原 著
*1 Fauculty of Health and Welfare, Prefectural University of Hiroshima *2 Graduate School of Health Sciences, Hiroshima University
Received 10 March 2008; accept 4 November 2008
Original article
A longitudinal study of changes in salivary sIgA during
pregnancy and the puerperal period, focusing on differences
between vaginal birth and cesarean section
Chie SHITAMI
*1, Masao TAMARU
*1Kazuko TAKENAKA
*2, Yoshito TANAKA
*2 AbstractObjective
It is known that the concentration of salivary secretory IgA (sIgA), which is a local immunity, changes accord-ing to different levels of stress. In previous research, it has been reported that there are changes in the concentra-tion of salivary sIgA due to exercise load and psychological stress, but there is not much data about pregnant and puerperal women. The objective of this research is to collect longitudinal and basic data about the salivary sIgA concentration from the time of pregnancy to the puerperal period, and to compare stress levels of Cesarean section delivery with those of vaginal delivery.
Method
The salivary sIgA concentration was measured using the enzyme immunoassay (EIA) against 61 healthy preg-nant women (of whom 19 had decided on scheduled Caesarean deliveries, and 42 on vaginal deliveries. Saliva samples were taken three times: during pregnancy, directly after delivery, and during the puerperal period. The sub-jects were also asked to complete a "Profile of Moods States" (POMS). The ages of the subsub-jects, parous experience, duration of labor, blood loss, and gestational age were also noted, as physical factors.
Results
1) There was a large individual difference in the salivary sIgA, between subjects but a rather strong positive correlation (P<.01) was seen in the longitudinal changes in the sIgA concentration (during pregnancy, directly after delivery, and in the puerperal period). 2) In the vaginal delivery group, there was no change in the sIgA concentra-tion between the pregnancy period and directly after the delivery, but there was an increase in the puerperal period (P<.01). 3) However, the salivary sIgA, directly after delivery were significant higher than that in during pregnancy and puerperal period in subjects who received Cesarean section (P<.0001). 4) There were no significant differences in the sIgA concentration due to physical factors such as parous experience, duration of labor, blood-loss during delivery, age and gestational age. 5) The POMS scores changed during pregnancy, directly after delivery and in the puerperal period, but did not have any relationship with the sIgA concentration.
Conclusions
Depending on the method of delivery, it can be understood that the changes in the sIgA concentration during pregnancy and the puerperal period have different dynamics. These findings suggest that directly after delivery Cesarean section group mothers were under a lot of stress by comparison with the vaginal birth group. However, in view of the marked increase in the sIgA concentration in the Cesarean section group, it is also possible that other variables apart from stress (such as the influence of anesthetics) may affect the sIgA values. There is a need to consider particular factors linked to method of delivery when evaluating levels of stress during pregnancy and the puerperal period.
A longitudinal study of changes in salivary sIgA during pregnancy and the puerperal period, focusing on differences between vaginal birth and cesarean section
I. Introduction
It is known that there are changes in the concen-tration of salivary secretory IgA (sIgA) depending on stress levels. Research up to now has given consider-ation from both the physical and psychological sides, and there has been a report on changes in sIgA due to exercise load (McDowell et al., 1992a), and psychologi-cal stress (Yajima et al., 2002). With regard to physipsychologi-cal stress, testing shows that high levels of exercise load, such as swimming, running, and using a treadmill re-duce the sIgA concentration (McDowell et al., 1992b; Akimoto et al., 1998). Also, with psychological stress, it has been reported (Farne et al., 1992) that the sIgA con-centration has a negative correlation with stress, as can be seen with lower levels of sIgA when there are more daily hassles, and with students during their examina-tion periods (Jemmott et al., 1988). Also, not only does stress cause the sIgA to drop, but there are also reports of stress causing it to increase (Yamada et al., 1995). In these ways, the levels of physical and psychological stresses are reflected in the salivary sIgA concentration. And all the research shows that there is an extreme dif-ference in individual levels of sIgA.
