目的 分析孕妇产前抑郁患病情况及其对小于胎龄(SGA)儿发生的影响,为母婴预后良好提供依据。方法 纳入2017年6月—2019年6月大兴区人民医院收治的537例孕妇,应用爱丁堡产后抑郁量表(EPDS)评价抑郁症状,根据是否合并抑郁分为抑郁组和对照组,比较两组孕妇的一般资料、分娩结局和新生儿体质量、头围、胸围及身长情况,确定抑郁对SGA儿的影响。结果 抑郁组孕妇106例,产前患病率为19.74%。 抑郁组的EPDS评分显著高于对照组(t=24.234,P<0.001),年龄显著小于对照组(t=2.480,P=0.013 )。抑郁组的新生儿出生胎龄显著小于对照组(t=2.398,P=0.017),新生儿体质量、头围、胸围、身长显著低于对照组(t=4.862、4.775、9.301、10.758,P<0.001),新生儿早产比例和SGA比例显著高于对照组(χ2=4.758、6.803,P<0.05)。Logistic回归分析显示抑郁(OR=1.802,95%CI:1.232~4.793,P=0.016)是SGA发生的独立危险因素。接受者操作特征曲线(ROC曲线)分析显示EPDS评分以12为界值预测SGA的曲线下面积为0.757。结论 孕妇产前抑郁高发,影响胎儿发育,是SGA发生的独立危险因素。应早期对孕妇进行产前抑郁的筛检,对于有抑郁症状的孕妇,应及时进行心理疏导和干预,促进母婴健康。
Abstract
Objective To explore the prevalence of prenatal depression in pregnant women and its impact on the occurrence of small for gestational age (SGA), in order to provide evidence for the good prognosis of mothers and infants. Methods A total of 537 pregnant women admitted to Daxing District People's Hospital from June 2017 to June 2019 were included in the study. The Edinburgh Postnatal Depression Scale (EPDS) was used to evaluate the depressive symptoms. According to EPDS result, the participants were divided into depression group and control group. The general information, delivery outcome, newborn weight, head circumference, chest circumference and body lengthwere compared between the two groups, so as to determine the impact of depression on SGA. Results There were 106 pregnant women in the depression group, with a prenatal prevalence rate of 19.74%. The EPDS score of the depression group was significantly higher than that of the control group (t=24.234, P＜0.001), and the age was significantly lower than that of the control group (t=2.480, P=0.013). In the depression group, the gestational age of infants was significantly smaller than that of the control group (t=2.398, P=0.017), the weight, head circumference, chest circumference and body length of the newborns were significantly lower than those of the control group (t=4.862, 4.775, 9.301, 10.758, P＜0.001), and the proportions of premature delivery(χ2=4.758) and SGA(χ2=6.803) of the newborns were significantly higher than those of the control group. Logistic regression analysis showed that antenatal depression (OR=1.802, 95%CI:1.232 - 4.793, P=0.016) was an independent risk factor for SGA. The receiver operating characteristic curve (ROC curve) analysis showed that the area under the curve of SGA predicted by the EPDS score of 12 was 0.757. Conclusions Prenatal depression is highly prevalent in pregnant women, impacts fetal development and is an independent risk factor for SGA. Pregnant women should be screened for antenatal depression at an early stage, and those with depressive symptoms should be offered timely psychological support and intervention to promote maternal and infant health.
关键词
孕妇 /
产前抑郁 /
小于胎龄儿
Key words
pregnant women /
prenatal depression /
small for gestational age infant
{{custom_sec.title}}
{{custom_sec.title}}
{{custom_sec.content}}
参考文献
[1] Dadi AF, Miller ER, Bisetegn TA, et al. Global burden of antenatal depression and its association with adverse birth outcomes: An umbrella review[J]. BMC Public Health.2020,20(1):173.
[2] 杨洋.产前抑郁影响因素及其妊娠结局[J].中国计划生育学杂志,2019,27(4):504-507.
Yang Y. Influencing factors of prenatal depression and pregnancy outcome[J]. Chinese Journal of Family Planning, 2019,27(4):504-507.(in Chinese)
[3] 张晓旭,李小妹,李渊彬, 等.中国西部城市女性产前抑郁现状及影响因素研究[J].中国妇幼保健,2019,34(22):5275-5277.
Zhang XX, Li XM, Li YB, et al. Study on the status quo and influencing factors of prenatal depression in urban women in western China[J]. China Maternal and Child Health Care,2019,34 (22):5275-5277.(in Chinese)
[4] Zhang L, Wang L, Yuan Q, et al. The mediating role of prenatal depression in adult attachment and maternal-fetal attachment in primigravida in the third trimester[J]. BMC Pregnancy Childbirth,2021,21(1):307.
