Department of Biomedical Science and Human Oncology.
Department of Education, Psychology and Communication.
J Pediatr Gastroenterol Nutr. 2021 Jul 1;73(1):30-36. doi: 10.1097/MPG.0000000000003107.
BACKGROUND/OBJECTIVES: Functional gastrointestinal disorders (FGIDs) are a heterogeneous group of conditions of unclear etiology. The biopsychosocial model approach to FGIDs posits that early-life stressors may trigger a cascade of complex interactions between genetic predisposition and risk factors eventually leading to the occurrence of FGIDs. The relationship between the psychological disposition of the mother and FGIDs occurrence is poorly understood. We conducted a study to investigate if parental psychological factors may contribute to the onset of FGIDs in offspring.
We performed a prospective cohort study of parent-infant pairs who completed a battery of self-reported psychological questionnaires and a validated Rome III questionnaire for the diagnosis of infant and toddler FGIDs. The Edinburgh Postpartum Depression Scale (EPDS) was used to examine postpartum depression (PPD) symptoms; the Maternity Blues Questionnaire (MBQ) was applied to measure maternity blues severity; the Symptoms Checklist-Revised (SCL90-R) was used to assess the presence of relevant psychiatric symptoms; adult attachment style in mothers was assessed in a continuous way through the five dimensions of the Attachment Style Questionnaire (ASQ).
Out of the 360 eligible mothers, 200 were enrolled, 113 completed the 3-month follow-up and were included in the final analysis. PPD symptoms prevalence was 20.4%, 20%, 13.2%, and 13.1% respectively at 3 days, 1 week, 1 month, and 3 months after delivery. 40.4% of mothers suffered from severe blues according to the MBQ. Relevant psychiatric symptoms (SCL90-R) were present in 7.8% and 10.9% of mothers, respectively at 1 week and 3 months after delivery. 48.7% of mothers showed a secure attachment pattern measured through the RQ. At 1-month follow-up, infant regurgitation was diagnosed in 26 (23%) of infants, infantile colic in 31 (27.4%), dyschezia in 17 (15%), and functional constipation in 9 (8%). At 3-month follow-up, FGIDs prevalence was respectively 16 (19.3%), 11 (13.3%), 4 (4.8%), and 11 (13.3%). A significant positive association between PPD symptoms starting 3 days after delivery and the presence of infantile colic on setting 1 month after birth was found (P = 0.028), as well as between PPD symptoms occurrence 7 days after delivery and infantile regurgitation beginning 1 month after birth (P = 0.042). A higher prevalence of infantile colic was found in the offspring of mothers suffering from PPD symptoms from 3 days after delivery (54.5 vs 19.8; P = 0.001). No significant association was found between FGIDs and psychiatric symptoms and maternity blues at any timepoint. On the other hand, mothers of infants with regurgitation with an onset 1 month after birth have higher insecurity score in avoidant and fearful ASQ-related attachment dimensions (respectively, P = 0.03, P = 0.042, P = 0.03).
Maternal psychological factors might contribute to the onset of infant FGIDs in offspring. Early screening of postpartum depression symptoms and early implementation of psychological interventions within the postpartum period might promote the health of the mother-infant dyad.
背景/目的：功能性胃肠疾病（FGIDs）是一组病因不明的异质性疾病。FGIDs 的生物心理社会模型方法假设，早期生活压力源可能会引发一系列复杂的遗传易感性和危险因素之间的相互作用，最终导致 FGIDs 的发生。母亲的心理状态与 FGIDs 发生之间的关系尚未得到充分了解。我们进行了一项研究，以调查父母的心理因素是否可能导致子女 FGIDs 的发生。
我们对母婴对进行了前瞻性队列研究，他们完成了一系列自我报告的心理问卷和罗马 III 问卷，以诊断婴儿和幼儿 FGIDs。使用爱丁堡产后抑郁量表（EPDS）检查产后抑郁（PPD）症状；使用产妇忧郁问卷（MBQ）测量产妇忧郁症的严重程度；使用症状清单修订版（SCL90-R）评估相关精神症状；通过五个维度的依恋风格问卷（ASQ）连续评估母亲的成人依恋风格。
在 360 名符合条件的母亲中，有 200 名母亲入组，其中 113 名在产后 3 个月完成了随访并纳入最终分析。产后 3 天、1 周、1 个月和 3 个月时 PPD 症状的患病率分别为 20.4%、20%、13.2%和 13.1%。根据 MBQ，有 20%的母亲患有严重的忧郁症。产后 1 周和 3 个月时，分别有 7.8%和 10.9%的母亲出现相关精神症状（SCL90-R）。通过 RQ 测量，48.7%的母亲表现出安全的依恋模式。在 1 个月的随访中，26 名（23%）婴儿被诊断为胃食管反流，31 名（27.4%）婴儿被诊断为婴儿绞痛，17 名（15%）婴儿被诊断为便秘，9 名（8%）婴儿被诊断为功能性便秘。在 3 个月的随访中，FGIDs 的患病率分别为 16%（19.3%）、11%（13.3%）、4%（4.8%）和 11%（13.3%）。产后 3 天出现 PPD 症状与产后 1 个月婴儿绞痛的发生之间存在显著的正相关（P=0.028），产后 7 天出现 PPD 症状与产后 1 个月婴儿胃食管反流的发生之间也存在显著的正相关（P=0.042）。在产后 3 天出现 PPD 症状的母亲中，婴儿绞痛的发生率更高（54.5% vs 19.8%；P=0.001）。在任何时间点，FGIDs 均与精神症状和产后忧郁症之间均无显著相关性。另一方面，在 1 个月后开始出现胃食管反流的婴儿的母亲，在回避和恐惧 ASQ 相关依恋维度的安全感评分较高（分别为 P=0.03、P=0.042、P=0.03）。
母亲的心理因素可能会导致婴儿 FGIDs 的发生。早期筛查产后抑郁症状并在产后期间尽早实施心理干预措施可能会促进母婴健康。
