Felder Jennifer N, Epel Elissa, Lewis Jessica B, Cunningham Shayna D, Tobin Jonathan N, Rising Sharon Schindler, Thomas Melanie, Ickovics Jeannette R
Department of Psychiatry, University of California, San Francisco.
Yale School of Public Health.
J Consult Clin Psychol. 2017 Jun;85(6):574-584. doi: 10.1037/ccp0000191. Epub 2017 Mar 13.
Depressive symptoms are associated with preterm birth among adults. Pregnant adolescents have high rates of depressive symptoms and low rates of treatment; however, few interventions have targeted this vulnerable group. Objectives are to: (a) examine impact of CenteringPregnancy® Plus group prenatal care on perinatal depressive symptoms compared to individual prenatal care; and (b) determine effects of depressive symptoms on gestational age and preterm birth among pregnant adolescents.
This cluster-randomized controlled trial was conducted in 14 community health centers and hospitals in New York City. Clinical sites were randomized to receive standard individual prenatal care (n = 7) or CenteringPregnancy® Plus group prenatal care (n = 7). Pregnant adolescents (ages 14-21, N = 1,135) completed the Center for Epidemiologic Studies Depression Scale during pregnancy (second and third trimesters) and postpartum (6 and 12 months). Gestational age was obtained from medical records, based on ultrasound dating. Intention to treat analyses were used to examine objectives.
Adolescents at clinical sites randomized to CenteringPregnancy® Plus experienced greater reductions in perinatal depressive symptoms compared to those at clinical sites randomized to individual care (p = .003). Increased depressive symptoms from second to third pregnancy trimester were associated with shorter gestational age at delivery and preterm birth (<37 weeks gestation). Third trimester depressive symptoms were also associated with shorter gestational age and preterm birth. All p < .05.
Pregnant adolescents should be screened for depressive symptoms prior to third trimester. Group prenatal care may be an effective nonpharmacological option for reducing depressive symptoms among perinatal adolescents. (PsycINFO Database Record
成人的抑郁症状与早产有关。怀孕青少年的抑郁症状发生率高而治疗率低；然而，针对这一弱势群体的干预措施很少。目标是：(a) 与个体产前护理相比，研究“孕期集中护理升级版（CenteringPregnancy® Plus）”小组产前护理对围产期抑郁症状的影响；(b) 确定抑郁症状对怀孕青少年的孕周和早产的影响。
这项整群随机对照试验在纽约市的14个社区卫生中心和医院进行。临床场所被随机分配接受标准个体产前护理（n = 7）或“孕期集中护理升级版”小组产前护理（n = 7）。怀孕青少年（年龄14 - 21岁，N = 1135）在孕期（孕中期和孕晚期）以及产后（6个月和12个月）完成了流行病学研究中心抑郁量表。孕周根据超声检查日期从病历中获取。采用意向性分析来检验目标。
与被随机分配到个体护理临床场所的青少年相比，被随机分配到“孕期集中护理升级版”临床场所的青少年围产期抑郁症状减少得更多（p = .003）。从妊娠第二个月到第三个月抑郁症状增加与分娩时孕周较短和早产（孕周<37周）有关。孕晚期抑郁症状也与孕周较短和早产有关。所有p < .05。
应在孕晚期之前对怀孕青少年进行抑郁症状筛查。小组产前护理可能是减少围产期青少年抑郁症状的一种有效的非药物选择。（PsycINFO数据库记录）