With regard to pregnant and puerperal woman, there are reports about the salivary sIgA concentration while giving birth (Shitami, 2004; Shitami, 2007), and reports about during pregnancy and the puerperal period (Widerstrom & Bratthall, 1984; Annie & Groer, 1991), but there is only a very limited number of reports that give longitudinal analysis. Parturition, whether by ce-sarean section or vaginal delivery, is a stressful event for women. Annie and Groer (1991) reported childbirth stress as measured by salivary sIgA concentrations from samples taken from subjects within one to two hours af-ter childbirth and found that salivary sIgA dropped afaf-ter giving birth. In the early postpartum period, depressive tendency are likely to occur in mothers, which may be related to psychological stress. It is therefore useful to investigate whether salivary sIgA levels at parturition and postpartum change from baseline values during pregnancy.
The major purpose of this research is to obtain basic and longitudinal data with regard to the salivary
sIgA concentration during pregnancy and the puerperal period, and to compare stress levels of Cesarean section delivery with those of vaginal delivery. An additional purpose is to determine what factors cause changes in the salivary sIgA concentration during pregnancy and the puerperal period, analyzing data concerning both physical and psychological aspects.
II. Research method
1. Subjects
With the cooperation of two facilities (one clinic and one hospital), the subjects were women who were planning to give birth. The survey period was from July 2005 to August 2006. The subjects were 68 healthy preg-nant women, who did not have any complications during their pregnancies, such as pregnancy induced hyperten-sion or diabetes. Of these, 21 had decided on scheduled Caesarean section ("CS") deliveries, but there were no emergency CS deliveries. 47 of the subjects made it to vaginal deliveries. Subject salivary sIgA data was ana-lyzed by exploratory data analysis, then the cases which were regarded as abnormal values were excluded from this study. Therefore, the final study sample was 61 subjects (19 who had decided CS and 42 who made it to vaginal deliveries).
These were all full-term deliveries. Differences between the vaginal subjects and the CS subjects were found in the influencing factors "age," "gestational age," and "blood loss during delivery" (Table 1).
2. Survey method
1) Saliva collection periods
Saliva was collected three times: during pregnancy, directly after delivery, and during the puerperal period.
As shown in Table 1, the sample taken during preg-nancy was during the last stage of pregpreg-nancy. With the sample taken directly after delivery, the aim was to take the sample two hours after, and the actual average time for vaginal subjects was 2.4 hours (range 2 to 5), and for CS subjects 3.0 hours (range 2 to 5). During the puer-peral period, the sample was taken on the third day.
2) Saliva collection method
A sterilized swab (salivette manufactured by SARSTEDT Co.) was used for collecting the saliva samples. The collected samples were immediately fro-zen and maintained at -85 degrees Celsius until the sIgA measurements were made.
3) Analysis according to psychological measure
Physical and psychological conditions are reflected in the sIgA concentration. Therefore, Profile of Moods States (POMS) was used (McNair et al., 1992) to under-stand the psychological conditions of the subjects. The subjects were asked to fill out these questionnaires at the same time as the samples were collected. POMS is able to measure temporary feelings and psychological conditions depending on the conditions of the subjects. A reduced version of POMS was made, to lighten the burden on the subjects, by omitting 30 of the 65 items. The credibility and suitability of this measurement has been verified, for the evaluation of six types of feelings: tension-anxiety (T-A), depression-dejection (D), anger-hostility (A-H), vigor (V), fatigue (F), and confusion (C).
3. Analytical method
1) Determination of the sIgA concentration
After the samples were thawed at room tempera-ture, they were treated by centrifugation (at four degrees Celsius, and at 12,000 rpm for 15 minutes), and the sIgA concentration was determined using the enzyme immu-noassay kit (the EIA s-IgA test manufactured by MBL).
2) Statistical processing
Because the sIgA data did not have a normal dis-tribution, the Friedman test was used for the time-series analysis, the Wilcoxon signed rank test for the later mul-tiple comparisons, and Bonferroni's inequality was used to make corrections. Also, the Spearman rank correla-tion coefficient was used to pursue correlative relacorrela-tion- relation-ship, and for the comparison between two groups, the Mann-Whitney test was used.
Three types of measurements were used for POMS: one-way analysis of variance (corresponding factors) for longitudinal data obtained from the repeat measure-ments; Bonferroni test for the later multiple comparison; and t-test for comparison between two groups.
SPSS was used for all the statistical analysis at the 5% significance level.
