A meta-analysis of depression during pregnancy and the risk of preterm birth, low birth weight, and intrauterine growth restriction.
A meta-analysis of depression during pregnancy and the risk of preterm birth, low birth weight, and intrauterine growth restriction.
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DOI：
10.1001/archgenpsychiatry.2010.111
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发表时间：
2010-10
影响因子：
--
通讯作者：
Katon, Wayne J.
中科院分区：
文献类型：
--
作者：
Grote, Nancy K.;Bridge, Jeffrey A.;Gavin, Amelia R.;Melville, Jennifer L.;Iyengar, Satish;Katon, Wayne J.
一些（但并非全部）研究报告称，妊娠期间母亲的抑郁症状与早产（PTB）、低出生体重（LBW）和宫内生长受限（IUGR）风险增加有关。评估与产前抑郁症相关的 PTB、LBW 和 IUGR 风险。我们通过 MEDLINE、PsycINFO、CINAHL、Social Work Abstracts、Social Services Abstracts 和 Dissertation Abstracts International 数据库（1980 年 1 月至 2009 年 12 月）检索英语和非英语文章。我们的目的是纳入报告产前抑郁症和至少 1 种不良出生结局数据的前瞻性研究：PTB（<妊娠 37 周）、LBW（<2500 g）或 IUGR（< 胎龄第 10 个百分位）。在 862 项审查的研究中，29 项美国发表和非美国发表的研究符合选择标准。提取有关研究特征、产前抑郁症测量和其他生物心理社会危险因素的信息，并进行两次审查以尽量减少错误。使用随机效应方法计算产前抑郁症对每个出生结果影响的汇总相对风险（RR）。在使用分类抑郁测量的 PTB、LBW 和 IUGR 研究中，与使用连续抑郁测量的研究 (1.03 [1.00–1.06], 分别为 1.04 [0.99–1.09] 和 1.02 [1.00–1.04]）。当使用修剪填充程序来纠正发表偏倚时，对明确定义的产前抑郁症以及 PTB 和 LBW 的风险估计仍然显着。与美国（RR=1.10；95%置信区间，1.01-1.21）或欧洲社会民主国家（RR=1.16；95%置信区间，0.92-1.47）相比，发展中国家低出生体重与产前抑郁症相关的风险显着更大（RR=2.05；95%置信区间，1.43-2.93）。在美国，社会经济地位较低的女性中，明确定义的产前抑郁症往往与 PTB 风险增加相关。怀孕期间患有抑郁症的女性患 PTB 和 LBW 的风险增加，尽管其影响程度因抑郁症测量、国家位置和美国社会经济地位而异。这些发现的一个重要意义是，应通过普遍筛查来识别产前抑郁症并进行治疗。
Maternal depressive symptoms during pregnancy have been reported in some, but not all, studies to be associated with an increased risk of preterm birth (PTB), low birth weight (LBW), and intrauterine growth restriction (IUGR). To estimate the risk of PTB, LBW, and IUGR associated with antenatal depression. We searched for English-language and non–English-language articles via the MEDLINE, PsycINFO, CINAHL, Social Work Abstracts, Social Services Abstracts, and Dissertation Abstracts International databases (January 1980 through December 2009). We aimed to include prospective studies reporting data on antenatal depression and at least 1 adverse birth outcome: PTB (<37 weeks’ gestation), LBW (<2500 g), or IUGR (<10th percentile for gestational age). Of 862 reviewed studies, 29 US-published and non–US-published studies met the selection criteria. Information was extracted on study characteristics, antenatal depression measurement, and other biopsychosocial risk factors and was reviewed twice to minimize error. Pooled relative risks (RRs) for the effect of antenatal depression on each birth outcome were calculated using random-effects methods. In studies of PTB, LBW, and IUGR that used a categorical depression measure, pooled effect sizes were significantly larger (pooled RR [95% confidence interval]=1.39 [1.19–1.61], 1.49 [1.25–1.77], and 1.45 [1.05–2.02], respectively) compared with studies that used a continuous depression measure (1.03 [1.00–1.06], 1.04 [0.99–1.09], and 1.02 [1.00–1.04], respectively). The estimates of risk for categorically defined antenatal depression and PTB and LBW remained significant when the trim-and-fill procedure was used to correct for publication bias. The risk of LBW associated with antenatal depression was significantly larger in developing countries (RR=2.05; 95% confidence interval, 1.43–2.93) compared with the United States (RR=1.10; 95% confidence interval, 1.01–1.21) or European social democracies (RR=1.16; 95% confidence interval, 0.92–1.47). Categorically defined antenatal depression tended to be associated with an increased risk of PTB among women of lower socioeconomic status in the United States. Women with depression during pregnancy are at increased risk for PTB and LBW, although the magnitude of the effect varies as a function of depression measurement, country location, and US socioeconomic status. An important implication of these findings is that antenatal depression should be identified through universal screening and treated.
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