Flynn Heather A, McBride Nicole, Cely Aura, Wang Yuxia, DeCesare Julie
1Department of Behavioral Sciences and Social Medicine,Florida State University College of Medicine,Tallahassee,Florida,USA.
2Florida State University,Tallahassee,Florida,USA.
CNS Spectr. 2015 Feb;20(1):20-8. doi: 10.1017/S1092852914000716. Epub 2014 Dec 19.
The purpose of this study was to provide information on the effect of prenatal depression and anxiety as assessed in the context of obstetrical care on key infant outcomes (gestational age at birth, birth weight, and APGAR scores), while simultaneously considering interactions with maternal medical conditions among primarily Medicaid enrollees.
Obstetrical medical records of 419 women presenting consecutively for prenatal care at a health system serving primarily Medicaid patients were examined. Information on maternal characteristics (age, race, education) and maternal medical health (BMI, high blood pressure, diabetes, and kidney problems), as well as mental health information, was extracted. Depression was assessed as part of routine care using the Patient Health Questionnaire-9 (PHQ-9), and any documentation of depression or anxiety by the obstetrics clinician was also used in the analyses.
Approximately one-third of the sample showed some evidence of prenatal depression, either based on PHQ-9 score (≥10) or clinician documentation of depression, and close to 10% showed evidence of anxiety. Multivariate analyses showed significant interactions between depression and anxiety on gestational age and birth weight, between depression and high blood pressure on gestational age, and also between anxiety and kidney problems on gestational age.
Among this sample, the effect of maternal depression and anxiety on birth outcomes was more evident when considered along with maternal chronic medical conditions. This information may be used to assist prenatal care clinicians to develop risk assessment based on knowledge of multiple risk factors that may exert and additive influence on poor birth outcomes.
本研究旨在提供有关在产科护理背景下评估的产前抑郁和焦虑对关键婴儿结局（出生孕周、出生体重和阿氏评分）影响的信息，同时考虑主要医疗补助参保者中与母亲医疗状况的相互作用。
检查了在一个主要为医疗补助患者服务的卫生系统中连续接受产前护理的419名妇女的产科病历。提取了有关母亲特征（年龄、种族、教育程度）和母亲医疗健康状况（体重指数、高血压、糖尿病和肾脏问题）以及心理健康信息。抑郁作为常规护理的一部分，使用患者健康问卷9（PHQ-9）进行评估，产科临床医生对抑郁或焦虑的任何记录也用于分析。
大约三分之一的样本显示出一些产前抑郁的证据，要么基于PHQ-9评分（≥10），要么基于临床医生对抑郁的记录，近10%显示出焦虑的证据。多变量分析显示，抑郁和焦虑在孕周和出生体重上存在显著相互作用，抑郁和高血压在孕周上存在显著相互作用，焦虑和肾脏问题在孕周上也存在显著相互作用。
在该样本中，当将母亲的抑郁和焦虑与母亲的慢性疾病状况一起考虑时，对出生结局的影响更为明显。这些信息可用于帮助产前护理临床医生基于对可能对不良出生结局产生累加影响的多种风险因素的了解来开展风险评估。
