Singal Deepa, Brownell Marni, Chateau Dan, Wall-Wieler Elizabeth, Longstaffe Sally, Hanlon-Dearman Ana, Roos Leslie L
Affiliations: Department of Community Health Sciences and the Manitoba Centre for Health Policy (Singal, Brownell, Chateau, Wall-Wieler, Roos) and Department of Pediatrics and Child Health (Longstaffe, Hanlon-Dearman), Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Man.
CMAJ Open. 2017 Aug 17;5(3):E646-E652. doi: 10.9778/cmajo.20160127.
Women who give birth to children with fetal alcohol spectrum disorder (FASD) may be at increased risk for suicide; however, there are few data in this area. The objective of this study was to compare rates of suicide between women who had given birth to children with FASD and women who had not given birth to children with FASD during critical periods in their lives, including before pregnancy, during pregnancy, during the postpartum period (maternal death) and until the end of the study period.
We conducted a retrospective cohort analysis of women with children born in Manitoba between Apr. 1, 1984, and Mar. 31, 2012 in whom FASD was diagnosed between Apr. 1, 1999, and Mar. 31, 2012, with follow-up until Dec. 1, 2013 (FASD group; = 702). We generated a comparison group of women who had not given birth to children with FASD ( = 2097), matched up to 1:3 on date of birth of the index child, socioeconomic status and region of residence. We used linked administrative data to investigate suicide attempt and completion rates in the 2 groups. Regression modelling produced relative rates (RRs) adjusted for socioeconomic status and age at birth of the index child and was used to assess suicide risk.
The 2799 participants produced 40 390.21 person-years until the end of the study period. Compared to the comparison group, the FASD group had higher rates of suicide completion (adjusted RR 6.20 [95% confidence interval (CI) 2.36-16.31]), a higher number of women who attempted suicide after the postpartum period until the end of the study period (adjusted RR 4.62 [95% CI 2.53-8.43]) and a higher number of attempts after the postpartum period until the end of the study period (adjusted RR 3.92 [95% CI 2.30-6.09]).
This study identified a group of women with increased rates of social complexities, mental disorders and alcohol use, which places them at risk for suicide. Interventions are needed that screen for suicidal behaviour in women who are at high risk to consume alcohol during pregnancy and have mental disorders.
生育患有胎儿酒精谱系障碍（FASD）子女的女性可能自杀风险增加；然而，该领域的数据很少。本研究的目的是比较在其生命关键时期（包括怀孕前、怀孕期间、产后期间（产妇死亡）以及直至研究期结束）生育患有FASD子女的女性与未生育患有FASD子女的女性之间的自杀率。
我们对1984年4月1日至2012年3月31日在曼尼托巴省出生子女的女性进行了一项回顾性队列分析，这些女性在1999年4月1日至2012年3月31日期间被诊断患有FASD，随访至2013年12月1日（FASD组；n = 702）。我们生成了一个未生育患有FASD子女的女性对照组（n = 2097），根据索引儿童的出生日期、社会经济地位和居住地区按1:3进行匹配。我们使用关联的行政数据调查两组中的自杀未遂和完成率。回归模型产生了根据社会经济地位和索引儿童出生时的年龄进行调整的相对率（RRs），并用于评估自杀风险。
在研究期结束前，2799名参与者产生了40390.21人年的数据。与对照组相比，FASD组的自杀完成率更高（调整后的RR为6.20 [95%置信区间（CI）2.36 - 16.31]），产后期间直至研究期结束后自杀未遂的女性人数更多（调整后的RR为4.62 [95% CI 2.53 - 8.43]），产后期间直至研究期结束后的自杀未遂次数更多（调整后的RR为3.92 [95% CI 2.30 - 6.09]）。
本研究确定了一组社会复杂性、精神障碍和酒精使用发生率增加的女性，这使她们面临自杀风险。需要对怀孕期间有高酒精消费风险且患有精神障碍的女性进行自杀行为筛查的干预措施。