4. Ethical consideration
With regard to the pregnant subjects, the objec-tives and methods used in the research were conveyed both orally and in writing, and consents were received in writing. Advance approval was also received from the Ethical Committee of the Graduate School of Health Sciences, Hiroshima University (Approval Number 101), before the research was undertaken.
III. Results
1. Concentration of salivary sIgA 1) Longitudinal changes (Table 2)
In the vaginal group, there was no change in the sIgA concentration from the time of pregnancy to
di-P-values primipara
(n=25) multipara(n=17) primipara(n=7) multipara(n=12)
Age (in years) 28.8 (±3.8) 31.4 (±5.4) <.05
Length of pregnancy (day) 277.1 (±5.5) 267.3 (±6.9) <.001
Duration of labor (hour) 7.7 (±5.9) – –
Amount of bleeding during labor(g) 193.2 (±123.3) 632.2 (±600.9) <.001
Time of Sampling during pregnacy (day) 259.3 (±8.6) 259.4 (±11.1) ns
Birth weight (g) 3012.7 (±379.3) 2862.2 (±254.5) ns
Apgar score (1min) 9 or 10 8~10 ns
A longitudinal study of changes in salivary sIgA during pregnancy and the puerperal period, focusing on differences between vaginal birth and cesarean section
rectly after birth, although there was an increase on the third day in the puerperal period (P<.01). On the other hand, with the CS subjects, there was a notable increase (P<.0001) directly after delivery, but during the puer-peral period the level returned to the same level as it was during pregnancy (P<.0001). The range for both types of delivery and all the saliva collection periods were very large, which means there was a large individual difference in the sIgA concentration between subjects. With both types of delivery, there was no significant dif-ference in the sIgA concentration between the primipara and the multipara subjects. Also, a significant positive correlation (r=.51~.63, P<.01) was seen with changes in the longitudinal concentration values (during pregnancy, directly after delivery, and in the puerperal period.
2) Comparison between vaginal and CS deliveries
(Figure 1)
At the puerperal period, there was no difference in the salivary sIgA concentration between the vaginal subjects and the CS subjects, but the sIgA concentration during pregnancy and directly after delivery became higher in the CS subjects compared to the vaginal sub-jects (P<.01). The dynamics of changes in the sIgA were very different depending on whether or not the deliver-ies were vaginal or CS.
The variables that showed differences depending on the method of delivery were "age," "gestational age" and "amount of blood loss during delivery." The results of analyses of the correlation between these variables and the sIgA concentration showed negative correla-tions between the sIgA directly after delivery and the gestational age (r= -.40, P<.01).
Table 2 Salivary sIgA consentrations by delivery mode (μg/ml)
vaginal birth (n=42) caesarean birth (n=19) during
pregnancy directly afterdelivery puerperalperiod pregnancyduring directly afterdelivery puerperalperiod
median 95.4 112.5 113.2 133.3 702.4 197.3
25 percentile 57.1 45.0 79.9 119.2 468.4 95.5
75 percentile 132.3 216.7 218.7 180.3 1324.3 258.5
max 387.0 670.9 751.8 335.1 2394.3 738.0
min 20.3 23.73 31.242 32.98 157.99 55.61
Friedman's test, P<.05 *P<.01, **P<.0001; Wilcoxon signed-ranks test
* ** ** 750 700 650 600 250 200 150 100 50 0 ∼ ∼
during pregnancy directly after delivery puerperal period
Salivary sIgA consentration (
Mg/ml) ** ○ ○ ○ ** ▲ ▲ ▲ ̶▲̶ vaginal (n=42) ̶○̶ CS (n=19)
Fig.1 Secretory IgA Concentrations-a comparision of vaginal delivery with caesarean section
2. Physical factors and sIgA in the vaginal sub-group analysis
The physical conditions between vaginal and CS deliveries are completely different. In the CS group, be-cause large changes in the sIgA directly after delivery could be seen in these studies, these cases have been omitted from the analysis.
Physical factors were defined as "age," "duration of labor," "blood loss during delivery," "whether or not there was any perineorrhaphy" and "the weight of the newborn" for the analysis of any relationship with the sIgA. With regard to the normality of any residual er-rors, multiple linear regression analysis was avoided, and the correlation with each factor was looked at. With regard to "whether or not there was any perineorrhaphy," a comparison was made between the two groups. These results showed no correlation or difference between any of the factors and the sIgA from the time of pregnancy to the puerperal period.
