Center for Experimental Drugs and Diagnostics, Center for Human Genetic Research and Department of Psychiatry, Massachusetts General Hospital, Boston, MA 02114, Unites States.
Department of Obstetrics and Gynecology, Massachusetts General Hospital and Brigham and Women's Hospital, the Division of Maternal Fetal Medicine, Boston, MA 02114, Unites States.
J Affect Disord. 2018 Oct 15;239:253-257. doi: 10.1016/j.jad.2018.05.083. Epub 2018 Jul 6.
Antenatal depression is associated with poor obstetric outcomes, but it has not been determined if treatment improves these outcomes. We hypothesized that psychotherapy for antenatal depression would decrease rates of low Apgar score, preterm birth, low birthweight, and high maternal weight gain.
Using longitudinal clinical data from the electronic health record (EHR) of a large academic medical center, we examined the association between exposure to psychotherapy during pregnancy among women with a history of major depressive disorder and obstetric outcomes. We compared outcomes between women with and without psychotherapy treatment during pregnancy, and included a dose response analysis.
Of 50,856 women with pregnancies between 1998 and 2013, 5413 had a lifetime diagnosis of depression (948 had a diagnosis of depression during pregnancy), and 536 received psychotherapy at least once during pregnancy. Women who received one or more psychotherapy sessions during pregnancy had increased odds of preterm delivery and decreased odds of high maternal weight gain (more than 40 pounds). Individuals who received four or more psychotherapy sessions during pregnancy had increased odds of preterm birth and low infant birth weight and decreased odds of high maternal weight gain.
Patients may have pursued treatment outside of this hospital's EHR data, and we cannot control for the quality of treatment or type of psychotherapy.
Psychotherapy was associated with negative obstetric outcomes. While treatment of depression in pregnant women has been shown to benefit the mother, the absence of benefit in terms of pregnancy outcomes merits further investigation.
产前抑郁症与不良产科结局有关，但尚未确定治疗是否能改善这些结局。我们假设产前抑郁症的心理治疗会降低低 Apgar 评分、早产、低出生体重和高产妇体重增加的发生率。
我们使用大型学术医疗中心电子健康记录 (EHR) 的纵向临床数据，研究了有重度抑郁症病史的女性在怀孕期间接受心理治疗与产科结局之间的关联。我们比较了怀孕期间接受和未接受心理治疗的女性的结局，并进行了剂量反应分析。
在 1998 年至 2013 年间的 50856 名孕妇中，有 5413 名女性有终生诊断为抑郁症（948 名女性在怀孕期间被诊断为抑郁症），有 536 名女性至少接受过一次孕期心理治疗。在怀孕期间接受过一次或多次心理治疗的女性，早产的几率增加，而高产妇体重增加（超过 40 磅）的几率降低。在怀孕期间接受过四次或更多次心理治疗的个体，早产和低出生体重的几率增加，而高产妇体重增加的几率降低。
患者可能在该医院的 EHR 数据之外寻求治疗，我们无法控制治疗的质量或心理治疗的类型。
心理治疗与不良产科结局有关。虽然已经证明在孕妇中治疗抑郁症对母亲有益，但在妊娠结局方面没有益处值得进一步研究。
