孕期心理状况与无医学指征剖宫产的关联研究  

Association between psychological status during pregnancy and non-indicated cesarean delivery

作　　者：李梅[1,2] 蒋杨倩 吕红 徐菠[1,3] 刘晓宇 周昆[1,3] 韩秀梅 蒋涛[1,5] 石中华 杜江波[1,3,4] 林苑 马红霞[1,3,4] 夏彦恺 胡志斌[1,3,4] 吴炜 LI Mei;JIANG Yangqian;LV Hong;XU Bo;LIU Xiaoyu;ZHOU Kun;HAN Xiumei;JIANG Tao;SHI Zhonghua;DU Jiangbo;LIN Yuan;MA Hongxia;XIA Yankai;HU Zhibin;WU Wei(State Key Laboratory of Reproductive Medicine,Nanjing Medical University,Nanjing 211166;Key Laboratory of Modern Toxicology of Ministry of Education,School of Public Health,Nanjing Medical University,Nanjing 211166;Department of Epidemiology,School of Public Health,Nanjing Medical University,Nanjing 211166;State Key Laboratory of Reproductive Medicine(Suzhou Centre),the Affiliated Suzhou Hospital of Nanjing Medical University,Suzhou Municipal Hospital,Gusu School,Nanjing Medical University,Suzhou 215002;Department of Biostatistics,School of Public Health,Nanjing Medical University,Nanjing 211166;Department of Obstetrics,Women’s Hospital of Nanjing Medical University,Nanjing Maternity and Child Health Care Hospital,Nanjing 210004;Department of Maternal,Child and Adolescent Health,School of Public Health,Nanjing Medical University,Nanjing 211166,China)

机构地区：[1]南京医科大学生殖医学国家重点实验室,江苏南京211166 [2]南京医科大学公共卫生学院现代毒理学教育部重点实验室,江苏南京211166 [3]南京医科大学公共卫生学院流行病学系,江苏南京211166 [4]南京医科大学附属苏州医院(苏州市立医院)生殖医学国家重点实验室(苏州中心),南京医科大学姑苏学院,江苏苏州215002 [5]南京医科大学公共卫生学院生物统计学系,江苏南京211166 [6]南京医科大学附属妇产医院(南京市妇幼保健院)产科,江苏南京210004 [7]南京医科大学公共卫生学院儿少卫生与妇幼保健学系,江苏南京211166

出　　处：《南京医科大学学报（自然科学版）》2023年第1期66-72,121,共8页Journal of Nanjing Medical University(Natural Sciences)

基　　金：国家重点研发计划(2021YFC2700600);江苏省卫生健康发展研究中心开放课题(JSHD2021047)。

摘　　要：目的:探讨孕期抑郁、焦虑和压力等心理因素对无医学指征剖宫产的影响。方法:采用前瞻性队列研究方法,以2016年10月—2019年1月在南京医科大学附属妇产医院纳入的1453例孕妇作为研究对象。采用焦虑自评量表、抑郁流行病学研究中心量表和压力知觉量表分别评估孕妇孕早、中、晚期的心理状况。根据产科病例获取分娩方式并判断是否具有剖宫产医学指征,在无剖宫产医学指征的孕妇人群中,采用广义估计方程分析孕期心理因素与剖宫产的关联。结果:本研究最终纳入1453例孕妇作为研究对象,其中516例孕妇有剖宫产医学指征。余937例无剖宫产医学指征的孕妇中,139例孕妇选择剖宫产。调整母亲分娩年龄、孕前体重指数、产次、妊娠合并糖尿病和分娩孕周后,发现孕妇孕晚期伴有任一不良心理症状(高压力、抑郁或焦虑)可增加无医学指征剖宫产发生的风险(OR=1.69,95%CI:1.04~2.73,P=0.034),孕晚期抑郁与无医学指征剖宫产呈正相关(OR=1.32,95%CI:1.03~1.69,P=0.028),焦虑和压力与无医学指征剖宫产的关联无统计学意义。结论:孕晚期抑郁与无医学指征剖宫产发生的风险增加有关。建议在未来产检护理中,应重视孕产妇的心理疏导,尤其是孕晚期的心理健康。Objective:The aim of this study was to investigate the associations between psychological factors(depression,anxiety,and stress)during pregnancy and non-indicated cesarean delivery.Methods:We conducted a prospective cohort study of 1453 women who were enrolled between October 2016 and January 2019 in the Women’s Hospital of Nanjing Medical University.The self-rating anxiety scale,Centre for Epidemiologic Studies Depression scale,and perceived stress scale were used to assess the psychological status of pregnant women in the first,second and third trimesters.The generalized estimation equation(GEE)was performed to investigate the association between antepartum psychological status and cesarean delivery among pregnant women without medical indications for cesarean delivery.Results:Among the 1453 participants in this study,516 had medical indications for cesarean delivery.The rest 937 women had no medical indications for cesarean delivery,among which 139 women had cesarean delivery.Any adverse psychological symptom(depression,anxiety,or stress)in late pregnancy was associated with increased risk of non-indicated cesarean delivery(OR=1.69,95%CI:1.04~2.73,P=0.034)after the adjustment for maternal age at delivery,pre-pregnancy body mass index(BMI),diabetes during pregnancy,parity,and gestational age.Particularly,depressive symptom in pregnant women was significantly related to the risk of non-indicated cesarean delivery(OR=1.32,95%CI:1.03~1.69,P=0.028).No statistically significant association was observed between stress and press in women and the risk of non-indicated cesarean delivery.Conclusion:Depressive symptom in the third trimester increased the risk of non-indicated cesarean delivery.It is suggested that more attention should be paid to the psychological counseling of pregnant women,especially in late pregnancy.

关 键 词：压力 抑郁 焦虑 无医学指征剖宫产 孕期 

分 类 号：R715.3[医药卫生—妇产科学]