3. Psychological measure and sIgA
In the vaginal sub-group analysis, changes in "de-pression-dejection," and "anger-hostility" could be seen depending on the period (p<.01; Table 3). Post hoc anal-ysis revealed that "depression-dejection" was signifi-cantly reduced at directly after delivery compared with
during pregnancy. "Anger-hostility" was significantly decreased at directly after delivery and puerperal period compared with during pregnancy. However, the analy-sis showed no correlation between each of these POMS items that showed changes, and the sIgA concentration. There was no significant alteration of POMS scores by the period in the CS group.
On the other hand, Measure of "tension-anxiety" mood in the CS group was significantly greater at during pregnancy and directly after delivery compared with the vaginal group (P<.05, Table 3). At puerperal period, "an-ger-hostility" in the CS group was significantly greater than the vaginal group (P<.05, Table 3). However, sta-tistically associations were not observed between sIgA measures and "tension-anxiety" or "anger-hostility".
IV. Discussion
1. Changes in the salivary sIgA concentration from pregnancy to the puerperal period - consideration of the physical factors
There is a large difference in the salivary sIgA con-centration between individuals, and a rather strong posi-tive correlation (p<.0001) was seen in the longitudinal changes in the sIgA concentration (during pregnancy, directly after delivery, and in the puerperal period). In vaginal birth (n=42) tension-anxiety 46.4±7.9 49.2±11.7 48.0±9.4 Depression-Dejection** 46.3±7.2a 42.6±5.7b 43.3±5.6 Anger-Hostility** 48.0±8.9a 42.0±7.8b 40.5±5.0b Vigor 43.6±7.4 45.7±9.8 45.6±9.9 Fatigue 47.9±10.0 51.8±11.2 47.7±8.6 confusion 50.1±8.4 50.1±7.3 49.9±8.9 caesarean birth (n=17) tension-anxiety 51.7±11.0 57.0±13.4 51.0±12.3 Depression-Dejection 46.4±7.7 46.4±9.8 47.8±10.6 Anger-Hostility 48.3±10.6 44.6±8.1 45.3±9.0 Vigor 46.1±9.9 44.1±6.2 47.3±10.4 Fatigue 47.8±9.8 54.9±11.0 48.5±10.6 confusion 50.7±11.2 51.9±9.8 51.1±10.3
Values are mean±SD. **significant effect of time (P<.01). Within eachvariable, different letters are significantly different from each other as determined by Bonferroni's multiple comparision as post hoc analysis (P<.05). The comparison of two groups was performed by t-test, *P<.05. The data which two participants with CS had not obtained, it excluded from this analysis.
* *
A longitudinal study of changes in salivary sIgA during pregnancy and the puerperal period, focusing on differences between vaginal birth and cesarean section
other words, there seems to be a tendency for the values of the higher subjects to remain at higher levels, and the values of the lower subjects to remain at lower levels. However, there were large differences in the dynam-ics of the changes in the sIgA with the vaginal and CS subjects. Research has indicated that sIgA until partu-rition is significantly lower in CS than in vaginal de-livery (Shitami, 2007), suggesting that stress is lower in that group than in the vaginal delivery group until parturition. However, directly after birth the CS group experienced a lot of stress by comparison with the vagi-nal birth group, which suggests that, although vagivagi-nal birth is a stressful event, the surgical stress of CS is also great.
The most obvious differences between the vaginal and CS subjects were surgical stress and the use of anes-thetics. Both cooperating facilities used local anesthet-ics during the operations, and post-operative pain relief was controlled for about 30 hours using an epidural tube. The use of anesthetics is known to cause changes in the immune system, and most research about the effects of anesthetics and surgery on the immune system use blood as the test subject. Some reports claim that there is no change in IgA in the blood serum after surgery (Slade et al., 1975; Lahteenmaki et al., 2005), but most reports claim there is a post-operative drop in IgA in the blood serum (Tsubo et al., 1985; Hashimoto et al., 1991).
