Efectos del acompañamiento prenatal sobre el estrés percibido y la respuesta inmune en el posparto: Un estudio transversal en Uruguay
Palabras clave:
Estrés subjetivo, Entorno del parto, Anticuerpos
Resumen
Objetivo: El objetivo de este estudio fue analizar la influencia de la participación en CPN sobre el estrés percibido y los niveles de IgA salival durante el puerperio inmediato. Material y métodos: Se realizó un estudio transversal en una institución privada de salud en Uruguay, que incluyó a 84 mujeres en el puerperio inmediato. Se aplicaron las escalas de estrés percibido PSS-10 y PSS-14, y se recolectaron muestras de saliva para la cuantificación de IgA mediante test de ELISA indirecto. Resultados: La participación en CPN se asoció con niveles moderadamente inferiores de estrés percibido (p=0,0216 para PSS-10 y p=0,0221 para PSS-14), aunque no se observaron diferencias significativas en las concentraciones de IgA entre grupos. No obstante, se evidenció una tendencia a la disminución de IgA en presencia de niveles elevados de estrés, efecto que resultó menos pronunciado en mujeres que asistieron a CPN. Conclusiones: Estos hallazgos sugieren que las CPN podrían desempeñar un papel protector indirecto al mitigar el impacto del estrés sobre la inmunidad materna durante el puerperio.
Citas
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Jiang Y, Zilioli S, Rodriguez-Stanley J, Peek KM, Cutchin MP. Socioeconomic status and differential psychological and immune responses to a human-caused disaster. Brain, Behavior, and Immunity. agosto de 2020;88:935-9.
Algren MH, Ekholm O, Nielsen L, Ersbøll AK, Bak CK, Andersen PT. Associations between perceived stress, socioeconomic status, and health-risk behaviour in deprived neighbourhoods in Denmark: a cross-sectional study. BMC Public Health. diciembre de 2018;18(1):250.
Vancampfort D, Koyanagi A, Ward PB, Veronese N, Carvalho AF, Solmi M, et al. Perceived Stress and Its Relationship With Chronic Medical Conditions and Multimorbidity Among 229,293 Community-Dwelling Adults in 44 Low- and Middle-Income Countries. American Journal of Epidemiology. 15 de octubre de 2017;186(8):979-89.
Mak TW, Saunders ME. Mucosal and cutaneous immunity. En: The Immune Response [Internet]. San Diego: Elsevier; 2006. p. 583-609.
Eddy P, Heckenberg R, Wertheim EH, Kent S, Wright BJ. A systematic review and meta-analysis of the effort-reward imbalance model of workplace stress with indicators of immune function. Journal of Psychosomatic Research. diciembre de 2016;91:1-8.
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Alotiby A. Immunology of stress: a review article. J Clin Med. 2024;13:6394.
Khandre V, Potdar J, Keerti A. Preterm birth: an overview. Cureus [Internet]. 2022.
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Herrmann M, Schölmerich J, Straub RH. STRESS AND RHEUMATIC DISEASES. Rheumatic Disease Clinics of North America. noviembre de 2000;26(4):737-63.
Rhen T, Cidlowski JA. Antiinflammatory Action of Glucocorticoids — New Mechanisms for Old Drugs. N Engl J Med. 20 de octubre de 2005;353(16):1711-23.
Koolhaas JM, De Boer SF, Coppens CM, Buwalda B. Neuroendocrinology of coping styles: Towards understanding the biology of individual variation. Frontiers in Neuroendocrinology. julio de 2010;31(3):307-21.
Segerstrom SC, Miller GE. Psychological Stress and the Human Immune System: A Meta-Analytic Study of 30 Years of Inquiry. Psychological Bulletin. 2004;130(4):601-30.
Sousa N. The dynamics of the stress neuromatrix. Mol Psychiatry. marzo de 2016;21(3):302-12.
Dhabhar FS, Mcewen BS. Acute Stress Enhances while Chronic Stress Suppresses Cell-Mediated Immunityin Vivo:A Potential Role for Leukocyte Trafficking. Brain, Behavior, and Immunity. diciembre de 1997;11(4):286-306.
Dhabhar FS. Enhancing versus Suppressive Effects of Stress on Immune Function: Implications for Immunoprotection and Immunopathology. Neuroimmunomodulation. 2009;16(5):300-17.
