Warnock Fay F, Bakeman Roger, Shearer Kim, Misri Shaila, Oberlander Tim
Child and Family Research Institute, Vancouver, British Columbia.
Georgia State University.
Infant Ment Health J. 2009 Jul;30(4):384-406. doi: 10.1002/imhj.20220.
This exploratory study aimed to examine time-based measures of the behaviors and interactions of prenatally depressed serotonin reuptake inhibitors (SRI)-medicated mothers to their infant's pain (n = 10) by comparing them with similar measures obtained from prenatally depressed nonmedicated mothers and their infants (n = 10), and nondepressed mothers and their infants (n = 10). During the second trimester of their pregnancy, the 30 study mothers were assessed for depression and anxiety, with no further measures of maternal mood taken. Maternal and infant interactions were continuously videorecorded while the infant underwent a scheduled heel lance for routine blood screening that occurred when study infants were between the ages of 24 and 60 hr. Maternal behavior and infant cry, for all 30 cases, were coded second-by-second for the full duration of each infant's heel lance using a reliable coding system and analyzed using odds ratio and regression analyses. Infants exposed to prenatal SRIs and depressed maternal mood were more likely to have lower Apgar scores and to exhibit weak and absent cry. Even when duration of the heel lance was controlled for, women with depression during the second trimester were more likely to exhibit depressed behavior at 2 days' postpartum despite sustained SRI antidepressant treatment. Both groups of prenatally depressed mothers were more likely to exhibit diminished response to their infants' pain cue although nonmedicated mothers' expressions of depressed behavior were more similar to healthy controls. Comprehensive understanding is essential to optimize the clinical care of mothers and their infants in this complex setting. This study contributes preliminary new findings that warrant prospective and longitudinal studies to clarify further the impacts of prenatal SRI and maternal mental mood (e.g., chronic depression and anxiety) effects on the mother-infant interaction and infant pain and stress reactivity.
这项探索性研究旨在通过将产前服用血清素再摄取抑制剂（SRI）的抑郁症母亲与其婴儿疼痛时的行为和互动的基于时间的测量结果（n = 10），与产前未服用药物的抑郁症母亲及其婴儿（n = 10）以及非抑郁症母亲及其婴儿（n = 10）的类似测量结果进行比较，来加以检验。在怀孕中期，对30名参与研究的母亲进行了抑郁和焦虑评估，之后未再对母亲的情绪进行测量。当研究婴儿处于24至60小时大时，在其接受预定的足跟采血进行常规血液筛查期间，对母婴互动进行了连续录像。使用可靠的编码系统，对所有30例母婴的足跟采血全过程每秒的母亲行为和婴儿哭声进行编码，并使用比值比和回归分析进行分析。暴露于产前SRI和母亲抑郁情绪下的婴儿更有可能具有较低的阿氏评分，并表现出哭声微弱或无哭声。即使控制了足跟采血的持续时间，怀孕中期患有抑郁症的女性在产后2天时更有可能表现出抑郁行为，尽管她们持续接受了SRI抗抑郁治疗。两组产前抑郁症母亲对婴儿疼痛提示的反应更有可能减弱，尽管未服用药物的母亲的抑郁行为表现与健康对照组更相似。在这种复杂情况下，全面了解对于优化母婴的临床护理至关重要。本研究提供了初步的新发现，有必要进行前瞻性和纵向研究，以进一步阐明产前SRI和母亲心理情绪（如慢性抑郁和焦虑）对母婴互动以及婴儿疼痛和应激反应性的影响。
