understand how a variety of psychobiological factors interact in the expression of the stress response as it relates to the development and/or maintenance of neuropsychiatric illnesses.