Influence of reproduction history on depression during pregnancy:a prospective cohort study
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摘要:
目的 探究孕育史对妊娠各期抑郁发生的影响。 方法 使用中国孕产妇队列研究·协和项目中孕育史与妊娠各期抑郁数据完整的3 792名孕妇进行研究。采用爱丁堡产后抑郁量表测量孕妇的抑郁状况。采用χ2检验进行单因素分析, 采用Log-binomial回归模型进行多因素分析, 计算调整相对危险度(relative risk, RR)值及其95%可信区间(confidence interval, CI), 并用森林图进行展示。 结果 Log-binomial回归结果显示, 分娩史增加孕妇孕中期抑郁(RR:1.04, 95% CI:1.01~1.08, P=0.042)和孕晚期抑郁(RR:1.05, 95% CI:1.01~1.10, P=0.020)的发生风险; 与无剖宫产史的孕妇相比, 有剖宫产史的孕妇孕晚期抑郁风险增加了6%(RR:1.06, 95% CI:1.01~1.11, P=0.041)。 结论 孕育史对妊娠抑郁的发生有重要影响, 妇幼保健人员应重点关注此类孕妇, 并开展针对性的健康宣教和心理护理, 加强对孕妇情绪变化的观察并及时给予心理调整。 Abstract:Objective To explore the influence of reproduction history on depression during pregnancy. Methods Data on 3 792 pregnant women from the Chinese pregnant women cohort study with complete information on reproduction history and depression were used in the present study. The Edinburgh postnatal depression scale was used to assess depression status among pregnant women. A chi-square test was used for univariate analysis, and a Log-binomial regression was used for multivariate analysis. The adjusted relative risks(RRs) with 95% confidence intervals(95% CIs) were calculated, and were presented in a forest plot. Results The results of Log-binomial regression showed that a history of delivery could increase the risk of depression during the second trimester(RR:1.04, 95% CI:1.01-1.08, P=0.042) and the third trimester(RR:1.05, 95% CI:1.01-1.10, P=0.020). There was a 6% increase of risk on depression in women with a history of cesarean delivery compared with women without that during the third trimester(RR:1.06, 95% CI:1.01-1.11, P=0.041). Conclusions There is a significant influence of reproduction history on gestational depression. Maternal and child health personnel should focus on these pregnant women, and conduct targeted health education and mental nursing. In addition, medical personnel should also pay attention to the emotional changes of these women and provide them with several adjustment strategies. -
Key words:
- Reproduction history /
- Pregnant women /
- Depression /
- Cohort study
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图 1 孕育史对孕期抑郁影响的多因素分析
Figure 1. Multivariate analysis of the influence of reproduction history on gestational depression
表 1 纳入人群的基线特征
Table 1. The characteristics of the included participants
特征 例数(人) 百分比(%) 年龄(岁) < 25 631 16.6 25~ 1 896 50.0 30~ 907 23.9 ≥35 358 9.5 孕前BMI(kg/m2) < 18.5 482 12.7 18.5~ 2 406 63.4 24~ 716 18.9 ≥28 188 5.0 民族 汉族 3 585 94.5 少数民族 207 5.5 户口类型 城镇 1 732 45.7 农村 2 060 54.3 家庭成员数(人) 1~ 1 170 30.8 3~ 1 721 45.4 ≥5 901 23.8 SES 低 1 171 30.9 中 1 329 35.0 高 1 292 34.1 地区划分1 北方 2 098 55.3 南方 1 694 44.7 地区划分2 东部 1 431 37.7 中部 1 277 33.7 西部 1 084 28.6 