There is a report on the mucous membrane pro-tection reaction of 30 women who had hysterectomies (Lahteenmaki et al., 1998). According to this report, on the day after the surgery, the salivary sIgA concentra-tion increased to four times that of the day before the surgery, and on the fourth day after the surgery, returned to around the pre-operative level. On the other hand, with dentistry local anesthetics, there is a report which claims that the level dropped straight after the anesthetic was given, and returned to normal immediately after the surgery (Uchibori & Nakamura, 1994). Although there are differences between local and general anesthetics, there is no general agreement on these differences, as the same with serum. As there are differences depending on the medical condition, the anesthetic method, and the type of anesthetic drug, full comparative consideration cannot be given, but there is a suggestion of the
possibil-ity that anesthetics and surgical stress have an effect on local immunity. What causes such a dramatic increase in the sIgA after CS is one point that this research has failed to prove, so it is unclear. In the future, there is a need for comparative evaluation with some emergency Caesarean and painless childbirth case studies.
In the vaginal group, there was no change in the sIgA between the pregnancy period and directly after the delivery, but there was an increase in the puerperal peri-od. There is a report that compared to non-breastfeeding mothers the sIgA concentration in breastfeeding mothers was higher (Tenovuo, 1989/1998). Engorgement of the breasts due to the buildup of blood and lymph required for the production of breast milk usually begins around the third day after delivery. The period when galacto-poietics activity increases due to physiological changes matches with the time when the samples were collected during the puerperal period. Also, there are reports that salivary sIgA concentration was high during the lacta-tion and puerperal periods (Widerstrom & Bratthall, 1984; Tenovuo, 1989/1998). Therefore, it is presumed that the increase in the salivary sIgA concentration in during the puerperal period has some relationship with physiological changes during the lactopoietic period.
In vaginal group, there was no difference in the salivary sIgA concentration directly after birth, as com-pared to during the pregnancy. There is also a report that claims that salivary sIgA concentration returned to the normal level one hour after heavy exercise load (Mc-Dowell et al., 1992b), so it is supposed that changes in sIgA concentration can happen within a relatively short period of time. In this research, the sampling was car-ried out from two to five hours after delivery. This time lag could have influenced the results.
Also, it is known that the salivary sIgA concen-tration has a circadian rhythm (Shirakawa et al., 2004; Dimitriou et al., 2002), showing high values in the early morning and when going to bed. After that the values drop, and there is only a small band of fluctuation. In this research, the sampling was carried out between 10 am and 3 pm, so changes due to the circadian rhythm are thought to be unlikely. However, there were several different delivery times for the vaginal subjects, so there is a possibility that differences in the sIgA directly after
with the CS subjects, because they were scheduled, the deliveries were all carried out at about the same time in the afternoon. Therefore, the marked increase directly after delivery in the CS sub-group analysis is not thought to be greatly influenced by the circadian rhythm.
Of the influencing factors of "age," "gestational age" and "blood loss during delivery," in which differ-ences were found depending on the method of delivery, correlations with the concentration of sIgA directly af-ter delivery were seen with "age" and "gestational age." With regard to changes in the sIgA with increasing age, there is a report that claims there was a tendency to drop after the age of 70 (Takeuchi & Kato, 1997), but in this research, there was very little age gap, and a positive correlation was confirmed, as opposed to previous re-search. There was also little difference according to the gestational age. The positive correlation is thought to be influenced by the marked increase directly after de-livery in the CS subjects. From these observations, the salivary sIgA concentration was very little influenced by age. The gestational age also had little influence.
2. The sIgA concentration and psychological factors
The psychological state of mind also influences the sIgA (Graham et al., 1988; Labott et al., 1990). In this study, although the POMS scores changed during pregnancy, directly after delivery and in the puerperal period, this had no relationship with the sIgA concentra-tion. Also, it is observed that "tension-anxiety" and "an-ger-hostility" were significantly greater in the CS group compared with the vaginal group. But correlational analysis failed to identify POMS scores as indicators of changes in sIgA of perinatal women.