[5] Gelaye B, Sanchez SE, Andrade A, et al.Association of antepartum depression, generalized anxiety, and posttraumatic stress disorder with infant birth weight and gestational age at delivery[J]. J Affect Disord,2020,262:310-316.
[6] Li X,Gao R, Dai X, etal. The association between symptoms of depression during pregnancy and low birth weight: A prospective study[J].BMC Pregnancy Childbirth,2020,20(1):147.
[7] Al-Hashimi FJG, Kareem Alalaf S, Al Tawil NG. Screening for depression during pregnancy using the Kurdish version of the Edinburgh Postnatal Depression Scale in Erbil city[J].Health Care Women Int, 2020,41(3):240-254.
[8] MacGinty RP, Kariuki SM, Barnett W, et al.Associations of antenatal maternal psychological distress with infant birth and development outcomes: Results from a South African birth cohort[J]. Compr Psychiatry,2020,96:152128.
[9] Ng QX,Venkatanarayanan N, Loke W, et al.A meta-analysis of the effectiveness of yoga-based interventions for maternal depression during pregnancy[J].Complement Ther Clin Pract,2019,34:8-12.
[10] 李洋,綦小蓉,赵斌.爱丁堡产后抑郁量表在产前抑郁筛查中的应用研究[J].中国妇幼保健,2019,34(23):5381-5384.
Li Y, Qi XR, Zhao B. Application of Edinburgh Postnatal Depression Scale in prenatal depression screening[J]. China Maternal and Child Health Care, 2019, 34 (23):5381-5384.(in Chinese)
[11] Mongan D, Lynch J, Hanna D, et al. Prevalence of self-reported mental disorders in pregnancy and associations with adverse neonatal outcomes: A population-based cross-sectional study[J]. BMC Pregnancy Childbirth,2019,19(1):412.
[12] Babu GR, Murthy GVS, Reddy Y, et al.Small for gestational age babies and depressive symptoms of mothers during pregnancy: Results from a birth cohort in India[J]. Wellcome Open Res,2020,3:76.
[13] Fekadu Dadi A, Miller ER, Mwanri L.Antenatal depression and its association with adverse birth outcomes in low and middle-income countries: A systematic review and meta-analysis[J]. PLoS One,2020,15(1):e0227323.
[14] Jacobson MH, Stein CR, Liu M, et al. Prenatal exposure to bisphenols and phthalates and postpartum depression: The role of neurosteroid hormone disruption[J]. J Clin Endocrinol Metab,2021,106(7):1887-1899.
[15] Toscano M, Royzer R, Castillo D, et al. Prevalence of depression or anxiety during antepartum hospitalizations for obstetric complications: A systematic review and Meta-analysis[J]. Obstet Gynecol,2021,137(5):881-891.
[16] Khanghah AG, Khalesi ZB, Hassanzadeh RA. The importance of depression during pregnancy[J]. JBRA Assist Reprod,2020,24(4):405-410.
[17] Neggers Y, Goldenberg R, Cliver S, et al.The relationship between psychosocial profile, health practices, and pregnancy outcomes[J]. Acta Obstet Gynecol Scand. 2006;85(3):277-285.
[18] Evans J, Heron J, Wiles N. Depressive symptoms during pregnancy and low birth weight at term:Longitudinalstudy[J]. Br J Psychiatry, 2007,191:84-85.
[19] Adhikari K, Patten SB, Lee S, et al.Risk of adverse perinatal outcomes among women with pharmacologically treated and untreated depression during pregnancy: A retrospective cohort study[J]. Paediatr Perinat Epidemiol,2019,33(5):323-331.
[20] Freedman R, Hunter SK, Noonan K, et al. Maternal prenatal depression in pregnancies with female and male fetuses and developmental associations with C-reactive protein and cortisol[J].Biol Psychiatry Cogn Neurosci Neuroimaging,2021,6(3):310-320.
[21] Hetherington E,Adhikari K, Tomfohr-Madsen L,et al. Birth outcomes, pregnancy complications, and postpartum mental health after the 2013 Calgary flood: A difference in difference analysis[J]. PLoS One,2021,16(2):e0246670.
[22] Miller ES,Saade GR, Simhan HN, et al. Trajectories of antenatal depression and adverse pregnancy outcomes[J]. Am J Obstet Gynecol,2022,226(1):108.e1-108.e9.
PDF(430 KB)
