Rotberg B, Horváth-Puhó E, Vigod S, Ray J G, Sørensen H T, Cohen E
Department of Psychiatry, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada.
Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark.
Acta Psychiatr Scand. 2020 Oct;142(4):264-274. doi: 10.1111/acps.13181. Epub 2020 Jun 10.
The birth of a child with a major congenital anomaly may create chronic caregiving stress for mothers, yet little is known about their psychiatric outcomes.
To evaluate the association of the birth of a child with a major congenital anomaly with subsequent maternal psychiatric risk.
This Danish nationwide cohort study included mothers who gave birth to an infant with a major congenital anomaly (n = 19 220) between 1997 and 2015. Comparators were randomly selected mothers, matched on maternal age, year of delivery and parity (n = 195 399). The primary outcome was any new-onset psychiatric diagnosis. Secondary outcomes included specific psychiatric diagnoses, psychiatric in-patient admissions and redeemed psychoactive medicines. Cox models were used to estimate hazard ratios (HRs), adjusted for socioeconomic and medical variables.
Mothers of affected infants had an elevated risk for a new-onset psychiatric disorder vs. the comparison group (adjusted HR, 1.16, 95% CI 1.11-1.22). The adjusted HR was particularly elevated during the first postpartum year (1.65, 95% CI 1.42-1.90), but remained high for years, especially among mothers of children with multiorgan anomalies (1.37, 95% CI 1.18-1.57). The risk was also elevated for most specific psychiatric diagnoses, admissions and medicines.
Mothers who give birth to a child with a major congenital anomaly are at increased risk of new-onset psychiatric disorders, especially shortly after birth and for mothers of children with more severe anomalies. Our study highlights the need to screen for mental illness in this high-risk population, as well as to integrate adult mental health services and paediatric care.
孩子患有严重先天性异常的出生可能会给母亲带来长期的照料压力，但对于她们的精神状况知之甚少。
评估孩子患有严重先天性异常的出生与随后母亲的精神疾病风险之间的关联。
这项丹麦全国队列研究纳入了1997年至2015年间生育患有严重先天性异常婴儿的母亲（n = 19220）。对照组是随机选择的母亲，根据母亲年龄、分娩年份和产次进行匹配（n = 195399）。主要结局是任何新发的精神疾病诊断。次要结局包括特定的精神疾病诊断、精神科住院治疗和已兑现的精神活性药物。使用Cox模型估计风险比（HRs），并对社会经济和医学变量进行调整。
与对照组相比，受影响婴儿的母亲患新发精神疾病的风险升高（调整后的HR，1.16，95%CI 1.11 - 1.22）。调整后的HR在产后第一年尤其升高（1.65，95%CI 1.42 - 1.90），但多年来一直居高不下，尤其是在患有多器官异常孩子的母亲中（1.37，95%CI 1.18 - 1.57）。大多数特定的精神疾病诊断、住院治疗和药物的风险也有所升高。
生育患有严重先天性异常孩子的母亲患新发精神疾病的风险增加，尤其是在出生后不久，以及患有更严重异常孩子的母亲。我们的研究强调了在这一高风险人群中筛查精神疾病的必要性，以及整合成人心理健康服务和儿科护理的必要性。