In surveys of students and nurses (Graham et al., 1988; Sakamoto et al., 2004), using State-Trait Anxiety Inventory (STAI) and POMS, a negative correlation was shown between the sIgA secretion rate and an unstable state of mind. There is also a report claiming the rela-tionship between sIgA after delivery and STAI (Annie & Groer, 1991), but the correlation coefficient was small. A report on healthy adults (Krieger et al., 2004) claims the connection between POMS scores and salivary sIgA
measured by POMS and the salivary sIgA concentration during pregnancy and the puerperal period is weak.
3. What was the biggest influence on salivary sIgA concentration?
According to previous research on vaginal deliver-ies by Shitami (2004; 2007), the salivary sIgA concen-tration gradually increased as labor progressed. There have also been reports that the salivary sIgA drops with acute stress (Ring et al., 2000; Willemsen et al., 2002), when the stressor can only be handled passively (Nagai et al., 2004). Labor is both psychologically and physically a stressful phenomena, and in addition it is a passive stressful condition. Nevertheless, the sIgA concentration shows a tendency to increase (Shitami, 2004; Shitami, 2007). The results of this research also hardly show any relationship, and at best only a weak relationship between psychological or physical factors and sIgA. Taking this into consideration, it can be pre-sumed that changes in the salivary sIgA concentration during pregnancy and the puerperal period are unique dynamics. It is thought that careful consideration should be given to the evaluation of stress conditions during pregnancy and the puerperal period. Also, as described above, the major psychological or physical factor influ-encing the salivary sIgA concentration was the method of delivery: vaginal delivery or CS. The difference in the sIgA concentration between methods of delivery is large, so it is necessary to give consideration to these factors during pregnancy and the puerperal period.
V. Conclusions
The results of researching the salivary sIgA con-centration during pregnancy, directly after delivery, and during the puerperal period show the following. 1. There was a large individual difference in the salivary
sIgA concentration between subjects, but a rather strong positive correlation (P<.01) was seen in the longitudinal changes in the sIgA concentration (dur-ing pregnancy, directly after delivery, and in the pu-erperal period).
A longitudinal study of changes in salivary sIgA during pregnancy and the puerperal period, focusing on differences between vaginal birth and cesarean section
2. In the vaginal delivery group, there was no change in the sIgA concentration during the pregnancy period and directly after delivery, but there was an increase during the puerperal period (P<.01).
3. In the CS delivery group, there was a dramatic in-crease in the sIgA concentration directly after deliv-ery (P<.0001), but in the puerperal period, the level returned to the same level as during the pregnancy (P<.0001).
4. There was hardly any difference in the sIgA concen-tration depending on physical factors such as parous experience, duration of labor, blood loss, age, and gestational age.
5. The POMS scores changed during the pregnancy, di-rectly after delivery, and in the puerperal period, but this did not have any relationship with the sIgA con-centration.
It can now be understood that the changes in the sIgA concentration during the pregnancy, directly af-ter delivery, and in the puerperal period have different dynamics, depending on whether or not the deliveries were vaginal or CS. Also, the results of the evaluation of various factors show that the factor most strongly influ-encing the sIgA concentration is the method of delivery. These findings suggest that directly after delivery CS group mothers were under a lot of stress by compari-son with the vaginal birth group. However, in view of the marked increase in the sIgA concentration in the CS group, it is also possible that other variables apart from stress (such as the influence of anesthetics) may affect the sIgA values. There is a need to give consideration to unique factors depending on the method of delivery, to more fully understand the stress conditions during preg-nancy and the puerperal period.
Acknowledgments
We thank our subjects for participating in this study. We also thank Professor Yukiko Miyakoshi, Professor Kyouko Yokoo, Professor Tutomu Inamizu and Associ-ate Professor Satoko Nakagomi of GraduAssoci-ate School of Health Sciences, Hiroshima University, for their sugges-tions. This study was presented at 27th JANS academic conference. It is also a part of a doctoral thesis submit-ted to Graduate School of Health Sciences, Hiroshima
University, in 2007. References
Akimoto, T., Akama, T. & Sugiura, K., et al. (1998). Alter-ration of Local Immunity in the Oral Cavity after end Urance Running, Japanese Journal of Physical Fitness and Sports Medicine, 47(1), 53-61.
Annie, CL. & Groer, M.J. (1991). Childbirth stress An im-munologic study, Journal of obstetric, gynecologic, and neonatal nursing, 20, 391-397.
