母亲抑郁和超重对新生儿结局的综合影响。

The combined effects of maternal depression and excess weight on neonatal outcomes.

作者信息

McDonald S D, McKinney B, Foster G, Taylor V, Lutsiv O, Pullenayegum E

机构信息

Division of Maternal-Fetal Medicine, Departments of Obstetrics and Gynecology, Diagnostic Imaging, and Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada.

Department of Obstetrics and Gynecology, McMaster University, Hamilton, ON, Canada.

出版信息

Int J Obes (Lond). 2015 Jul;39(7):1033-40. doi: 10.1038/ijo.2015.44. Epub 2015 Mar 30.

DOI:10.1038/ijo.2015.44

PMID:25817069

Abstract

OBJECTIVE

Maternal overweight/obesity and depression are among the most prevalent pregnancy complications, and although individually they are associated with poor pregnancy outcomes, their combined effects are unknown. Owing to this, the objective of this study was to determine the prevalences and the individual and combined effects of depression and overweight/obesity on neonatal outcomes.

METHODS

A retrospective cohort study of all singleton hospital births at >20 weeks gestation in Ontario, Canada (April 2007 to March 2010) was conducted. The primary outcome measure was a composite neonatal outcome, which included: stillbirth, neonatal death, preterm birth, birth weight <2500 g, <5% or >95%, admission to a neonatal special care unit, or a 5-min Apgar score <7.

RESULTS

Among the 70,605 included women, 49.7% had a healthy pre-pregnancy BMI, whereas 50.3% were overweight/obese; depression was reported in 5.0% and 6.2%, respectively. Individually, depression and excess pre-pregnancy weight were associated with an increased risk of adverse neonatal outcomes, but the highest risk was seen when they were both present (16% of non-depressed healthy weight pregnant women, 19% of depressed healthy weight women, 20% of non-depressed overweight/obese women and 24% of depressed overweight/obese women). These higher risks of adverse neonatal outcomes persisted after accounting for potential confounding variables, such as maternal age, education and pre-existing health problems (adjusted odds ratio (OR) 1.22, 95% confidence interval (CI) 1.13-1.33, adjusted OR 1.23, 95% CI 1.18-1.28 and adjusted OR 1.42, 95% CI 1.31-1.54, in the last three groups above, respectively, relative to non-depressed healthy weight women). There was no significant interaction between weight category and depression (P=0.2956).

CONCLUSIONS

When dually present, maternal overweight/obesity and depression combined have the greatest impact on the risk of adverse neonatal outcomes. Our findings have important public health implications given the exorbitant proportions of both of these risk factors.

摘要

目的

孕产妇超重/肥胖和抑郁症是最常见的妊娠并发症，虽然它们各自都与不良妊娠结局相关，但其综合影响尚不清楚。因此，本研究的目的是确定抑郁症和超重/肥胖对新生儿结局的发生率、个体影响及综合影响。

方法

对加拿大安大略省（2007年4月至2010年3月）所有孕周>20周的单胎医院分娩进行回顾性队列研究。主要结局指标是一个综合新生儿结局，包括：死产、新生儿死亡、早产、出生体重<2500g、<5%或>95%、入住新生儿特殊护理病房或5分钟阿氏评分<7。

结果

在纳入的70605名女性中，49.7%孕前BMI正常，而50.3%超重/肥胖；报告有抑郁症的分别为5.0%和6.2%。单独来看，抑郁症和孕前体重超标均与不良新生儿结局风险增加相关，但两者同时存在时风险最高（非抑郁且体重正常的孕妇为16%，抑郁且体重正常的女性为19%，非抑郁且超重/肥胖的女性为20%，抑郁且超重/肥胖的女性为24%）。在考虑了潜在的混杂变量，如产妇年龄、教育程度和既往健康问题后，这些不良新生儿结局的较高风险仍然存在（上述最后三组相对于非抑郁且体重正常的女性，调整后的比值比（OR）分别为1.22，95%置信区间（CI）为1.13 - 1.33；调整后的OR为1.23，95%CI为1.18 - 1.28；调整后的OR为1.42，95%CI为1.31 - 1.54）。体重类别与抑郁症之间无显著交互作用（P = 0.2956）。