初产妇疼痛灾难化与产后抑郁状态的关联：一项前瞻性研究
Association of Pain Catastrophizing with Postnatal Depressive States in Nulliparous Parturients: A Prospective Study.
作者信息
Zeng Yanzhi, Tan Chin Wen, Sultana Rehena, Chua Tze-Ern, Chen Helen Yu, Sia Alex Tiong Heng, Sng Ban Leong
机构信息
Department of Women's Anaesthesia, KK Women's and Children's Hospital, Singapore.
Anaesthesiology and Perioperative Sciences Academic Clinical Program, Duke-NUS Medical School, Singapore.
出版信息
Neuropsychiatr Dis Treat. 2020 Jul 30;16:1853-1862. doi: 10.2147/NDT.S256465. eCollection 2020.
PURPOSE
Postnatal depression (PND) is associated with maternal morbidity and socioeconomic burden. Recent studies have shown an association between pain catastrophizing, increased labor pain, and subsequent adverse postnatal adjustment; however, little is known on its role in PND development. We aimed to investigate the association between pain catastrophizing and probable PND.
METHODS
Parturients planning to undergo epidural labor analgesia were recruited. Predelivery questionnaires, including the Pain Catastrophizing Scale (PCS) and Edinburgh Postnatal Depression Scale (EPDS), were administered during early labor. A phone survey at 5- 9 weeks postdelivery was conducted to determine postdelivery EPDS and Spielberger's State-Trait-Anxiety Inventory scores. The primary outcome was a binary variable of postdelivery EPDS with cutoff of ≥10, whereas the secondary outcome was a continuous variable on increases in EPDS score.
RESULTS
Probable PND (EPDS ≥10) occurred in 10.5% (95% CI 8.0%-13.5%, 55 of 525) of women who underwent epidural labor analgesia. We found that high pain catastrophizing (PCS ≥25) was associated with increased postdelivery EPDS scores (adjusted estimate 0.36, 95% CI 0.15-0.57; =0.0008), but did not meet significance for increased risk of probable PND (=0.1770). Additionally, presence of breakthrough pain during epidural analgesia (adjusted estimate 0.24, 95% CI 0.02-0.46; =0.0306) and lower BMI at term (adjusted estimate -0.04, 95% CI -0.07 to -0.01; =0.0055) were associated with increased postdelivery EPDS scores.
CONCLUSION
No significant association was found between high pain catastrophizing and probable PND; however, high predelivery pain catastrophizing, presence of breakthrough pain during epidural analgesia, and lower BMI at term were associated with increased postdelivery EPDS scores. Further research will be needed to validate this association in the context of the risk of PND development.
目的
产后抑郁症（PND）与产妇发病及社会经济负担相关。近期研究表明，疼痛灾难化、分娩疼痛加剧与产后不良适应之间存在关联；然而，其在产后抑郁症发展中的作用尚不清楚。我们旨在研究疼痛灾难化与可能的产后抑郁症之间的关联。
方法
招募计划接受硬膜外分娩镇痛的产妇。在分娩早期发放包括疼痛灾难化量表（PCS）和爱丁堡产后抑郁量表（EPDS）在内的产前问卷。在产后5 - 9周进行电话调查，以确定产后EPDS及斯皮尔伯格状态 - 特质焦虑量表得分。主要结局是产后EPDS的二元变量，临界值为≥10，次要结局是EPDS得分增加的连续变量。
结果
接受硬膜外分娩镇痛的女性中，10.5%（95%CI 8.0% - 13.5%，525例中的55例）可能患有产后抑郁症（EPDS≥10）。我们发现，高疼痛灾难化（PCS≥25）与产后EPDS得分增加相关（校正估计值0.36，95%CI 0.15 - 0.57；P = 0.0008），但在可能患产后抑郁症风险增加方面未达到显著水平（P = 0.1770）。此外，硬膜外镇痛期间出现突破性疼痛（校正估计值0.24，95%CI 0.02 - 0.46；P = 0.0306）和足月时较低的体重指数（校正估计值 - 0.04，95%CI - 0.07至 - 0.01；P = 0.0055）与产后EPDS得分增加相关。
结论
未发现高疼痛灾难化与可能的产后抑郁症之间存在显著关联；然而，产前高疼痛灾难化、硬膜外镇痛期间出现突破性疼痛和足月时较低的体重指数与产后EPDS得分增加相关。需要进一步研究以在产后抑郁症发展风险的背景下验证这种关联。
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