产前身心调节以降低产后抑郁风险并改善分娩结局：西班牙和法国的一项随机对照试验
Antenatal psychosomatic programming to reduce postpartum depression risk and improve childbirth outcomes: a randomized controlled trial in Spain and France.
作者信息
Ortiz Collado Maria Assumpta, Saez Marc, Favrod Jérôme, Hatem Marie
机构信息
La Source, School of Nursing Sciences, University of Applied Sciences of Western Switzerland, 30 Avenue Vinet, CH-1004 Lausanne, Switzerland.
出版信息
BMC Pregnancy Childbirth. 2014 Jan 15;14:22. doi: 10.1186/1471-2393-14-22.
BACKGROUND
Postpartum depression (PPD) and poor childbirth outcomes are associated with poverty; these variables should be addressed by an adapted approach. The aim of this research was to evaluate the impact of an antenatal programme based on a novel psychosomatic approach to pregnancy and delivery, regarding the risk of PPD and childbirth outcomes in disadvantaged women.
METHODS
A multi-centre, randomized, controlled trial comparing a novel to standard antenatal programme. Primary outcome was depressive symptoms (using EPDS) and secondary outcome was preterm childbirth (fewer 37 weeks). The sample comprised 184 couples in which the women were identified to be at PPD risk by validated interview. The study was conducted in three public hospitals with comparable standards of perinatal care. Women were randomly distributed in to an experimental group (EG) or a control group (CG), and evaluated twice: during pregnancy (T1) and four weeks post-partum (T2). At T2, the variables were compared using the chi square test. Data analysis was based on intention to treat. The novel programme used the Tourné psychosomatic approach focusing on body awareness sensations, construction of an individualized childbirth model, and attachment. The 10 group antenatal sessions each lasted two hours, with one telephone conversation between sessions. In the control group, the participants choose the standard model of antenatal education, i.e., 8 to 10 two-hour sessions focused on childbirth by obstetrical prophylaxis.
RESULTS
A difference of 11.2% was noted in postpartum percentages of PPD risk (EPDS ≥ 12): 34.3% (24) in EG and 45.5% (27) in CG (p = 0.26). The number of depressive symptoms among EG women decreased at T2 (intragroup p = 0.01). Premature childbirth was four times less in EG women: three (4.4%) compared to 13 (22.4%) among CG women (p = 0.003). Birth weight was higher in EG women (p = 0.01).
CONCLUSIONS
The decrease of depressive symptoms in women was not conclusive. However, because birth weight was higher and the rate of preterm childbirth was lower in the EG, our results suggest that the psychosomatic approach may be more helpful to the target population than the standard antenatal programs.
背景
产后抑郁症（PPD）和不良分娩结局与贫困相关；这些变量应通过适应性方法来解决。本研究的目的是评估一种基于新型身心方法的产前计划对弱势妇女产后抑郁症风险和分娩结局的影响。
方法
一项多中心、随机对照试验，比较新型产前计划与标准产前计划。主要结局是抑郁症状（使用爱丁堡产后抑郁量表），次要结局是早产（小于37周）。样本包括184对夫妇，其中女性通过有效访谈被确定为有产后抑郁症风险。该研究在三家围产期护理标准相当的公立医院进行。妇女被随机分为实验组（EG）或对照组（CG），并进行两次评估：孕期（T1）和产后四周（T2）。在T2时，使用卡方检验比较变量。数据分析基于意向性分析。新型计划采用图尔内身心方法，重点关注身体感知觉、构建个性化分娩模式和依恋。10次小组产前课程每次持续两小时，课程之间有一次电话沟通。在对照组中，参与者选择标准的产前教育模式，即8至10次两小时的课程，重点是产科预防分娩知识。
结果
产后抑郁症风险（爱丁堡产后抑郁量表≥12）的百分比差异为11.2%：实验组为34.3%（24人），对照组为45.5%（27人）（p = 0.26）。实验组女性的抑郁症状数量在T2时减少（组内p = 0.01）。实验组女性的早产率是对照组的四分之一：实验组为3例（4.4%），对照组为13例（22.4%）（p = 0.003）。实验组女性的出生体重更高（p = 0.01）。
结论
女性抑郁症状的减少并不具有决定性。然而，由于实验组的出生体重更高且早产率更低，我们的结果表明，身心方法可能比标准产前计划对目标人群更有帮助。
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