孕妇抑郁/焦虑的产科相关因素  

Obstetric factors for maternal depression/anxiety

作　　者：夏贤 胡卫红 贺木兰 胡瑶[2] Xia Xian;Hu Weihong;He Mulan;Hu Yao(Department of Obstetrics,Obstetrics and Gynecology Hospital of Fudan University,Shanghai 200011,China;Department of Psychiatrics,Shanghai Mental Health Center,Shanghai 200030,China)

机构地区：[1]复旦大学附属妇产科医院产科,上海200011 [2]上海市精神卫生中心精神科,200030

出　　处：《中华围产医学杂志》2019年第3期180-185,共6页Chinese Journal of Perinatal Medicine

基　　金：国家重点研发计划(2016YFC1000403);上海市精神卫生中心院级课题(2016-YJ-06).

摘　　要：目的探讨孕妇抑郁/焦虑的筛查阳性率及筛查阳性的产科相关因素。方法选择2015年9月至2016年9月在复旦大学附属妇产科医院登记并初次进行产前检查的6 923例孕妇进行问卷调查,内容包括抑郁自评量表(Self-Rating Depression Scale, SDS)、焦虑自评量表(Self-Rating Anxiety Scale, SAS)、产科一般情况及病史资料。采用χ^2检验及logistic回归分析孕妇抑郁/焦虑的产科相关因素。结果6 923例孕妇中抑郁筛查阳性率为23.15%(1 603/6 923),焦虑筛查阳性率为9.56%(659/6 893)。单因素分析显示,年龄、孕次、产次和不良孕产史与孕妇抑郁筛查阳性有关,年龄、孕次和不良孕产史与孕妇焦虑筛查阳性有关(P值均<0.05)。多因素分析显示,相对于适龄孕妇(≥25~<35岁),低龄孕妇(<25岁)抑郁和焦虑筛查阳性的风险均较高(OR=2.945,95%CI:2.266~3.829;OR=1.959,95%CI:1.381~2.780;P值均<0.05)。相对于既往有妊娠史的初产妇,初次妊娠的孕妇抑郁和焦虑筛查阳性的风险均较低(OR=0.732,95%CI:0.630~0.851;OR=0.630,95%CI:0.512~0.775;P值均<0.05);经产妇焦虑筛查阳性的风险也较低(OR=0.748,95%CI:0.561~0.996,P<0.05)。此外,有不良孕产史的孕妇抑郁和焦虑筛查阳性的风险均较高(OR=1.549,95%CI:1.123~2.137;OR=1.712,95%CI:1.138~2.577;P值均<0.05)。结论孕妇抑郁/焦虑比例较高,尤其是低龄、既往有妊娠史的初产妇及有不良孕产史者,临床应关注孕妇抑郁/焦虑的产科相关因素。Objective To investigate the current situation of depression/anxiety in gravidas and to analyze the related obstetric factors. Methods A questionnaire survey was conducted among 6 923 gravidas who registered for their first prenatal examination at Obstetrics and Gynecology Hospital of Fudan University from September 2015 to September 2016. Self-Rating Depression Scale (SDS) and Self-Rating Anxiety Scale (SAS) were completed during the survey and general obstetric conditions and medical history were reviewed. Related obstetric factors were statistically analyzed by Chi-square test and logistic regression. Results In this study, the positive rates of depression and anxiety screening were 23.15%(1 603/6 923) and 9.56%(659/6 893), respectively. Univariate analysis showed that maternal depression was associated with maternal age, gravidity, parity and history of adverse pregnancies (all P<0.05), while anxiety was related to maternal age, gravidity and history of adverse pregnancies (all P<0.05). Multivariate analysis showed that younger gravidas (<25 years old) had higher risks of depression and anxiety than those aged between 25 and 35 (OR=2.945, 95%CI: 2.266-3.829;OR=1.959, 95%CI: 1.381-2.780;both P<0.05). Compared to primiparas with a history of conception, the first-time pregnant women had lower risks of depression and anxiety (OR=0.732, 95%CI: 0.630-0.851;OR=0.630, 95%CI: 0.512-0.775;both P<0.05), and the risk of anxiety in multiparas was also decreased (OR=0.748, 95%CI: 0.561-0.996, P<0.05). In addition, gravidas with previous adverse pregnant outcome showed higher risks of depression and anxiety (OR=1.549, 95%CI: 1.123-2.137;OR=1.712, 95%CI: 1.138-2.577;both P<0.05). Conclusions The positive rates of depression and anxiety are high in gravidas, especially younger or primiparas with a history of conception and those with history of adverse pregnancies. Clinicians should pay attention to any obstetric factors related to maternal depression and anxiety.

关 键 词：孕妇 抑郁 焦虑 精神病状态评定量表 年龄因素 妊娠结局 

分 类 号：R715.3[医药卫生—妇产科学]