Unintended Birth, Fetal and Infant Loss and Maternal Depressive Symptoms

描述(由申请者提供)：抑郁症是最普遍的精神健康疾病，在全球范围内，女性发生抑郁症的可能性是前者的两倍。在孟加拉国农村地区，妇女在计划怀孕方面的自主权和成功怀孕的可能性仍然不确定，死产、围产期和新生儿死亡率比发达国家高五倍以上。对于几乎没有机会获得医疗服务的农村妇女来说，这一比例可能会更高。我们的目的是研究：1)意外怀孕与妊娠晚期和产后6个月母亲抑郁症状的关系；2)意外怀孕、胎儿和新生儿丧失与产后母亲抑郁症状的关系；3a)意外怀孕与产后母亲抑郁症状的关系是否因子女性别而异；以及3b)胎儿或新生儿丧失与产后母亲抑郁症状的关系是否因子女性别而不同。流产、死产、围产期死亡和新生儿死亡将作为危险因素单独检查。拟议的二次分析使用了2001年至2007年在孟加拉国西北部农村对约60,000名孕妇进行的一项基于人群的随机产前微量营养素补充试验的数据。妇女在怀孕早期登记，产后随访6个月。妊娠结局和婴儿生命状态在3个月大期间每周监测一次。在妊娠晚期和6个月时，母亲对常见抑郁症状和自杀问题的反应引发了抑郁症状。统计方法将包括描述性分析和计算调整后的风险比，以检查意外怀孕和胎儿和新生儿死亡事件，作为随后抑郁症状的预测因素。我们将评估每个父母的怀孕意图以及母亲和父亲怀孕意图之间的不协调对母亲抑郁症状的影响。在大量南亚人口中，将意外怀孕和失去胎儿或婴儿作为抑郁症状的风险因素的记录，将有助于显示这些因素的程度，并指导与脆弱时期有关的干预措施，因为在这个时期，母亲的心理健康对其其他孩子的健康发展至关重要。 公共卫生相关性：这项拟议的研究利用了在孟加拉国农村地区的孕妇和产后妇女中进行的一项基于人群的大型补充试验。我们的目标是更好地了解意外怀孕、胎儿和新生儿丢失以及儿童性别作为母亲抑郁症状的预测因素。最终，产前和产后抑郁症状的危险因素的识别将为筛查程序、未来的流行病学研究以及干预设计和评估提供依据。

DESCRIPTION (provided by applicant): Depression is the most prevalent mental health disorder and globally is two times more likely to occur in women. In rural areas of Bangladesh, women's autonomy in planning pregnancy and the likelihood of successful pregnancy remain uncertain, with stillbirth, perinatal and neonatal death occurring at over five-fold higher rates than in developed countries. These rates are likely to be higher for rural women with little access to medical care. Our aims are to study: 1) the relation of unintended pregnancy to maternal depressive symptoms in the third trimester of pregnancy and at six months postpartum; 2) the relation of unintended pregnancy and fetal and neonatal loss to postpartum maternal depressive symptoms; 3a) whether the relation of unintended pregnancy with postpartum maternal depressive symptoms differs by gender of the offspring; and 3b) whether the relation of fetal or neonatal loss with postpartum maternal depressive symptoms differs by gender of the offspring. Miscarriage, stillbirth, perinatal death, and neonatal death will be examined separately as risk factors. The proposed secondary analysis uses data from a population-based, randomized antenatal micronutrient supplementation trial conducted from 2001 to 2007 in northwestern rural Bangladesh among ~60,000 pregnant women. Women were enrolled in early gestation and followed through 6 months postpartum. Pregnancy outcomes and infant vital status were monitored weekly through 3 months of age. In the third trimester and at 6 months, symptoms of depression were elicited by maternal responses to questions about common depressive symptoms as well as about suicide. Statistical methods will include descriptive analyses and calculation of adjusted risk ratios to examine unintended pregnancy and fetal and neonatal death events as predictors of subsequent depressive symptoms. We will assess the effects of pregnancy intent from each parent as well as discordance between maternal and paternal pregnancy intentions on maternal depressive symptoms. Documentation of unintended pregnancy and loss of a fetus or infant as risk factors for depressive symptoms in a large South Asian population will help to show their extent and guide interventions relevant to a vulnerable period when maternal mental health is critical for the healthy development of her other children. PUBLIC HEALTH RELEVANCE: The proposed research takes advantage of a large population-based supplementation trial conducted among pregnant and postpartum women in rural Bangladesh. Our goal is to better understand unintended pregnancy, fetal and neonatal loss, and child gender as predictors of maternal depressive symptoms. Ultimately, identification of risk factors for prenatal and postpartum depressive symptoms will inform screening procedures, future epidemiological studies and intervention design and evaluation.