Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research, Singapore.
Department of Obstetrics and Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Saw Swee Hock School of Public Health, National University of Singapore, Singapore; Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research, Singapore.
Compr Psychiatry. 2020 Nov;103:152210. doi: 10.1016/j.comppsych.2020.152210. Epub 2020 Sep 30.
Studies have identified lifestyle risk factors for perinatal depression, but none have examined the cumulative effect of these risk factors in pregnant women.
We considered the following six factors during pregnancy: poor diet quality (Healthy eating index for Singapore pregnant women<median), poor sleep quality (global Pittsburgh sleep quality index score > 5), physical inactivity (<600 MET-minutes/week), vitamin D insufficiency (<50 nmol/l), smoking before or during pregnancy, and the perceived need for social support. Probable depression was assessed using the Edinburgh postnatal depression scale during pregnancy (>15) and at three months postpartum (≥13). Prevalence risk ratios were calculated with Poisson regressions while adjusting for potential confounders.
Of 535 pregnant women, 207 (39%) had zero or one risk factor, 146 (27%) had two, 119 (22%) had three, 48 (9%) had four, and 15 (3%) had ≥5 risk factors at 26-28 weeks' gestation. These six lifestyle habits contributed to 32% of the variance in depressive symptoms during pregnancy. The prevalence of being probably depressed was 6.4 (95% CI 2.1, 19.8; p < 0.001) for expecting women who had ≥4 risk factors compared to women who had ≤1 risk factor. No association was observed between the number of risk factors and depressive symptoms at 3 months postpartum (p = 0.746).
Pregnant women with ≥4 lifestyle risk factors showed a higher prevalence of depression during pregnancy, while no associations were observed for postpartum depression.
This cohort is registered under the Clinical Trials identifier NCT01174875; http://www.clinicaltrials.gov/ct2/show/NCT01174875?term=GUSTO&rank=2.
已有研究确定了围产期抑郁的生活方式风险因素，但尚无研究探讨这些风险因素在孕妇中的累积效应。
我们在孕期考虑了以下 6 个因素：不良饮食质量（新加坡孕妇健康饮食指数<中位数）、睡眠质量差（全球匹兹堡睡眠质量指数评分>5）、身体活动不足（<600 梅脱-分钟/周）、维生素 D 不足（<50nmol/l）、孕前或孕期吸烟以及感知到的社会支持需求。孕期（>15）和产后 3 个月（≥13）使用爱丁堡产后抑郁量表评估可能的抑郁。使用泊松回归计算在调整潜在混杂因素后，患病率风险比。
在 535 名孕妇中，26-28 周时，207 名（39%）孕妇有零个或 1 个风险因素，146 名（27%）孕妇有 2 个，119 名（22%）孕妇有 3 个，48 名（9%）孕妇有 4 个，15 名（3%）孕妇有≥5 个风险因素。这 6 种生活方式习惯导致孕期抑郁症状的 32%存在差异。与≤1 个风险因素的孕妇相比，有≥4 个风险因素的孕妇产后抑郁的可能性更高，其患病率为 6.4（95%CI 2.1，19.8；p<0.001）。在产后 3 个月时，风险因素的数量与抑郁症状之间没有关联（p=0.746）。
有≥4 个生活方式风险因素的孕妇在孕期有更高的抑郁发生率，而产后抑郁则没有关联。
本队列在临床试验标识符 NCT01174875下注册；http://www.clinicaltrials.gov/ct2/show/NCT01174875?term=GUSTO&rank=2.
