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Depression, anxiety, stress and expression of 11β hydroxysteroid dehydrogenase-1 in placental membrane as a risk factor of preterm labor

Abstract

Introduction: Preterm birth is delivery that occurs prematurely, and is still a global problem because it is the largest contributor to perinatal mortality and neonatal morbidity, both in the short and long term. This study aims to investigate the role of psychosocial status, in the form of degrees of depression, anxiety, and stress in pregnant women as evidenced by the expression of the enzyme 11β Hydroxysteroid Dehydrogenase-1 (11β HSD-1) in amnion in relation to premature activation of maternal-fetal hypothalamic-pituitary-adrenal (HPA) axis as a risk factor of preterm labor.

Method: Case-control study, comparing preterm and term groups (n=54) who underwent labor in Obstetrics Emergency Room, Sanglah Central General Hospital Denpasar, Bali. The degree of depression, anxiety, and stress was assessed using the Depression, Anxiety, and Stress Score (DASS 42) questionnaire. Amnion expression of 11β HSD-1 was examined semi-quantitatively using immunohistochemistry methods. An independent T-test and Mann-Whitney test were performed. Cut off of 11β HSD-1 expression was determined using Receiver Operating Characteristic (ROC) curve. Bivariate analysis between labor status and degrees of depression, anxiety, and stress, as well as the expression of 11β HSD-1 with simple logistic regression test and multivariate analysis of all variables with multiple logistic regression test was used to estimate odds ratio (OR) and 95% confidence interval (95% CI).

Results: Depression (OR = 5.045; 95% CI = 1.302 – 19,559; p = 0.019) and stress (OR = 14.943; 95% CI = 1.860 – 120.064, p = 0,011) is a risk factor for preterm delivery. Whereas for the anxiety variable, there was no significant difference between the case and control groups in bivariate analysis (p = 0.125) with OR = 1.647; 95% CI = 0.870 – 3.117. Analysis of 11β-HSD-1 expression and preterm delivery showed a statistically significant difference between the case and control groups, with p = 0.013 (OR = 4.156; 95% CI = 1.312 – 13.169). Furthermore, in multivariate analysis showed that stress was statistically significant (p = 0.034) with OR = 11.354; 95% CI = 1.209 – 106.651 as a risk factor for preterm delivery.

Conclusion: The abnormal degree of depression and stress based on the DASS criteria and high expression of 11β-HSD-1 is a risk factor for preterm delivery.

References

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How to Cite

Parwin, Wiradnyana, A. A. G. P. ., Kusuma, A. A. N. J., Manuaba, I. B. G. F. ., Surya, I. G. N. H. W. ., & Marta, K. F. . (2022). Depression, anxiety, stress and expression of 11β hydroxysteroid dehydrogenase-1 in placental membrane as a risk factor of preterm labor. Bali Medical Journal, 11(2), 1077–1083. https://doi.org/10.15562/bmj.v11i2.3456

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Anak Agug Gede Putra Wiradnyana
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