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表 2 不同特征孕期抑郁的分布情况[n (%)]
Table 2. Distribution of gestational depression with different characteristics [n (%)]
特征 孕早期 孕中期 孕晚期 抑郁(n=898) χ2值 P值 Ptrend 抑郁(n=792) χ2值 P值 Ptrend 抑郁(n=837) χ2值 P值 Ptrend 年龄(岁) 0.002 0.015 < 0.001 0.001 < 0.001 0.005 年龄(岁) 14.712 0.002 0.015 19.124 < 0.001 0.001 19.803 < 0.001 0.005 < 25 186(20.7) 172(21.7) 181(21.6) 25~ 430(47.9) 376(47.5) 388(46.4) 30~ 197(21.9) 179(22.6) 196(23.4) ≥35 85(9.5) 65(8.2) 72(8.6) 孕前BMI(kg/m2) 13.813 0.003 0.721 9.698 0.021 0.936 2.139 0.544 0.445 < 18.5 136(15.1) 118(14.9) 117(14.0) 18.5~ 524(58.4) 468(59.1) 526(62.8) 24~ 189(21.0) 168(21.2) 150(17.9) ≥28 49(5.5) 38(4.8) 44(5.3) 民族 7.256 0.007 1.202 0.273 2.790 0.095 汉族 865(96.3) 755(95.3) 801(95.7) 少数民族 33(3.7) 37(4.7) 36(4.3) 户口类型 5.711 0.017 19.989 < 0.001 14.415 < 0.001 城镇 379(42.2) 306(38.6) 334(39.9) 农村 519(57.8) 486(61.4) 503(60.1) 家庭成员数(人) 3.664 0.160 0.218 11.701 0.003 0.001 6.273 0.043 0.014 1~ 255(28.4) 217(27.4) 231(27.6) 3~ 428(47.7) 353(44.6) 388(46.4) ≥5 215(23.9) 222(28.0) 218(26.0) SES 5.683 0.058 0.024 25.779 < 0.001 < 0.001 22.741 < 0.001 < 0.001 低 296(33.0) 296(37.4) 309(36.9) 中 325(36.2) 277 (35.0) 290(34.6) 高 277(30.8) 219 (27.6) 238(28.4) 地区划分1 5.255 0.022 0.113 0.736 1.201 0.273 北方 467(52.0) 434(54.8) 477(57.0) 南方 431(48.0) 358(45.2) 360(43.0) 地区划分2 9.250 0.010 31.125 < 0.001 12.796 0.002 东部 319(35.5) 270(34.1) 293(35.0) 中部 340(37.9) 332(41.9) 325(38.8) 西部 239(26.6) 190(24.0) 219(26.2)
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表 3 孕育史对孕期抑郁影响的单因素分析
Table 3. Univariate analysis of the influence of reproduction history on gestational depression
孕育史 例数 孕早期 孕中期 孕晚期 抑郁检出率% (95% CI)值 χ2值 P值 抑郁检出率% (95% CI)值 χ2值 P值 抑郁检出率% (95% CI)值 χ2值 P值 妊娠史 1.292 0.256 4.108 0.043 5.851 0.016 无 1190 22.5(20.1~24.9) 18.9(16.7~21.1) 19.7(17.4~21.9) 有 2602 24.2(22.6~25.9) 21.8(20.2~23.4) 23.2(21.6~24.8) 分娩史 0.035 0.851 6.469 0.011 6.126 0.013 无 2341 23.6(21.9~25.3) 19.6(18.0~21.2) 20.8(19.1~22.4) 有 1451 23.8(21.7~26.0) 23.0(20.9~25.2) 24.2(22.0~26.4) 剖宫产史 0.193 0.661 0.979 0.322 4.541 0.033 无 3189 23.5(22.1~25.0) 20.6(19.2~22.0) 21.4(20.0~22.9) 有 603 24.4(20.9~27.8) 22.4(19.1~25.7) 25.4(21.9~28.9) 流产史 0.067 0.795 0.482 0.488 0.083 0.774 无 2585 23.6(21.9~25.2) 21.2(19.6~22.8) 22.2(20.6~23.8) 有 1207 23.9(21.5~26.4) 20.2(17.9~22.5) 21.8(19.5~24.1)
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