Gold Katherine J, Dalton Vanessa K, Schwenk Thomas L, Hayward Rodney A
Department of Family Medicine, University of Michigan, Ann Arbor, MI 48109-0239, USA.
Gen Hosp Psychiatry. 2007 May-Jun;29(3):207-13. doi: 10.1016/j.genhosppsych.2007.02.002.
Maternal mental health disorders in pregnancy are common and are associated with prematurity, low birth weight and delivery complications. We explored whether existing mental illness was associated not just with fetal complications but also with fetal death.
We conducted a retrospective cohort analysis using data from the National Comorbidity Survey (NCS). The NCS is a nationally representative multistage probability study of the prevalence of psychiatric disorders in the United States. We analyzed the association between a prepregnancy mental health diagnosis and subsequent miscarriage or stillbirth, using multivariable logistic regression to control for maternal age, race, health risks and other independent risk factors for fetal death.
Patients with any mental health disorder prior to pregnancy [odds ratio (OR)=1.8], specifically those with affective disorders (OR=1.6) or substance use disorders (OR=1.4), were at significantly higher risk for fetal mortality in pregnancy. This risk remained significant even when controlling for health and behavioral risk factors that cause fetal loss.
These results are consistent with studies showing mental health to be independently associated with morbidity and mortality in heart disease, stroke and cancer. The etiology remains poorly understood, but may include neuroendocrine, behavioral and genetic mediators.
孕期母亲心理健康障碍很常见，且与早产、低出生体重和分娩并发症有关。我们探讨了现有的精神疾病是否不仅与胎儿并发症有关，还与胎儿死亡有关。
我们使用来自全国共病调查（NCS）的数据进行了一项回顾性队列分析。NCS是一项对美国精神疾病患病率进行的具有全国代表性的多阶段概率研究。我们分析了孕前心理健康诊断与随后的流产或死产之间的关联，使用多变量逻辑回归来控制母亲年龄、种族、健康风险和其他胎儿死亡的独立风险因素。
孕前患有任何心理健康障碍的患者[比值比（OR）=1.8]，特别是患有情感障碍（OR=1.6）或物质使用障碍（OR=1.4）的患者，孕期胎儿死亡风险显著更高。即使在控制了导致胎儿丢失的健康和行为风险因素后，这种风险仍然显著。
这些结果与表明心理健康与心脏病、中风和癌症的发病率和死亡率独立相关的研究一致。病因仍知之甚少，但可能包括神经内分泌、行为和遗传介质。
