焦虑和抑郁是复发性妊娠丢失的风险因素：一项巢式病例对照研究。
Anxiety and depression are risk factors for recurrent pregnancy loss: a nested case-control study.
机构信息
Department of Scientific Research Center of Gansu Provincial Maternity and Child-Care Hospital, No.143. Qilihe North Rd., Lanzhou, 730050, Gansu, People's Republic of China.
Department of Perinatal Medicine Center of Gansu Provincial Maternity and Child-Care Hospital, No.143. Qilihe North Rd., Lanzhou, 730050, Gansu, People's Republic of China.
出版信息
Health Qual Life Outcomes. 2021 Mar 8;19(1):78. doi: 10.1186/s12955-021-01703-1.
BACKGROUND
To evaluate the interaction of depression and anxiety with the development of recurrent pregnancy loss (RPL).
METHODS
A nested case-control study involving 2558 participants was conducted with data from the prospective Miscarriage Woman Cohort study between 2017 and 2019 in the province of Gansu, China. The questionnaire data, self-rating anxiety scale and self-rating depression scale were collected after each participant's first miscarriage. Information on RPL outcomes was obtained from the medical records within the subsequent 2 years. All patients diagosed RPL were recruited as cases whilst a randomly selected group of women with only one miscarriage in the past were recruited as controls. The logistic regression and the interaction effects between anxiety and depression and RPL were analysed.
RESULTS
The prevalence of anxiety (n = 325, 28.7% vs. n = 278, 19.5%) and depression symptoms (n = 550, 48.6% vs. n = 589, 41.3%) for the 1132 RPL cases were higher than 1426 non-RPL controls (P < 0.001). After adjusting for possible confounding variables, the odds ratio (OR) value, reflecting the multiplicative interaction, was 1.91 (95% CI 1.50-2.44, P < 0.001) for cases with both anxiety and depression symptoms compared with the non-RPL group. The relative excess risk of interaction value, reflecting the additive interaction between anxiety and depression to RPL was 1.15 (95% CI 0.32-4.21). Moreover, the adjusted OR for RPL cases with mild anxiety and severe depression was 2.77 (95% CI 1.07-44.14, P < 0.001), for RPL cases with severe anxiety and mild depression was 4.23 (95% CI 1.01-22.21, P < 0.001), for RPL cases with severe anxiety and moderate depression was 4.34 (95% CI 1.03-21.28, P < 0.001) and for RPL cases with severe anxiety and severe depression was 5.95 (95% CI 1.09-45.09, P < 0.05).
CONCLUSIONS
Either depression or anxiety alone could increase the risk of subsequent RPL. Anxiety and depression had a synergistic effect after the first miscarriage which increased the development of subsequent RPL disease.
背景
评估抑郁和焦虑与复发性妊娠丢失（RPL）发展之间的相互作用。
方法
这是一项嵌套病例对照研究，纳入了 2017 年至 2019 年期间在中国甘肃省前瞻性流产女性队列研究中的 2558 名参与者。在每位参与者首次流产后收集问卷数据、焦虑自评量表和抑郁自评量表。在随后的 2 年内从病历中获得 RPL 结局的信息。所有被诊断为 RPL 的患者均被招募为病例，而过去仅流产一次的随机选择的一组女性被招募为对照组。分析焦虑和抑郁与 RPL 之间的逻辑回归和交互作用。
结果
1132 例 RPL 病例中焦虑（n=325，28.7%）和抑郁症状（n=550，48.6%）的发生率高于 1426 例非 RPL 对照组（n=278，19.5%；n=589，41.3%）（P<0.001）。调整可能的混杂变量后，与非 RPL 组相比，同时存在焦虑和抑郁症状的病例的比值比（OR）值为 1.91（95%CI 1.50-2.44，P<0.001）。反映焦虑和抑郁对 RPL 相加作用的交互作用的相对超额风险值为 1.15（95%CI 0.32-4.21）。此外，RPL 病例中轻度焦虑和重度抑郁的调整 OR 为 2.77（95%CI 1.07-44.14，P<0.001），RPL 病例中重度焦虑和轻度抑郁的调整 OR 为 4.23（95%CI 1.01-22.21，P<0.001），RPL 病例中重度焦虑和中度抑郁的调整 OR 为 4.34（95%CI 1.03-21.28，P<0.001），RPL 病例中重度焦虑和重度抑郁的调整 OR 为 5.95（95%CI 1.09-45.09，P<0.05）。
结论
单独的抑郁或焦虑都可能增加随后发生 RPL 的风险。焦虑和抑郁在首次流产后具有协同作用，增加了随后 RPL 疾病的发展。
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