Prepregnancy body mass index, gestational weight gain, and the likelihood of major depressive disorder during pregnancy.
Prepregnancy body mass index, gestational weight gain, and the likelihood of major depressive disorder during pregnancy.
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DOI：
10.4088/jcp.08m04651
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发表时间：
2009-09
期刊：
影响因子：
--
通讯作者：
Hanusa BH
中科院分区：
文献类型：
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作者：
Bodnar LM;Wisner KL;Moses-Kolko E;Sit DK;Hanusa BH
我们评估了孕前体重指数（BMI）与孕期重度抑郁症（MDD）可能性之间的关系，并测试了这种关联是否会因孕期体重增加而改变。妇女（n=242）在妊娠<20周时被纳入前瞻性队列研究。在20、30和36周时，通过DSM-IV的结构化临床访谈对重度抑郁症进行诊断。将妊娠期体重增加与1990年医学研究所体重增加建议值进行比较。为了评估孕前BMI与MDD几率之间的独立相关性，在采用广义估计方程的多变量纵向logistic回归模型中，将各时间点的MDD作为因变量。孕前BMI与MDD的可能性之间存在强烈的正剂量反应相关性（p=0.002）。与BMI为18的患者相比，BMI为23、28和33的校正优势比（95%可信区间）分别为1.4（1.1,1.7）、1.9（1.3,2.9）和2.6（1.4,4.3）。妊娠期体重增加明显改变了这种效果。在体重增加达到或超过1990年IOM建议值的女性中，孕前超重与患重度抑郁症的可能性较大有关。相比之下，所有体重增加低于推荐水平的女性患抑郁症的几率都增加，无论孕前BMI如何（p<0.05）。因为孕前超重、妊娠期体重增加不佳和重度抑郁症都对胎儿发育和出生结果构成重大风险，卫生保健提供者应监测这些妇女的抑郁水平，以促进适当的抑郁干预。
We assessed the relation between prepregnancy body mass index (BMI) and the likelihood of major depressive disorder (MDD) during pregnancy and test whether this association was modified by gestational weight gain. Women (n=242) were enrolled at <20 weeks gestation into a prospective cohort study. Diagnosis of MDD was made with the Structured Clinical Interview for DSM-IV at 20, 30, and 36 weeks. Gestational weight gain was compared with the 1990 Institute of Medicine weight gain recommendations. To assess the independent association between prepregnancy BMI and the odds of MDD, MDD at each time point was used as the dependent measure in a multivariable longitudinal logistic regression model employing generalized estimating equations. There was a strong, positive dose-response association between prepregnancy BMI and the likelihood of MDD (p=0.002). Compared with a BMI of 18, the adjusted odds ratios (95% confidence interval) for BMIs of 23, 28, and 33 were 1.4 (1.1, 1.7), 1.9 (1.3, 2.9), and 2.6 (1.4, 4.3), respectively. Gestational weight gain significantly modified this effect. Among women with weight gains within and above the 1990 IOM recommendations, pregravid overweight was associated with a greater likelihood of major depression. In contrast, all women with weight gains below recommended levels had an elevated odds of depression, regardless of their pregravid BMI (p<0.05). Because pregravid overweight, poor gestational weight gain, and major depression all pose substantial risks for fetal development and birth outcomes, health care providers should monitor depression levels in these women to facilitate appropriate depression intervention.