The primary goal of the current study was to examine the association between maternal distress during pregnancy, conceptualized as stress, anxiety, and depression, and infant reproductive outcomes. It was hypothesized that women who report high levels of distress during pregnancy would be more likely to experience adverse reproductive outcomes. An additional goal of the study was to examine the hypothesis that social support and coping style moderate the association between prenatal maternal distress and birth outcomes. This study utilized a prospective, longitudinal design. Pregnant women (N = 257) completed self-report questionnaires and clinical interviews at two time points during pregnancy. Following delivery, birth weight, week of delivery, head circumference, and Apgar score were extracted from medical records. Results suggested that women who were clinically depressed during pregnancy were more likely to experience adverse birth outcomes. In addition, maternal stress, anxiety, and depression were best conceptualized as one general "distress" factor, which did not predict variance in birth outcomes over and above demographic variables. However, when self-report measures were considered individually, they decreased over the course of pregnancy, and were associated with birth outcomes, particularly at time 2. Significant interactions between maternal distress and social support, as well as maternal distress and coping emerged as predictors of birth outcomes. Results suggest that women with high levels of stress, who also have small support networks, are at higher risk of adverse birth outcomes than women with large networks, who were relatively insulated from effects of higher distress. This study points to the need for ongoing assessment of maternal distress and resources throughout pregnancy, such that women at risk for adverse birth outcomes can be identified and supported as soon as possible.

Made available in DSpace on 2014-06-11T19:29:51Z (GMT). No. of bitstreams: 0 Previous issue date: 2011-02-21Bitstream added on 2014-06-13T19:39:22Z : No. of bitstreams: 1 moreli_jb_me_botfm.pdf: 522780 bytes, checksum: f823279b232bbcd45aa94cb502231c63 (MD5) / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) / Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP) / O objetivo dessa revisão foi explorar a literatura sobre a atuação das citocinas IL-10 e TNF-α na gestação, destacando aspectos de interesse para a clínica obstétrica. A literatura disponível destaca várias funções da IL-10 e do TNF-α na gestação. Via de regra, estas citocinas desempenham papéis antagônicos e dependentes do balanço entre elas, condição que é orquestrada pela função imunomoduladora específica da IL-10. O TNF-α tem ação de característica inflamatória, sendo relacionado a perdas fetais recorrentes, síndromes hipertensivas, restrição do crescimento fetal e diabete melito gestacional. Entretanto, os resultados ainda são controversos e não completamente definidos. Tais conflitos são atribuídos à heterogeneidade dos estudos, principalmente relacionada à natureza, ao tamanho amostral, aos métodos de avaliação e à multiplicidade de fatores e condições que influenciam a produção das citocinas. Estas questões são fundamentais e devem ser consideradas em futuras investigações para que resultados mais consistentes possam nortear a prática obstétrica / The purpose of this work was to review the literature concerning the action of cytokines IL-10 and TNF-a in pregnancy, giving emphasis to aspects of interest to clinical obstetrics. The literature available highlights several IL-10 and TNF-a actions in pregnancy. These cytokines usually play balance-dependent opposing roles orchestrated by the IL-10-specific immunomodulatory function. TNF-a action is characteristically inflammatory and has been associated with recurrent fetal loss, hypertensive syndromes, fetal growth restriction and gestational diabetes mellitus. However, study results are controversial and remain not clearly defined. These conflicts are attributed to the heterogeneity of the studies, particularly regarding sample nature and size, evaluation methods, and the multiplicity of factors and conditions that influence cytokine production. These questions are fundamental, and should be addressed in future investigations so that more consistent results can be obtained and applied to obstetric practice

Resumo: O objetivo dessa revisão foi explorar a literatura sobre a atuação das citocinas IL-10 e TNF-α na gestação, destacando aspectos de interesse para a clínica obstétrica. A literatura disponível destaca várias funções da IL-10 e do TNF-α na gestação. Via de regra, estas citocinas desempenham papéis antagônicos e dependentes do balanço entre elas, condição que é orquestrada pela função imunomoduladora específica da IL-10. O TNF-α tem ação de característica inflamatória, sendo relacionado a perdas fetais recorrentes, síndromes hipertensivas, restrição do crescimento fetal e diabete melito gestacional. Entretanto, os resultados ainda são controversos e não completamente definidos. Tais conflitos são atribuídos à heterogeneidade dos estudos, principalmente relacionada à natureza, ao tamanho amostral, aos métodos de avaliação e à multiplicidade de fatores e condições que influenciam a produção das citocinas. Estas questões são fundamentais e devem ser consideradas em futuras investigações para que resultados mais consistentes possam nortear a prática obstétrica / Abstract: The purpose of this work was to review the literature concerning the action of cytokines IL-10 and TNF-a in pregnancy, giving emphasis to aspects of interest to clinical obstetrics. The literature available highlights several IL-10 and TNF-a actions in pregnancy. These cytokines usually play balance-dependent opposing roles orchestrated by the IL-10-specific immunomodulatory function. TNF-a action is characteristically inflammatory and has been associated with recurrent fetal loss, hypertensive syndromes, fetal growth restriction and gestational diabetes mellitus. However, study results are controversial and remain not clearly defined. These conflicts are attributed to the heterogeneity of the studies, particularly regarding sample nature and size, evaluation methods, and the multiplicity of factors and conditions that influence cytokine production. These questions are fundamental, and should be addressed in future investigations so that more consistent results can be obtained and applied to obstetric practice / Orientador: Iracema de Mattos Paranhos Calderon / Coorientador: Débora Cristina Damasceno / Banca: Marilza Vieira Cunha Rudge / Banca: Estela Bevilacqua / Mestre