Previous pregnancy loss has an adverse impact on distress and behaviour in subsequent pregnancy
Previous pregnancy loss has an adverse impact on distress and behaviour in subsequent pregnancy
复制标题
DOI：
10.1111/1471-0528.13233
复制
发表时间：
2015-12-01
影响因子：
5.8
通讯作者：
O'Donoghue, K.
中科院分区：
文献类型：
--
作者：
McCarthy, F. P.;Moss-Morris, R.;O'Donoghue, K.
目的调查有流产史或终止妊娠史的妇女在再次妊娠时是否有更高水平的焦虑、抑郁、压力和行为改变。设计一项对5575名参加妊娠终点筛查（SCOPE）研究的妇女的回顾性分析，该研究是一项前瞻性队列研究。地点：新西兰奥克兰、澳大利亚阿德莱德、爱尔兰科克、曼彻斯特、利兹和伦敦。方法在妊娠15和20周时记录结果，主要结果测量：短形式状态-特质焦虑量表（STAI）评分，感知压力量表评分，爱丁堡产后抑郁量表评分，和妊娠相关行为的测量使用行为反应怀孕评分。结果在最终分析中包括的5465名妇女，559例（10%）有一次流产史，94例（2%）有两次流产史，415例（8%）有一次流产史，66例（1%）有两次流产史。有过一次流产经历的妇女焦虑增加（调整后的平均差异1.85; 95%置信区间，95% CI 0.61-3.09），感知压力（校正的平均差异0.76; 95% CI 0.48-1.03），抑郁（校正比值比，aOR 1.26; 95% CI 1.08-1.45）和妊娠期限制/休息行为（校正平均差异0.80; 95% CI 0.62-0.97）。在两次流产的女性中，抑郁更常见（aOR 1.65; 95% CI 1.01-2.70），并且在妊娠15周时，她们在妊娠期限制/休息行为方面的得分更高（校正平均差异1.70; 95% CI 0.90-2.53）。有一次终止妊娠史的妇女在妊娠15周时表现出较高的压力感知（校正均值差0.65; 95%CI 0.08-1.23）和抑郁（aOR 1.25; 95%CI 1.08-1.45）。妇女与两个以前终止显示增加感知压力（调整后的平均差异1.43; 95%CI 0.00-2.87）和抑郁症（aOR 1.67; 95%1.28 -2.18）。
ObjectiveTo investigate whether women with previous miscarriages or terminations have higher levels of anxiety, depression, stress, and altered behaviours in a subsequent pregnancy.DesignA retrospective analysis of 5575 women recruited into the Screening for Pregnancy Endpoints (SCOPE) study, a prospective cohort study.SettingAuckland, New Zealand, Adelaide, Australia, Cork, Ireland, and Manchester, Leeds, and London, UK.PopulationHealthy nulliparous women with singleton pregnancies.MethodsOutcomes were recorded at 15 and 20weeks of gestation.Main outcome measuresShort-form State-Trait Anxiety Inventory (STAI) score, Perceived Stress Scale score, Edinburgh Postnatal Depression Scale score, and pregnancy-related behaviour measured using behavioural responses to pregnancy score.ResultsOf the 5465 women included in the final analysis, 559 (10%) had one and 94 (2%) had two previous miscarriages, and 415 (8%) had one and 66 (1%) had two previous terminations of pregnancy. Women with one previous miscarriage had increased anxiety (adjusted mean difference 1.85; 95% confidence interval, 95% CI 0.61-3.09), perceived stress (adjusted mean difference 0.76; 95% CI 0.48-1.03), depression (adjusted odds ratio, aOR 1.26; 95% CI 1.08-1.45), and limiting/resting behaviour in pregnancy (adjusted mean difference 0.80; 95% CI 0.62-0.97). In women with two miscarriages, depression was more common (aOR 1.65; 95% CI 1.01-2.70) and they had higher scores for limiting/resting behaviour in pregnancy (adjusted mean difference 1.70; 95% CI 0.90-2.53) at 15weeks of gestation. Women with one previous termination displayed elevated perceived stress (adjusted mean difference 0.65; 95% CI 0.08-1.23) and depression (aOR 1.25; 95% 1.08-1.45) at 15weeks of gestation. Women with two previous terminations displayed increased perceived stress (adjusted mean difference 1.43; 95% CI 0.00-2.87) and depression (aOR 1.67; 95% 1.28-2.18).ConclusionsThis study highlights the psychological implications of miscarriage and termination of pregnancy.