Isowa T, Ohira H, Murashima S. Reactivity of immune, endocrine and cardiovascular parameters to active and passive acute stress. Biological Psychology. enero de 2004;65(2):101-20.
Takatsuji K, Sugimoto Y, Ishizaki S, Ozaki Y, Matsuyama E, Yamaguchi Y. The effects of examination stress on salivary cortisol, immunoglobulin A, and chromogranin A in nursing students. Biomed Res. 2008;29(4):221-4.
Engeland CG, Hugo FN, Hilgert JB, Nascimento GG, Junges R, Lim HJ, et al. Psychological distress and salivary secretory immunity. Brain, Behavior, and Immunity. febrero de 2016;52:11-7.
Welch TR. 50 Years Ago in T J P. The Journal of Pediatrics. enero de 2018;192:104.
da Silva Campos MJ, Souza Alves CC, Barbosa Raposo NR, Ferreira AP, Farinazzo Vitral RW. Influence of salivary secretory immunoglobulin A level on the pain experienced by orthodontic patients. Med Sci Monit. septiembre de 2010;16(9):CR405-409.
Grande LA, Olsavsky AK, Erhart A, Dufford AJ, Tribble R, Phan KL, et al. Postpartum Stress and Neural Regulation of Emotion among First-Time Mothers. Cogn Affect Behav Neurosci. octubre de 2021;21(5):1066-82.
Bennett A, Kearney J. Factors Associated with Maternal Wellbeing at Four Months Post-Partum in Ireland. Nutrients. 14 de mayo de 2018;10(5):609.
Groer MW, Davis MW, Hemphill J. Postpartum Stress: Current Concepts and the Possible Protective Role of Breastfeeding. Journal of Obstetric, Gynecologic & Neonatal Nursing. mayo de 2002;31(4):411-7.
Biaggi A, Conroy S, Pawlby S, Pariante CM. Identifying the women at risk of antenatal anxiety and depression: A systematic review. Journal of Affective Disorders. febrero de 2016;191:62-77.
Smith MV, Shao L, Howell H, Lin H, Yonkers KA. Perinatal Depression and Birth Outcomes in a Healthy Start Project. Matern Child Health J. abril de 2011;15(3):401-9.
Leppert B, Junge KM, Röder S, Borte M, Stangl GI, Wright RJ, et al. Early maternal perceived stress and children’s BMI: longitudinal impact and influencing factors. BMC Public Health. diciembre de 2018;18(1):1211.
Razurel C, Kaiser B, Sellenet C, Epiney M. Relation Between Perceived Stress, Social Support, and Coping Strategies and Maternal Well-Being: A Review of the Literature. Women & Health. enero de 2013;53(1):74-99.
Nolan ML, Hicks C. Aims, processes and problems of antenatal education as identified by three groups of childbirth teachers. Midwifery. diciembre de 1997;13(4):179-88.
Barimani M, Forslund Frykedal K, Rosander M, Berlin A. Childbirth and parenting preparation in antenatal classes. Midwifery. febrero de 2018;57:1-7.
Rouhe H, Salmela‐Aro K, Toivanen R, Tokola M, Halmesmäki E, Saisto T. Obstetric outcome after intervention for severe fear of childbirth in nulliparous women – randomised trial. BJOG. enero de 2013;120(1):75-84.
Saisto T, Toivanen R, Salmela‐Aro K, Halmesmäki E. Therapeutic group psychoeducation and relaxation in treating fear of childbirth. Acta Obstet Gynecol Scand. noviembre de 2006;85(11):1315-9.
Lu MC, Prentice J, Yu SM, Inkelas M, Lange LO, Halfon N. Childbirth Education Classes: Sociodemographic Disparities in Attendance and the Association of Attendance with Breastfeeding Initiation. Matern Child Health J. junio de 2003;7(2):87-93.
Mueller CG, Webb PJ, Morgan S. The Effects of Childbirth Education on Maternity Outcomes and Maternal Satisfaction. J Perinat Educ. 1 de enero de 2020;29(1):16-22.
Gluck O, Pinchas‐Cohen T, Hiaev Z, Rubinstein H, Bar J, Kovo M. The impact of childbirth education classes on delivery outcome. Intl J Gynecology & Obste. marzo de 2020;148(3):300-4.
Elm EV, Altman DG, Egger M, Pocock SJ, Gøtzsche PC, Vandenbroucke JP. Strengthening the reporting of observational studies in epidemiology (STROBE) statement: guidelines for reporting observational studies. BMJ. 20 de octubre de 2007;335(7624):806-8.
