社区为基础的加拿大队列研究：邻里社会经济地位改变了妊娠期间焦虑和抑郁与早产之间的关联。
Neighbourhood socioeconomic status modifies the association between anxiety and depression during pregnancy and preterm birth: a Community-based Canadian cohort study.
机构信息
Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada.
出版信息
BMJ Open. 2020 Feb 10;10(2):e031035. doi: 10.1136/bmjopen-2019-031035.
OBJECTIVE
This study examined the association of anxiety alone, depression alone and the presence of both anxiety and depression with preterm birth (PTB) and further examined whether neighbourhood socioeconomic status (SES) modified this association.
DESIGN
Cohort study using individual-level data from two community-based prospective pregnancy cohort studies (All Our Families; AOF) and Alberta Pregnancy Outcomes and Nutrition (APrON) and neighbourhood SES data from the 2011 Canadian census.
SETTING
Calgary, Alberta, Canada.
PARTICIPANTS
Overall, 5538 pregnant women who were <27 weeks of gestation and >15 years old were enrolled in the cohort studies between 2008 and 2012. 3341 women participated in the AOF study and 2187 women participated in the APrON study, with 231 women participated in both studies. Women who participated in both studies were only counted once.
PRIMARY AND SECONDARY OUTCOME MEASURES
PTB was defined as delivery prior to 37 weeks of gestation. Depression was defined as an Edinburgh Postnatal Depression Scale (EPDS) score of ≥13, anxiety was defined as an EPDS-anxiety subscale score of ≥6, and the presence of both anxiety and depression was defined as meeting both anxiety and depression definitions.
RESULTS
Overall, 7.3% of women delivered preterm infants. The presence of both anxiety and depression, but neither of these conditions alone, was significantly associated with PTB (OR 1.6, 95% CI 1.1 to 2.3) and had significant interaction with neighbourhood deprivation (p=0.004). The predicted probability of PTB for women with both anxiety and depression was 10.0%, which increased to 15.7% if they lived in the most deprived neighbourhoods and decreased to 1.4% if they lived in the least deprived neighbourhoods.
CONCLUSIONS
Effects of anxiety and depression on risk of PTB differ depending on where women live. This understanding may guide the identification of women at increased risk for PTB and allocation of resources for early identification and management of anxiety and depression.
目的
本研究旨在探讨焦虑症、抑郁症和两者并存与早产（PTB）的相关性，并进一步探讨社区社会经济地位（SES）是否会改变这种相关性。
设计
利用两项基于社区的前瞻性妊娠队列研究（All Our Families；AOF）和艾伯塔省妊娠结局和营养（APrON）的个体水平数据以及 2011 年加拿大人口普查的社区 SES 数据进行队列研究。
地点
加拿大艾伯塔省卡尔加里市。
参与者
2008 年至 2012 年期间，共有 5538 名妊娠不足 27 周且年龄大于 15 岁的孕妇参加了这两项队列研究。其中 3341 名妇女参加了 AOF 研究，2187 名妇女参加了 APrON 研究，有 231 名妇女同时参加了这两项研究。同时参加这两项研究的妇女只计算一次。
主要和次要结局测量
PTB 定义为妊娠 37 周前分娩。抑郁症定义为爱丁堡产后抑郁量表（EPDS）评分≥13，焦虑症定义为 EPDS 焦虑分量表评分≥6，同时存在焦虑和抑郁定义为同时符合焦虑和抑郁的定义。
结果
总体而言，7.3%的妇女分娩早产儿。同时存在焦虑和抑郁，而不是仅存在其中一种，与 PTB 显著相关（OR 1.6，95%CI 1.1 至 2.3），且与社区贫困程度有显著交互作用（p=0.004）。同时存在焦虑和抑郁的妇女 PTB 的预测概率为 10.0%，如果她们生活在最贫困的社区，这一比例增加到 15.7%，如果她们生活在最富裕的社区，这一比例下降到 1.4%。
结论
焦虑和抑郁对 PTB 风险的影响因妇女居住的地点而异。这种理解可能有助于确定有较高 PTB 风险的妇女，并为早期识别和管理焦虑和抑郁提供资源分配。
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