Dimitriou, L., Sharp, NCC. & Doherty, M. (2002). Circadian effects on the acute responses of salivary cortisol and IgA in well trained swimmers, British Journal of Sports Medicine, 36, 260-264.
Farne, M., Boni, P. & Gnugnoli, D., et al. (1992). The effect of daily hassles on salivary IgA : experimental evidence, Bollettino della Società italiana di biologia sperimen-tale, 68(6), 409-412.
Graham, NM., Bartholomeusz, RC. & Taboonpong, N., et al. (1988). Dose anxiety reduce the rate of secretory IgA in saliva?, The Medical journal of Australia, 148, 131-133.
Hashimoto, H., Araki, I. & Sato, T., et al. (1991). Clinical study on total intravenous anesthesia with droperidol, fentanyl and ketamine-12. Effects on plasma comple-ment and immunoglobulin concentrations, Masui, 40(12), 1838-1842.
Jemmott, JB, 3rd. & Magloire, K. (1988). Academic stress, social support, and secretory immunoglobulin A, Jour-nal of persoJour-nality and social psychology, 55(5), 803-810.
Krieger, James., Crowe, M. & Blank, S.E. (2004). Chronic glutamine supplementation increases nasal but not sali-vary IgA during 9days of interval traning, Journal of Applied Physiology, 97, 585-591.
Labott, SM., Ahleman, S. & Wolever, ME., et al. (1990). The physiological and psychological effects of the expres-sion and inhibition of emotion, Behavioral medicine (Washington, D.C.), 16, 182-189.
Lahteenmaki, M., Salo, M. & Tenovuo, J. (1998). Mucosal host defence response to hysterectomy assessed by sa-liva analyses: a comparison of propofol and isoflurane anaesthesia, Anaesthesia, 53(11), 1067-1073.
Ef-oral mucosal host defences during minor surgery, Acta anaesthesiologica Scandinavica, 49(9), 1318-1325. McDowell, SL., Hughes, RA. & Hughes, RJ., et al. (1992a).
The effect of exhaustive exercise on salivary immuno-globulin A, The Journal of sports medicine and physi-cal fitness, 32, 412-415.
McDowell, SL., Hughes, RA. & Hughes, RJ., et al. (1992b). The effect of exercise training on salivary immuno-globulin A and cortisol responses to maximal exercise, International journal of sports medicine, 13, 577-580. McNair, DM. Lorr, M.& Droppleman, LF. (1992). POMS
Manual. Profile Of Mood States. San Diego: Educa-tional and Industrial Testing Service.
Nagai, M., Ohno, H. & Saitoh, J., et al. (2004). Effects of stress on the secretion of immunoglobulin A in saliva, The Autonomic nervous system, 41(3), 347-349. Ring, C., Harrison, LK. & Winzer, A., et al. (2000).
Secre-tory immunoglobulin A and cardiovascular reactions to mental arithmetic, cold pressor, and exercise : Effect of alpha-adrenergic blockade, Psychophysiology, 37(5), 634-643.
Sakamoto, Y., Ueki, S. & Yoshida, H., et al. (2004). The fluctu-ation of salivary secretory IgA levels, mood and anxiety of university student participated in care worker practi-cal training for the first time, Journal of health and social services, 2, 13-22.
Shirakawa, T., Mitome, M. & Oguchi, H. (2004). Circadian rhythms of S-IgA and cortisol in whole saliva : Com-pensatory mechanism of oral immune system for noc-turnal fall of saliva secretion, Pediatric Dental Journal, 14, 115-120.
Shitami, C. (2004). Changes in Secretory IgA concentra-tions in the saliva during parturition and associated stress factors, Journal of Japan Academy of Midwifery, 18(1), 29-36.
parison of vaginal births with cesarean births, Maternal health, 47(4), 643.-648.
Slade, MS., Simmons, RL. & Yunis, E., et al. (1975). Immu-nodepression after major surgery in normal patients, Sur-gery, 78(3), 363-72.
Takeuchi, Y. & Kato, Y. (1997). The Relationship between Aging and the Concentration of Saliva IgA in Middle Aged and Elderly People, Kawasaki medical welfare journal, 7(2), 395-398.
