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孕前体质量、孕期增重等因素对产前抑郁的影响研究

Effects of prepregnancy weight, gestational weight gain and other related factors on antepartum depression

    摘要
  • 摘要:
    目的 探讨孕前体质量、孕期增重(GWG)及其他相关因素对产前抑郁的影响。
    方法 选取559例单胎妊娠孕妇作为研究对象，孕前体质量情况根据体质量指数(BMI)分为孕前低体质量(BMI < 18.5 kg/m2)、孕前正常体质量(BMI 18.5~ < 25.0 kg/m2)和孕前超重/肥胖(BMI≥25.0 kg/m2), GWG情况参照美国医学研究院(IOM)GWG推荐标准分为GWG不足、GWG适宜和GWG过多，分析孕前体质量、GWG及其他相关因素与孕妇产前爱丁堡产后抑郁量表(EPDS)评分的相关性。
    结果 559例孕妇中，孕前低体质量54例(9.7%)、正常体质量427例(76.4%)、超重/肥胖78例(13.9%), GWG不足96例(17.2%)、GWG适宜191例(34.2%)、GWG过多272例(48.7%); 孕前超重/肥胖孕妇中, GWG过多者占65.4%(51/78)。单因素分析结果显示，孕前低体质量、正常体质量、超重/肥胖孕妇的产前EPDS评分比较，差异有统计学意义(P=0.035); GWG不足、GWG适宜、GWG过多孕妇的产前EPDS评分比较，差异无统计学意义(P=0.388)。不同生活质量满意度孕妇、不同妊娠意愿孕妇的产前EPDS评分比较，差异有统计学意义(P=0.002、0.005)。多元线性回归分析结果显示，妊娠意愿、生活质量满意度、产次、孕前超重/肥胖是产前EPDS评分的影响因素(P < 0.05)，其中妊娠意愿、生活质量满意度、产次与产前EPDS评分呈负相关，孕前超重/肥胖与产前EPDS评分呈正相关。
    结论 孕前体质量、妊娠意愿、生活质量满意度、产次是产前抑郁的影响因素, GWG则与产前抑郁无关。孕前超重/肥胖女性孕期抑郁预防措施应侧重于孕前超重/肥胖干预方面，医护人员在围产期保健工作中应重点关注非意愿妊娠和生活质量满意度不高孕妇的心理状态，从而改善其妊娠结局。

     

    Abstract:
    Objective To explore the effects of pre-pregnancy weight, gestational weight gain(GWG) and other relevant factors on antepartum depression.
    Methods A total of 559 singleton pregnant women were selected as research objects. According to the pre-pregnancy body mass index (BMI), the pre-pregnancy body mass was divided into pre-pregnancy underweight (BMI < 18.5 kg/m2), normal body weight (BMI 18.5 to 25 kg/m2) and overweight/obese (BMI≥25.0 kg/m2). Further according to the GWG recommended value by the Institute of Medicine (IOM), GWG were divided into insufficient GWG, appropriate GWG and excessive GWG. The correlations of pre-pregnancy weight, GWG and other related factors with pre-pregnancy score of Edinburgh Postnatal Depression Scale (EPDS) were analyzed.
    Results Among 559 pregnant women, there were 54 cases (9.7%) of low body weight before pregnancy, 427 cases (76.4%) of normal body weight, 78 cases (13.9%) of overweight/obese, 96 cases (17.2%) of insufficient GWG, 191 cases (34.2%) of appropriate GWG, 272 cases (48.7%) of excessive GWG. 65.4% (51/78) of overweight/obese pregnant women had excessive GWG before pregnancy. Single factor analysis results showed that there were significant differences in pre-pregnancy EPDS score among underweight, normal weight and overweight/obese pregnant women (P=0.035). There was no significant difference in pre-pregnancy EPDS among pregnant women with insufficient GWG, appropriate GWG and excessive GWG (P=0.388). There were significant differences in pre-pregnancy EPDS scores among pregnant women with different quality of life satisfaction and different pregnancy intention(P=0.002, P=0.005). Multiple linear regression analysis results showed that pregnancy intention, quality of life satisfaction, parity, overweight/obesity were influencing factors of pre-pregnancy EPDS score(P < 0.05). Pre-pregnancy EPDS score was negatively correlated with pregnancy intention, quality of life satisfaction and parity, and was positively correlated with overweight/obesity before pregnancy.
    Conclusion Pre-pregnancy body mass, pregnancy intention, satisfaction of quality of life, and delivery time are the influencing factors of pre-pregnancy depression, while GWG has no correlation with pre-pregnancy depression. Prevention of depression during pregnancy in overweight/obese women should focus on intervention of overweight/obesity before pregnancy. In the perinatal health care work, medical staff should pay attention to the psychological state of pregnant women with unwanted pregnancy and low satisfaction of life quality, thereby improving their pregnancy outcome.

     

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