Winkel Susanne, Einsle Franziska, Pieper Lars, Höfler Michael, Wittchen Hans-Ulrich, Martini Julia
Institute for Clinical Psychology and Psychotherapy, Technische Universität Dresden, Chemnitzer Straße 46, 01187, Dresden, Germany,
Arch Womens Ment Health. 2015 Jun;18(3):473-83. doi: 10.1007/s00737-014-0474-z. Epub 2014 Nov 25.
The purpose of this study was to prospectively examine the relationships between maternal DSM-IV-TR anxiety disorders, depressive disorders, and body mass index (BMI) with arterial hypertension and blood pressure during pregnancy. In the Maternal Anxiety in Relation to Infant Development (MARI) study, N = 306 women were enrolled in early pregnancy and repeatedly assessed during peripartum period. DSM-IV-TR anxiety and depressive disorders prior to pregnancy, lifetime anxiety/depression liability, and BMI during early pregnancy were assessed with the Composite International Diagnostic Interview for Women (CIDI-V). Based on their prepregnancy status, all participants were assigned to one of the following initial diagnostic groups: no anxiety nor depressive disorder (no AD), pure depressive disorder (pure D), pure anxiety disorder (pure A), and comorbid anxiety and depressive disorder (comorbid AD). Blood pressure measurements were derived from medical records. Arterial hypertension during pregnancy was defined by at least two blood pressure values ≥140 mmHg systolic and/or ≥90 mmHg diastolic. N = 283 women with at least four documented blood pressure measurements during pregnancy were included in the analyses. In this sample, N = 47 women (16.6 %) were identified with arterial hypertension during pregnancy. Women with comorbid AD (reference group: no AD) had a significantly higher blood pressure after adjustment for age, parity, smoking, occupation, household income, and education (systolic: linear regression coefficient [β] = 3.0, 95 % confidence interval [CI] = 0.2-5.7; diastolic, β = 2.3, 95 % CI = 0.1-4.4). Anxiety liability was associated with an increased risk of hypertension (odds ratio [OR] = 1.1, 95 % CI = 1.0-1.3) and a higher systolic blood pressure (β = 0.4, 95 % CI = 0.0-0.7). The adjusted interaction model revealed a significant interaction between the diagnostic group pure A and BMI for hypertension (ORIT = 1.5, 95 % CI = 1.1-2.1). Especially, women with a lifetime history of comorbid anxiety and depression and obese pregnant women with a lifetime history of pure anxiety disorder should be informed about their heightened risk of hypertension, monitored with regular blood pressure measurements, and provided with strategies for prevention and early intervention such as changes in diet and physical activity.
本研究的目的是前瞻性地探讨孕期母亲的《精神疾病诊断与统计手册》第四版修订版（DSM-IV-TR）焦虑症、抑郁症和体重指数（BMI）与动脉高血压和血压之间的关系。在母婴焦虑与婴儿发育关系（MARI）研究中，306名女性在孕早期入组，并在围产期进行多次评估。使用女性综合国际诊断访谈（CIDI-V）评估孕前的DSM-IV-TR焦虑症和抑郁症、终生焦虑/抑郁易感性以及孕早期的BMI。根据孕前状态，所有参与者被分配到以下初始诊断组之一：无焦虑症和抑郁症（无AD）、单纯抑郁症（单纯D）、单纯焦虑症（单纯A）以及焦虑症和抑郁症共病（共病AD）。血压测量值来自病历记录。孕期动脉高血压的定义为至少两次血压值收缩压≥140 mmHg和/或舒张压≥90 mmHg。分析纳入了283名在孕期至少有四次记录血压测量值的女性。在这个样本中，47名女性（16.6%）在孕期被诊断为动脉高血压。在对年龄、产次、吸烟、职业、家庭收入和教育进行调整后，共病AD的女性（参照组：无AD）血压显著更高（收缩压：线性回归系数[β]=3.0，95%置信区间[CI]=0.2 - 5.7；舒张压，β=2.3，95% CI=0.1 - 4.4）。焦虑易感性与高血压风险增加（优势比[OR]=1.1，95% CI=1.0 - 1.3）和更高的收缩压（β=0.4，95% CI=0.0 - 0.7）相关。调整后的交互模型显示，单纯A诊断组与BMI之间在高血压方面存在显著交互作用（ORIT=1.5，95% CI=1.1 - 2.1）。特别是，有焦虑症和抑郁症共病终生史的女性以及有单纯焦虑症终生史的肥胖孕妇，应被告知其高血压风险增加，通过定期测量血压进行监测，并提供预防和早期干预策略，如饮食和体育活动的改变。