Tenovuo, Jorma (1989)./ Ishii, T. & Takae, Y. (1998). DAE-KI NO KAGAKU HUMAN SALIVA CLINICAL CHEMISTRY and MICROBIOLIGY, 165-165,Tokyo: IsseiShuppan.
Tsubo, T., Oka, Y. & Matsuki, A., et al. (1985). Changes of serum immunoglobulin and complement levels during and after open heart surgery, Masui, 34(2), 211-215. Uchibori, K. & Nakamura, T. (1994). A Study of Salivary
Acid Soluble Glycoprotein and s-IgA in Human Saliva on Tooth Extraction, Nihon University Journal of Oral Science, 20, 109-119.
Willemsen, G., Carroll, D. & Ring, C., et al. (2002). Cellular and mucosal immune reactions to mental and cold stress : associations with gender and cardiovascular reactivity, Psychophysiology, 39(2), 222-228.
Widerstrom, L. & Bratthall, D. (1984). Increased IgA lev-els in saliva during pregnancy, Scandinavian journal of dental research, 92, 33-37.
Yajima, J., Thuda, A. & Kuwahata, T., et al. (2002). Relation-ship between Psychoneuroimmunological Responses Induced by Mental Stress Testing and General Health State in Human Volunteers Japanese, Journal of behav-ioral medicine, 8(1), 17-22.
Yamada, T., Miyata, H. & Takenaka, K., et al. (1995). Secre-tory IgA as an Index of Stress Reactivity, Bulletin of Osaka Prefectural College of Nurs., 1(1), 47-50.
A longitudinal study of changes in salivary sIgA during pregnancy and the puerperal period, focusing on differences between vaginal birth and cesarean section
妊娠期から産褥期における唾液中sIgAの
変化に関する縦断的研究
—経腟分娩と帝王切開分娩による違いに焦点を当てて—
下 見 千 恵＊1，田 丸 政 男＊1 竹 中 和 子＊2，田 中 義 人＊2 ＊１県立広島大学保健福祉学部，＊2広島大学大学院保健学研究科 抄 録 目 的 局所免疫である唾液中の分泌型IgA（sIgA）は，ストレスにより変動することが知られている。先行研 究では運動負荷やメンタルストレスによりsIgAが変動することが報告されているが，妊産褥婦を対象 としたデータは少ない。本研究では妊娠期から産褥期の母の唾液中sIgA濃度について，縦断的な基礎 データを得て，帝王切開分娩と経腟分娩のストレス状態を比較することを目的とした。 方 法 健康な妊婦61名（予定帝王切開が決定しているのは19名，経腟分娩に至ったのは42名）を対象とし，sIgA濃度をenzyme immunoassay法で定量した。妊娠期，分娩直後，産褥期の3回唾液採取し，同時期
にProfile of Moods States（POMS）を対象に記載してもらった。また，身体的因子として年齢，分娩既往， 分娩所要時間，出血量や分娩週数等を調査した。 結 果 唾液中sIgA濃度は個人差が大きく，妊娠期̶分娩直後̶産褥期の各期の値はやや強い正の相関を認 めた（P＜.01）。 経腟分娩事例では妊娠期と分娩直後では変化がなく，産褥期において増加した（P＜.01）。 しかし， 帝王切開事例では分娩直後のsIgAは産褥期と妊娠期より有意に高かった（P＜.0001）。 分娩既 往や分娩所要時間，分娩時出血量，年齢，分娩週数等の身体的因子による唾液中sIgA濃度の差は，殆 どなかった。 POMS得点は，妊娠期，分娩直後，産褥期で変化したが，唾液中sIgA濃度とは関連がなかっ た。 結 論 妊産褥婦の唾液sIgA濃度は，分娩様式によってその動態が異なることが明らかになった。分娩直後 において，帝王切開分娩のほうが経腟分娩よりストレスが高いことが推測された。しかしながら，経腟 分娩に比べると帝王切開分娩のsIgA濃度は著しく高かったことから，ストレスだけでなく麻酔などの 他の変数が影響した可能性もある。妊産褥婦の時期には，そのストレス評価について特に分娩様式など の要因を考慮する必要がある。 キーワード：唾液，分泌型IgA，妊産褥婦，分娩様式
