产前抑郁轨迹与胎儿不良出生结局之间的关联:同济-华西-双流出生队列  

Trajectories of antenatal depression in pregnant women and their association with adverse birth outcomes:Tongji-Huaxi-Shuangliu birth cohort

作　　者：李娴丽 王静怡 徐嘉婧 袁佳英 刘刚 潘安 潘雄飞 LI Xianli;WANG Jingyi;XU Jiajing;YUAN Jiaying;LIU Gang;PAN An;PAN Xiongfei(Department of Epidemiology and Biostatistics,Ministry of Education Key Laboratory of Environment and Health,School of Public Health,Tongji Medical College,Huazhong University of Science and Technology,Wuhan 430030,China;Shuangliu Institute of Women′s and Children′s Health,Shuangliu Maternal and Child Health Hospital,Chengdu 610200,China;Department of Nutrition and Food Hygiene,Hubei Key Laboratory of Food Nutrition and Safety,School of Public Health,Tongji Medical College,Huazhong University of Science and Technology,Wuhan 430030,China;Ministry of Education Key Laboratory of Birth Defects and Related Diseases of Women and Children,West China Second University Hospital,Sichuan University,Chengdu 610041,China)

机构地区：[1]华中科技大学同济医学院公共卫生学院,环境与健康教育部重点实验室,流行病学与生物统计学教研室,武汉430030 [2]成都市双流区妇幼保健院双流妇幼医学研究中心,成都610200 [3]华中科技大学同济医学院公共卫生学院营养与食品卫生系食品营养与安全湖北省重点实验室,武汉430030 [4]四川大学华西第二医院出生缺陷与相关妇儿疾病教育部重点实验室,成都610041

出　　处：《中华疾病控制杂志》2025年第1期8-14,41,共8页Chinese Journal of Disease Control & Prevention

基　　金：国家重点研发计划(2022YFC2702905)。

摘　　要：目的分析中国西南地区女性产前抑郁的变化轨迹,并进一步探究产前抑郁轨迹与胎儿不良出生结局之间的关联。方法基于2017―2020年同济-华西-双流出生队列,本研究纳入4741对孕妇及其子代。所有参与者在孕早期(≤15孕周)、孕中期(24~28孕周)和孕晚期(>28孕周)通过爱丁堡产后抑郁量表进行3次抑郁症状的评估。胎儿的出生结局从分娩时的电子医疗记录中获得。通过潜在类别混合模型拟合产前抑郁的变化轨迹,使用基于倾向性评分的逆概率加权法平衡混杂因素,利用logistic回归分析模型探究不同轨迹对胎儿出生结局的影响。结果本研究定义了4组产前抑郁轨迹,并根据其变化趋势分别定义为低水平稳定组(n=1327,27.99%)、中等水平稳定组(n=2610,55.05%)、先升高后下降组(n=407,8.59%)和先下降后升高组(n=397,8.37%)。相较于低水平稳定组,先下降后升高组的孕妇分娩低出生体重儿(OR=2.29,95%CI:1.06~4.97)和早产儿(OR=1.91,95%CI:1.09~3.33)的风险增加(均P<0.05),而小于胎龄儿的风险差异无统计学意义(OR=0.80,95%CI:0.45~1.39,P=0.424)。结论产前抑郁在妊娠期间处于动态变化中,且不同的抑郁轨迹与不良出生结局风险关系存在差异。全孕期了解孕妇抑郁症状的发生发展有助于及时采取干预措施,以预防不良出生结局的发生。Objective To identify longitudinal trajectories of antenatal depression among pregnant women in southwest China and assess their associations with adverse birth outcomes.Methods From 2017 to 2020,4741 pairs of pregnant women and their offspring were included in the Tongji-Huaxi-Shuangliu Birth Cohort.All participants used the validated Chinese version of the Edinburgh Postnatal Depression Scale to assess depressive symptoms throughout early(≤15 weeks),middle(24-28 weeks),and late(>28 weeks)pregnancy stages.Fetal birth outcomes were obtained from electronic medical records at delivery.The latent class mixed model was used to identify the trajectories of antenatal depression.The associations between depression trajectories and adverse birth outcomes were examined using propensity score-based inverse probability of treatment weighting and logistic regression modeling.Results We identified four distinct trajectories,including the low-stable group(n=1327,27.99%),moderate-stable group(n=2610,55.05%),up-then-down group(n=407,8.59%),and down-then-up group(n=397,8.37%).Compared to the low-stable group,the down-then-up group showed higher risks of low birth weight(OR=2.29,95%CI:1.06-4.97)and preterm birth(OR=1.91,95%CI:1.09-3.33)(all P<0.05),but the association was not significant for newborns of small for gestational age(OR=0.80,95%CI:0.45-1.39,P=0.424).Conclusions There existed dynamic change patterns in antennal depression during the whole pregnancy,which were differentially associated with adverse birth outcomes.Identifying the onset and development of antenatal depression can facilitate timely interventions in order to prevent adverse birth outcomes.

关 键 词：产前抑郁 潜在类别混合模型 轨迹 不良出生结局 

分 类 号：R181[医药卫生—流行病学] R173[医药卫生—公共卫生与预防医学]