Calvo JJ, Borrás V, Cabella W, Carrasco P, Hugo D los C, Koolhaas M, et al. Atlas sociodemográfico y de la desigualdad del Uruguay: Las necesidades básicas insatisfechas a partir de los Censos 2011 [Internet]. 1.a ed. Ediciones Trilce; 2013. 78 p.
Cohen S, Kamarck T, Mermelstein R. A Global Measure of Perceived Stress. Journal of Health and Social Behavior. diciembre de 1983;24(4):385.
Cohen S. Perceived stress in a probability sample of the United States. En: The social psychology of health. Thousand Oaks, CA, US: Sage Publications, Inc; 1988. p. 31-67. (The Claremont Symposium on Applied Social Psychology.).
Yokokura AVCP, Silva AAMD, Fernandes JDKB, Del-Ben CM, Figueiredo FPD, Barbieri MA, et al. Perceived Stress Scale: confirmatory factor analysis of the PSS14 and PSS10 versions in two samples of pregnant women from the BRISA cohort. Cad Saúde Pública [Internet]. 2017;33(12).
Shorey S, Chan SWC, Chong YS, He H. A randomized controlled trial of the effectiveness of a postnatal psychoeducation programme on self‐efficacy, social support and postnatal depression among primiparas. Journal of Advanced Nursing. junio de 2015;71(6):1260-73.
Kozinszky Z, Dudas RB, Devosa I, Csatordai S, Tóth É, Szabó D, et al. Can a Brief Antepartum Preventive Group Intervention Help Reduce Postpartum Depressive Symptomatology? Psychother Psychosom. 2012;81(2):98-107.
Prabhu S, George LS, Guruvare S, Noronha JA, Jose TT, Nayak BS, et al. Effectiveness of psychosocial education program on postnatal depression, stress, and perceived maternal parenting self-efficacy among pregnant women in South India. Patient Education and Counseling. enero de 2025;130:108458.
Jiang Y, Zilioli S, Rodriguez-Stanley J, Peek KM, Cutchin MP. Socioeconomic status and differential psychological and immune responses to a human-caused disaster. Brain, Behavior, and Immunity. agosto de 2020;88:935-9.
Algren MH, Ekholm O, Nielsen L, Ersbøll AK, Bak CK, Andersen PT. Associations between perceived stress, socioeconomic status, and health-risk behaviour in deprived neighbourhoods in Denmark: a cross-sectional study. BMC Public Health. diciembre de 2018;18(1):250.
Vancampfort D, Koyanagi A, Ward PB, Veronese N, Carvalho AF, Solmi M, et al. Perceived Stress and Its Relationship With Chronic Medical Conditions and Multimorbidity Among 229,293 Community-Dwelling Adults in 44 Low- and Middle-Income Countries. American Journal of Epidemiology. 15 de octubre de 2017;186(8):979-89.
Mak TW, Saunders ME. Mucosal and cutaneous immunity. En: The Immune Response [Internet]. San Diego: Elsevier; 2006. p. 583-609.
Eddy P, Heckenberg R, Wertheim EH, Kent S, Wright BJ. A systematic review and meta-analysis of the effort-reward imbalance model of workplace stress with indicators of immune function. Journal of Psychosomatic Research. diciembre de 2016;91:1-8.
Seizer L, Stasielowicz L, Löchner J. Timing matters: A meta-analysis on the dynamic effect of stress on salivary immunoglobulin. Brain, Behavior, and Immunity. julio de 2024;119:734-40.
Alotiby A. Immunology of stress: a review article. J Clin Med. 2024;13:6394.
Khandre V, Potdar J, Keerti A. Preterm birth: an overview. Cureus [Internet]. 2022.
the GAPPS Review Group, Barros FC, Bhutta ZA, Batra M, Hansen TN, Victora CG, et al. Global report on preterm birth and stillbirth (3 of 7): evidence for effectiveness of interventions. BMC Pregnancy Childbirth. febrero de 2010;10(S1):S3.
Hueston W, Knox M, Eilers G, Pauwels J, Lonsdorf D. The effectiveness of pretermbirth prevention educational programs for high-risk women: A meta-analysis. Obstetrics & Gynecology. octubre de 1995;86(4):705-12.
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2025-11-20
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