Presence of depressive symptoms during early pregnancy and the risk of preterm delivery: a prospective cohort study
Presence of depressive symptoms during early pregnancy and the risk of preterm delivery: a prospective cohort study
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DOI：
10.1093/humrep/den342
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发表时间：
2009-01-01
影响因子：
6.1
通讯作者：
Odouli, R.
中科院分区：
文献类型：
--
作者：
Li, D.;Liu, L.;Odouli, R.
产前抑郁症对妊娠结局的影响在很大程度上是未知的。我们在Kaiser Permanente医疗保健计划的孕妇中进行了一项基于人群的前瞻性队列研究，以检查产前抑郁症对早产风险的影响。我们采访了怀孕早期的孕妇。妇女的抑郁症状采用标准的流行病学研究中心抑郁量表（CESD）确定。显著的产前抑郁症状和严重抑郁症状的存在分别由CESD评分>= 16和>= 22来确定。在回答CESD问题并分娩活产的791名参与者中，在使用考克斯比例风险回归控制潜在混杂因素后，CESD评分>= 16的妇女早产风险几乎是无抑郁症状妇女的两倍：校正风险比（aHR）= 1.9，95%置信区间（CI）1.0-3.7。早产的风险随着抑郁严重程度的增加而增加：CESD 16-21的aHR = 1.6（CI 0.7-3.6），CESD ≥ 22的aHR = 2.2（CI 1.1-4.7）。与产前抑郁症相关的早产风险似乎因教育水平低、生育问题史、肥胖和压力事件的存在而加剧。所观察到的关联并没有被抗抑郁药的使用所混淆，尽管其中一些关联没有达到统计学显著性，我们的研究结果表明，有抑郁症状的孕妇早产的风险增加，此外，提供了初步证据表明，社会和生殖风险因素以及肥胖和压力事件可能会加剧这种影响。
The impact of prenatal depression on pregnancy outcomes is largely unknown.We conducted a population-based prospective cohort study among pregnant women of the Kaiser Permanente Medical Care Program to examine the impact of prenatal depression on the risk of preterm delivery. We interviewed pregnant women in their early pregnancy. Women's depressive symptoms were ascertained using the standard Center for Epidemiological Studies Depression Scale (CESD). The presence of significant prenatal depressive symptoms and severe depressive symptoms was determined by CESD scores >= 16 and >= 22, respectively.Among the 791 participants who answered CESD questions and delivered a live birth, after controlling for potential confounders using the Cox proportional hazard regression, women with CESD scores >= 16 had almost twice the risk of preterm delivery compared with women without depressive symptoms: adjusted hazard ratio (aHR) = 1.9, 95% confidence interval (CI) 1.0-3.7. The risk of preterm delivery increased with increasing severity of depression: aHR = 1.6 (CI 0.7-3.6) for CESD 16-21 and aHR = 2.2 (CI 1.1-4.7) for CESD >= 22. The risk of preterm delivery associated with prenatal depression appears to be exacerbated by low educational level, a history of fertility problems and the presence of obesity and stressful events. The observed associations were not confounded by the use of antidepressants, although some of the associations did not reach statistical significance.Our findings show that pregnant women with depressive symptoms are at increased risk of preterm delivery and, in addition, provide preliminary evidence that social and reproductive risk factors as well as obesity and stressful events may exacerbate the effect.