Association of antepartum depression, generalized anxiety, and posttraumatic stress disorder with infant birth weight and gestational age at delivery
Association of antepartum depression, generalized anxiety, and posttraumatic stress disorder with infant birth weight and gestational age at delivery
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DOI：
10.1016/j.jad.2019.11.006
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发表时间：
2020-02-01
影响因子：
6.6
通讯作者：
Williams, Michelle A.
中科院分区：
文献类型：
--
作者：
Gelaye, Bizu;Sanchez, Sixto E.;Williams, Michelle A.
背景：低收入和中等收入国家承受着不成比例的早产（PTB）和低出生体重（LBW）并发症负担，在这些国家，产前情感和焦虑障碍比工业化国家更为常见。目的：在秘鲁的一组孕妇中，评估妊娠早期产前抑郁、广泛性焦虑障碍和创伤后应激障碍（PTSD）与婴儿出生体重和分娩时胎龄的关联程度。方法：我们的前瞻性队列研究包括4408名孕妇。产前抑郁、广泛性焦虑和创伤后应激障碍在怀孕早期分别使用患者健康问卷-9、广泛性焦虑障碍量表-7和创伤后应激障碍检查表-平民版进行评估。妊娠结局数据来自医疗记录。使用多变量线性和逻辑回归程序来估计调整后的相关性测量（β系数和优势比）和95%置信区间（CI）。结果：调整混杂因素后，产前广泛性焦虑妇女（患病率32.6%）发生LBW的几率较高(校正优势比(OR) = 1.47；95%CI: 1.10-1.95)，与没有焦虑的人相比，更有可能产下小于胎龄的婴儿（OR = 1.39; 95%CI: 1.01-1.92）。与没有创伤后应激障碍的妇女相比，患有创伤后应激障碍的妇女（34.5%）早产的几率更高（OR = 1.28; 95%CI: 1.00-1.65），但创伤后应激障碍与LBW和分娩时胎龄无关。患有产前抑郁症的妇女（26.2%）没有增加早产、低出生体重或小于胎龄婴儿的风险。局限性：我们从观察性研究中随意推断的能力是有限的；然而，这些发现与先前的研究一致。结论：怀孕期间的广泛性焦虑障碍似乎增加了分娩低出生体重或胎龄小的婴儿的几率，而创伤后应激障碍与早产的几率增加有关。我们的研究结果和其他人的研究结果表明，产前护理应该量身定制，以筛查并为患者提供额外的心理健康服务。
Background: Low- and middle-income countries bear a disproportionate burden of preterm birth (PTB) and low infant birth weight (LBW) complications where affective and anxiety disorders are more common in the antepartum period than in industrialized countries.Objective: To evaluate the extent to which early pregnancy antepartum depression, generalized anxiety disorder, and posttraumatic stress disorder (PTSD) are associated with infant birth weight and gestational age at delivery among a cohort of pregnant women in Peru.Methods: Our prospective cohort study consisted of 4408 pregnant women. Antepartum depression, generalized anxiety, and PTSD were assessed in early pregnancy using the Patient Health Questionnaire-9, Generalized Anxiety Disorder Scale-7 and PTSD Checklist - Civilian Version, respectively. Pregnancy outcome data were obtained from medical records. Multivariable linear and logistic regression procedures were used to estimate adjusted measures of association (beta coefficients and odds ratios) and 95% confidence intervals (CI).Results: After adjusting for confounders, women with antepartum generalized anxiety (32.6% prevalence) had higher odds of LBW (adjusted odds ratio (OR) = 1.47; 95%CI: 1.10-1.95) and were more likely to deliver small for gestational age (OR = 1.39; 95%CI: 1.01-1.92) infants compared to those without anxiety. Compared to those without PTSD, women with PTSD (34.5%) had higher odds of delivering preterm (OR = 1.28; 95%CI: 1.00-1.65) yet PTSD was not associated with LBW nor gestational age at delivery. Women with antepartum depression (26.2%) were at no increased risk of delivering a preterm, low-birth-weight or small-for-gestational-age infant.Limitations: Our ability to make casual inferences from this observational study is limited; however, these findings are consistent with prior studies.Conclusion: Generalized anxiety disorder during pregnancy appeared to increase odds of delivering a low-birth-weight or small-for-gestational-age infant, while PTSD was associated with increased odds of delivering preterm. Our findings, and those of others, suggest antenatal care should be tailored to screen for and provide additional mental health services to patients.