孕期抑郁症状的变化轨迹对分娩方式的影响:从孕早期到孕中晚期的动态观察  

The Impact of changes in antenatal depressive symptoms trajectory on delivery mode:a dynamic observation from first trimester to third trimester

作　　者：于莹[1] 刘凯波[1] 杨惠娟[1] YU Ying;LIU Kaibo;YANG Huijuan(Department of Perinatal Healthcare,Beijing Obstetrics and Gynecology Hospital,Capital Medical University.Beijing Maternal and Child Health Care Hospital,Beijing 100026,China)

机构地区：[1]首都医科大学附属北京妇产医院/北京妇幼保健院围产保健科,100026

出　　处：《中国生育健康杂志》2025年第3期208-213,234,共7页Chinese Journal of Reproductive Health

基　　金：首都卫生发展科研专项项目-北京市高危孕产妇管理策略研究与评估(2018-2-2111)。

摘　　要：目的探讨孕期抑郁症状的变化轨迹对分娩方式的影响,揭示孕期抑郁症状与剖宫产之间的关系。方法在北京市领取母子健康手册的孕妇分别于孕早期和孕中晚期通过“北京妇幼健康服务”公众号使用患者健康问卷抑郁量表(PHQ-9)进行心理健康评估,评估结果实时上传至北京市妇幼信息系统中。数据来源于北京市妇幼信息系统中于2023年1月1日—2023年12月31日分娩的孕产妇。根据孕期抑郁症状(定义为PHQ-9总分≥5分且最后一项不为0被视为结果异常)的变化将孕产妇分为正常组和异常组,正常组包括孕早期和孕中晚期评估结果均正常(全程正常组),或孕早期出现异常但孕中晚期恢复正常的孕产妇(转变为正常组);异常组包括孕早期心理健康评估结果正常但孕中晚期出现异常(转变为异常组),或孕早期和孕中晚期均出现异常者(全程异常组)。对孕期抑郁症状变化及其与分娩方式之间的关系进行单因素和多因素统计学分析。结果共纳入孕产妇100258人,正常组84386人(84.2%),异常组15872(15.8%)人。正常组中全程正常组67575人(80.1%)、转变为正常组16811人(19.9%);异常组中全程异常组9053人(57.0%)、转变为异常组6819人(43.0%)。分娩方式比较结果显示,转变为异常组剖宫产率最高(43.0%)。单因素分析显示,分娩年龄、户籍、BMI、产次、剖宫产史、高血压以及前置胎盘与孕期抑郁症状变化显著相关,阴道分娩孕产妇中孕期抑郁症状变化异常比例(15.9%)略高于剖宫产孕产妇(15.2%)。多因素分析显示,孕期抑郁症状变化异常与选择剖宫产显著相关(OR=1.06,95%CI:1.01~1.11)。分层分析显示,在高学历、初产妇以及无剖宫产史、无前置胎盘和无胎盘早剥的孕妇中,关联更为显著。结论孕期抑郁症状的变化轨迹与分娩方式之间存在一定关联,孕期抑郁症状变化异常孕妇更倾向于选择剖宫产。提示在孕期保健工Objective To explore the impact of changes in prenatal depressive symptoms on delivery methods and to reveal the relationship between prenatal depressive symptoms and cesarean section.Methods Pregnant women who received the Mother and Child Health Handbook in Beijing underwent mental health assessments using the Patient Health Questionnaire-9(PHQ-9)via the“Beijing Maternal and Child Health Service”WeChat public account during early pregnancy and mid-to-late pregnancy.The assessment results were uploaded in real-time to the Beijing Maternal and Child Health Information System.Data were obtained from pregnant women who gave birth between January 1,2023,and December 31,2023.Based on changes in prenatal depressive symptoms(defined as a PHQ-9 total score≥5 with a non-zero score on the last item indicating abnormal results),pregnant women were divided into a normal group and an abnormal group.The normal group included those whose assessment results were normal in both early pregnancy and mid-to-late pregnancy(consistently normal group),as well as those who had abnormal results in early pregnancy but returned to normal in mid-to-late pregnancy(recovered to normal group).The abnormal group included those with normal results in early pregnancy but abnormal results in mid-to-late pregnancy(developed abnormalities group)and those with abnormal results in both early pregnancy and mid-to-late pregnancy(consistently abnormal group).Univariate and multivariate statistical analyses were conducted to examine the relationship between changes in prenatal depressive symptoms and delivery methods.Results A total of 100,258 pregnant women were included,with 84,386(84.2%)in the normal group and 15,872(15.8%)in the abnormal group.Among the normal group,67,575(80.1%)were in the consistently normal group,and 16,811(19.9%)were in the recovered to normal group.In the abnormal group,9,053(57.0%)were in the consistently abnormal group,and 6,819(43.0%)were in the developed abnormalities group.Comparisons of delivery methods showed that t

关 键 词：孕期抑郁症状 分娩方式 剖宫产率 心理健康评估 动态观察 

分 类 号：R17[医药卫生—妇幼卫生保健] R71[医药卫生—公共卫生与预防医学]