Polycystic ovary syndrome and postpartum depression symptoms: a population-based cohort study.
Polycystic ovary syndrome and postpartum depression symptoms: a population-based cohort study.
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DOI：
10.1016/j.ajog.2020.12.1215
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发表时间：
2021-06
影响因子：
9.8
通讯作者：
Schliep K
中科院分区：
文献类型：
--
作者：
Koric A;Singh B;VanDerslice JA;Stanford JB;Rogers CR;Egan DT;Agyemang DO;Schliep K
多囊卵巢综合征的女性比没有多囊卵巢综合征的女性更容易经历几种妊娠并发症，包括高血压疾病，妊娠糖尿病和早产。然而，目前，关于多囊卵巢综合征是否与怀孕期间的焦虑和抑郁有关，以及这是否会增加妇女患产后抑郁症的风险，特别是在获得护理有限的高危人群中，研究有限。我们的主要目的是评估孕前多囊卵巢综合征和产后抑郁症之间的关系，考虑重要的基线混杂因素。我们的次要目的是评估产前抑郁和焦虑在多囊卵巢综合征和产后抑郁之间的中介作用。这项研究涉及3906名产后（2-6个月）妇女的基于人群的样本，这些妇女完成了犹他州妊娠风险评估监测系统第8期问卷（2016-2018年）。加权校正患病率被用来评估多囊卵巢综合征和产后抑郁症之间的关联，考虑潜在的混杂因素，并评估怀孕期间经历的抑郁和焦虑的中介作用。根据排除标准，8.2%的女性报告了临床多囊卵巢综合征，19.1%、6.2%和4.4%的女性分别报告了月经不调和痤疮、月经不调和多毛症以及所有3种症状。此外，分别有17.7%和23.5%的人报告经历过产前抑郁和焦虑，9.5%和10.2%的人报告经历过产后抑郁情绪和快感缺乏。在考虑年龄、孕前体重指数、种族/民族、教育和婚姻状况后，临床多囊卵巢综合征与产后抑郁情绪或快感缺乏的校正患病率比高1.76（95%置信区间，1.03-3.00）相关。月经不调和痤疮的患病率也较高（校正患病率比，1.65; 95%置信区间，1.13-2.41），月经不规则和多毛症（校正患病率比，1.40; 95%置信区间，0.82-2.40），所有3种症状（校正的患病率比，1.75; 95%可信区间，0.96-3.19）和产后抑郁情绪或快感缺乏。产前抑郁和焦虑分别介导了临床多囊卵巢综合征对产后抑郁情绪和快感缺乏的20%和32%的影响。临床多囊卵巢综合征与产后抑郁情绪和症状之间的这一人口为基础的样本，包括高风险的母亲。产前抑郁和焦虑介导了这种关联，强调了多囊卵巢综合征妇女产前心理筛查的重要性。这项研究的另一个重要的临床和公共卫生意义在于发现，在这个基于人群的样本中，近20%报告至少2种多囊卵巢综合征症状的女性（包括可能无法获得护理的高危女性）没有接受过多囊卵巢综合征的临床诊断。
Women with polycystic ovary syndrome are more likely to experience several pregnancy complications including hypertensive disorders, gestational diabetes mellitus, and preterm births than women without polycystic ovary syndrome. However, at present, there is limited research on whether polycystic ovary syndrome is associated with both anxiety and depression during pregnancy and whether this augments a woman’s risk of postpartum depression, particularly among high-risk populations who have limited access to care. Our primary objective was to assess the association between prepregnancy polycystic ovary syndrome and postpartum depression, considering important baseline confounding factors. Our secondary objective was to evaluate the mediating role of prenatal depression and anxiety on the association between polycystic ovary syndrome and postpartum depression. This study involved a population-based sample of 3906 postpartum (2–6 months) women who completed the Utah Pregnancy Risk Assessment Monitoring System Phase 8 questionnaire (2016–2018). Weighted adjusted prevalence ratios were used to assess the association between polycystic ovary syndrome and postpartum depression, considering potential confounding factors and assessing mediating effects of depression and anxiety experienced during pregnancy. Following the exclusion criteria, 8.2% of women reported clinical polycystic ovary syndrome and 19.1%, 6.2%, and 4.4% reported irregular periods and acne, irregular periods and hirsutism, and all 3 symptoms, respectively. Moreover, 17.7% and 23.5% reported experiencing prenatal depression and anxiety and 9.5% and 10.2% reported experiencing postpartum depressed mood and anhedonia, respectively. Clinical polycystic ovary syndrome was associated with a 1.76 higher adjusted prevalence ratio (95% confidence interval, 1.03–3.00) for postpartum depressed mood or anhedonia after taking into consideration age, prepregnancy body mass index, race/ethnicity, education, and marital status. A similar higher prevalence was seen for irregular periods and acne (adjusted prevalence ratio, 1.65; 95% confidence interval, 1.13–2.41), irregular periods and hirsutism (adjusted prevalence ratio, 1.40; 95% confidence interval, 0.82–2.40), and all 3 symptoms (adjusted prevalence ratio, 1.75; 95% confidence interval, 0.96–3.19) and postpartum depressed mood or anhedonia. Prenatal depression and anxiety mediated 20% and 32% of the effect of clinical polycystic ovary syndrome on postpartum depressed mood and anhedonia, respectively. Clinical polycystic ovary syndrome is associated with postpartum depressed mood and symptoms among this population-based sample inclusive of high-risk mothers. Prenatal depression and anxiety mediate this association, emphasizing the importance of prenatal psychological screening among women with polycystic ovary syndrome. An additional important clinical and public health implication of this study lies in the finding that nearly 20% of women in this population-based sample who reported at least 2 polycystic ovary syndrome symptoms (including at-risk women who may not have access to care) had not received a clinical diagnosis for polycystic ovary syndrome.
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