Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK; Department of Obstetrics and Gynaecology, Shrewsbury and Telford NHS Trust, Princess Royal Hospital, Telford, Shropshire, UK.
Institute of Applied Health Research, University of Birmingham, Birmingham, UK.
J Psychiatr Res. 2021 May;137:419-425. doi: 10.1016/j.jpsychires.2021.03.022. Epub 2021 Mar 18.
There is a gap in the literature investigating the impact of obstetric complications on subsequent mental ill health outcomes. The aim of this study was to establish the association between post-partum haemorrhage (PPH) and mental ill health. We conducted a retrospective open cohort study utilizing linked primary care (The Health Improvement Network (THIN)) and English secondary care (Hospital Episode Statistics (HES)) databases, from January 1, 1990 to January 31, 2018. A total of 42,327 women were included: 14,109 of them were exposed to PPH during the study period and 28,218 unexposed controls were matched for age and date of delivery. Hazard ratios (HRs) for mental illness among women with and without exposure to PPH were estimated after controlling for covariates. Women who had had PPH were at an increased risk of developing postnatal depression (adjusted HR: 1·10, 95%CI: 1·01-1·21) and post-traumatic stress disorder (PTSD) (adjusted HR: 1·17, 95%CI: 0·73-1·89) compared to women unexposed to PPH. When restricting the follow-up to the first year after childbirth, the adjusted HR for PTSD was 3·44 (95% CI 1·31-9·03). No increase in the overall risk was observed for other mental illnesses, including depression (adjusted HR: 0·94, 95%CI: 0·87-1·01), severe mental illness (adjusted HR: 0·65, 95%CI: 0·40-1·08, p = 0·239) and anxiety (adjusted HR: 0·99, 95%CI: 0·90-1·09). PPH is associated with a significant increase in the risk of developing postnatal depression and PTSD in the first year after delivery. Active monitoring for mental illness should form an integral part of the follow-up in women who suffered a PPH.
目前，文献中对于产科并发症对后续精神健康结果影响的研究存在空白。本研究旨在确定产后出血（PPH）与精神健康不良之间的关联。我们进行了一项回顾性开放队列研究，利用了 1990 年 1 月 1 日至 2018 年 1 月 31 日期间的初级保健（健康改善网络（THIN））和英国二级保健（医院发病统计数据（HES））数据库。共纳入 42327 名女性：其中 14109 名女性在研究期间发生 PPH，28218 名未暴露于 PPH 的对照组按年龄和分娩日期匹配。在控制了混杂因素后，估计了发生 PPH 的女性与未发生 PPH 的女性发生精神疾病的风险比（HR）。与未发生 PPH 的女性相比，发生 PPH 的女性发生产后抑郁症（调整后的 HR：1.10，95%CI：1.01-1.21）和创伤后应激障碍（PTSD）（调整后的 HR：1.17，95%CI：0.73-1.89）的风险增加。当将随访时间限制在产后第一年时，PTSD 的调整后 HR 为 3.44（95%CI 1.31-9.03）。未观察到其他精神疾病的总体风险增加，包括抑郁症（调整后的 HR：0.94，95%CI：0.87-1.01）、严重精神疾病（调整后的 HR：0.65，95%CI：0.40-1.08，p=0.239）和焦虑症（调整后的 HR：0.99，95%CI：0.90-1.09）。PPH 与产后第一年发生产后抑郁症和 PTSD 的风险显著增加相关。应对发生 PPH 的女性进行主动监测，以发现精神疾病。
