Page 309 - Encyclopedia of Nursing Research

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• Plasticity of the hypothalamic–adrenal–
Maternal anxiety and pituitary axis through life, modifiable
Psychosocial adaPtation by the environment, to create hypervigi-
during norMal and lance to condition or kindle future stress
responses.
high-risk Pregnancy • Placental hormones (e.g., CRH).
Up-regulation of hormones by both mater-
nal and fetal cortisol correlate inversely
Pregnancy, with its joyful expectation, also with gestational length and parturition
is expected to be accompanied by some risk triggering.
to the life of the mother, baby, family, and • Neuroendocrine infection/inflammation
other children. The risks often extend on a of the maternal tract that occurs in 20%
continuum and are well documented from to 30% of PTB (McLean et al., 1995; Rich-
pregnancy throughout life; these elements Edwards & Grizzard, 2005; Teixteira,
are documented below by Rich-Edwards Fisk, & Glover, 2003; Warren, Patrick, &
and Grizzard (2005). The psychosocial and Goland, 1992).
psychophysical factors identified with high-
risk pregnancy and preterm birth (PTB) are Publications prepared by Behrman
thought to be interrelated in a host of ways: and Butler (2007) and review panels on the
prevention of PTB by the U.S. Office of the
• Psychosocial stressors: low income and Surgeon General and the Eunice Kennedy
education, lack of a partner, and minority Shriver National Institute of Child Health
status. Behavioral and physical factors may and Human Development (2008) made sev-
further complicate maternal risk status. eral novel recommendations for research
• “Weathering”: sharp age-related risk of on the assessment of PTB risk factors and
poor pregnancy outcomes in black high- personalized, specific interventions for pre-
risk mothers and those with low socioeco- vention. Many recommendations imply a
nomic factors and neighborhood poverty. significant nursing role in psychosocial nor-
• Chronic stress: long-term poverty, racism, mal and high-risk assessment and interven-
and lack of neighborhood safety so that tion. Emphasis is placed on assessment of
the reproductive axis may be vulnerable pregnancy-specific anxiety, and on assess-
to chronic stress. ment/intervention methods that focus on
• Maternal endocrine and immune systems family system methodologies that include
already predisposed to chronic stressors the father/partner, spouse, couple, and other
before conception, which may create vul- family members.
nerabilities to pregnancy complications Although the surgeons general’s con-
and preterm delivery. ference covered several pertinent topics,
• Neuroendocrine pathways between this entry focuses on those with particu-
chronic stress and PTB are exemplified by lar relevance to nursing practice, education,
the “weathering” hypothesis, altering neu- and research. Topics that appear to be
roendocrine mechanisms risks for PTB. of particular importance to nursing are