孕期吸烟与被动吸烟对产后抑郁、焦虑和抑郁焦虑共病的影响  

Combined effect of active smoking history and passive smoking during pregnancy on postpartum depression and anxiety

作　　者：尚孟晴 候严严 古悦 李海滟 甄华龙 江敏敏 朱贝贝 陶芳标[1,2,3] Shang Mengqing;Hou Yanyan;Gu Yue;Li Haiyan;Zhen Hualong;Jiang Minmin;Zhu Beibei;Tao Fangbiao(School of Public Health,Anhui Medical University,Hefei 230032,China;Key Laboratory of Population Health Across Life Cycle,Ministry of Education,Hefei 230032,China;Anhui Provincial Key Laboratory of Population Health and Aristogenics,Hefei 230032,China)

机构地区：[1]安徽医科大学公共卫生学院,合肥230032 [2]出生人口健康教育部重点实验室,合肥230032 [3]人口健康与优生安徽省重点实验室,合肥230032

出　　处：《卫生研究》2023年第5期732-739,共8页Journal of Hygiene Research

基　　金：国家自然科学基金(No.81761128034);加拿大国立卫生研究院-Covid-19快速研究基金(No.RN419823-439880)。

摘　　要：目的探讨孕期吸烟和被动吸烟对产妇抑郁、焦虑和抑郁焦虑共病情绪的独立作用和交互作用。方法招募2020年8月—2022年2月在合肥市长丰县妇幼保健计划生育中心和双凤医院进行产后42天检查的产妇,分别使用爱丁堡产后抑郁量表、广泛性焦虑量表评估其抑郁、焦虑症状,同时收集其孕期吸烟及被动吸烟状况。使用多因素Logistic回归分析产妇孕期吸烟、被动吸烟情况对产后抑郁、焦虑和抑郁焦虑共病情绪的独立及交互作用。结果共纳入2447位产妇,年龄(29.23±4.20)岁,58.6%的产妇居住在城市,97.2%产妇是非辅助生殖,73.5%产妇怀孕意愿是顺其自然。其中发生抑郁362人(14.8%),焦虑523人(21.4%),抑郁焦虑共病270人(11.0%)。在独立作用分析中,产妇孕期吸烟与产后抑郁(OR=3.86,95%CI 2.37~6.28)、焦虑(OR=2.58,95%CI 1.60~4.17)和抑郁焦虑共病(OR=3.34,95%CI 2.00~5.71)发生风险增加相关;产妇孕期被动吸烟也与产后抑郁(OR=1.56,95%CI 2.00~5.71)、焦虑(OR=1.71,95%CI 1.24~2.37)和抑郁焦虑共病(OR=1.52,95%CI 1.02~2.28)的发生风险增加相关,且被动吸烟暴露频率越高,抑郁、焦虑以及抑郁焦虑共病的发生风险越大。未观察到孕期吸烟与被动吸烟暴露对产后抑郁(RERI=0.69,95%CI-4.62~6.00;AP=10.84,95%CI-73.37~95.04;S=0.58,95%CI 0.02~15.18)、焦虑(RERI=0.27,95%CI 0.05~0.49;AP=4.02,95%CI-0.52~8.57;S=0.78,95%CI 0.64~0.94)和抑郁焦虑共病(RERI=0.07,95%CI-0.25~0.39;AP=1.74,95%CI-6.03~9.52;S=0.93,95%CI 0.68~1.27)风险增加存在交互作用。结论孕期吸烟和被动吸烟均与产妇抑郁、焦虑和抑郁焦虑共病情绪的发生风险增加相关。OBJECTIVE To explore the independent and combined effects of smoking and passive smoking during pregnancy on maternal depression,anxiety and depressive anxiety comorbidities.METHODS From August 2020 to February 2022,women who underwent 42-day postpartum examination in Changfeng Women's Center and Shuangfeng Hospital of Hefei were recruited.Their depression and anxiety symptoms were assessed using EPDS Scale and GAD Scale,respectively,and smoking and passive smoking status during pregnancy were collected.Multivariate Logistic regression was used to analyze the independent and combined effects of smoking and passive smoking during pregnancy on postpartum depression,anxiety and depression and anxiety comorbidities.RESULTS A total of 2447 parturients were included,whose mean age was(29.23±4.20)years old.58.6%of parturients lived in urban areas.97.2%parturients had unassisted reproduction and 73.5%pregnancy intention was spontaneous.Among them,362(14.8%)had depression,523(21.4%)had anxiety,and 270(11.0%)had depression and anxiety comorbidities.In an independent analysis of effects,maternal smoking during pregnancy was statistically associated with postpartum depression(OR=3.86,95%CI 2.37-6.28),anxiety(OR=2.58,95%CI 1.60-4.17)and depressive anxiety comorbidity(OR=3.34,95%CI 2.00-5.71).Maternal passive smoking during pregnancy was also positively associated with the risk of postpartum depression(OR=1.56,95%CI 2.00-5.71),anxiety(OR=1.71,95%CI 1.24-2.37)and depression and anxiety comorbidities(OR=1.52,95%CI 1.02-2.28),and the higher the frequency of exposure to passive smoking,the higher risk of depression,anxiety,and depressive and anxiety comorbidities.No interaction between smoking during pregnancy and passive smoking exposure on postpartum depression(RERI=0.69,95%CI-4.62-6.00;AP=10.84,95%CI-73.37-95.04;S=0.58,95%CI 0.02-15.18),anxiety(RERI=0.27,95%CI 0.05-0.49;AP=4.02,95%CI-0.52-8.57;S=0.78,95%CI 0.64-0.94)and depression and anxiety comorbidities(RERI=0.07,95%CI-0.25-0.39;AP=1.74,95%CI-6.03-9.52;S=0.93,95%CI 0.68-1.2

关 键 词：产后抑郁 产后焦虑 抑郁焦虑共病 孕期吸烟 孕期被动吸烟 交互作用 

分 类 号：R173[医药卫生—妇幼卫生保健] R395.6[医药卫生—公共卫生与预防医学]