Ertmann Ruth K, Nicolaisdottir Dagny R, Kragstrup Jakob, Siersma Volkert, Lutterodt Melissa C, Bech Per
a Research Unit for General Practice and Section for General Practice, Institute of Public Health , University of Copenhagen, Psychiatric Research Unit Mental Health Centre North Zealand, University of Copenhagen , Copenhagen , Denmark.
Nord J Psychiatry. 2019 Apr;73(3):200-206. doi: 10.1080/08039488.2019.1579861. Epub 2019 Mar 8.
Pregnancy examinations conducted in general practice focus mainly on identifying high-risk pregnancies and pregnancy complications. The pregnancy health record has a biomedical focus, and consequently the woman's mental well-being may receive less attention. The aim of this study was to evaluate the extent to which early pregnancy-related symptoms should be considered as indicators of an increased risk of postpartum depression.
For a prospective cohort of 1508 pregnant women, the presence of 11 pregnancy-related symptoms was recorded at the first prenatal care consultation together with background information about socio-demography and health. Depression was assessed 8 weeks postpartum with the major depression inventory (MDI) and depression was considered present if MDI > 20. Multivariable logistic regression was used to assess the association between pregnancy-related symptoms and postpartum depressive symptoms, and to adjust for potential confounders.
A high depression score (MDI score >20) 8 weeks postpartum was found among 6.6% of the women and showed apparent associations with physical discomfort in early pregnancy, such as back pain and pelvic cavity pain. Analysis of confounding revealed, however, that signs of vulnerable mental health, present in early pregnancy, explained most of these associations.
Indicators of an increased risk of postpartum depressive symptoms may be found in early pregnancy. Pregnancy-related pain in the first trimester may be a sign of psychological vulnerability or an aspect of an existing depressive state that calls for attention.
全科医疗中的孕期检查主要侧重于识别高危妊娠和妊娠并发症。妊娠健康记录以生物医学为重点，因此女性的心理健康可能较少受到关注。本研究的目的是评估早期妊娠相关症状在多大程度上应被视为产后抑郁风险增加的指标。
对于1508名孕妇的前瞻性队列，在首次产前检查时记录了11种妊娠相关症状以及社会人口统计学和健康方面的背景信息。产后8周用重度抑郁量表（MDI）评估抑郁情况，若MDI>20则认为存在抑郁。采用多变量逻辑回归评估妊娠相关症状与产后抑郁症状之间的关联，并对潜在混杂因素进行调整。
6.6%的女性在产后8周出现高抑郁评分（MDI评分>20），且与妊娠早期的身体不适，如背痛和盆腔疼痛有明显关联。然而，对混杂因素的分析表明，妊娠早期存在的心理健康脆弱迹象解释了这些关联中的大部分。
产后抑郁症状风险增加的指标可能在妊娠早期就已出现。孕早期与妊娠相关的疼痛可能是心理脆弱的迹象，或是现有抑郁状态的一个方面，需要引起关注。
