Bilbul Melanie, Caccese Christina, Horsley Kristin, Gauvreau Alexandre, Gavanski Isabella, Montreuil Tina, Konci Rea, Lai Jonathan K, Da Costa Deborah, Zelkowitz Phyllis, Shen Hao Cheng, Gryte Kailas Rumjahn, Larosa Amanda, Brown Richard Nicolas, Suarthana Eva, Nguyen Tuong-Vi
Department of Psychiatry, Icahn School of Medicine, New York, NY, USA; Department of Psychiatry, McGill University, Montreal, QC, Canada.
Department of Psychiatry, McGill University, Montreal, QC, Canada.
J Psychosom Res. 2022 Mar;154:110722. doi: 10.1016/j.jpsychores.2022.110722. Epub 2022 Jan 25.
We aim to clarify whether type and timing of mental health symptoms in early pregnancy distinctly contribute to maternal-fetal vascular function, independent from the psychotropic medications given to treat these conditions.
Data from a prospective cohort study (n = 1678) were used to test whether self-reported fears about giving birth and depressive symptoms prior to 16 weeks of gestation were associated with vascular outcomes predictive of hypertensive disorders of pregnancy (HDP) i.e., systolic and diastolic blood pressure (BP); uterine artery pulsatility index (UAPI); umbilical artery resistance index (UmbARI); and urine protein creatinine ratio. Multiple linear regressions models and mediation models were used to test for associations between predictors and outcomes, controlling for previously identified risk factors for vascular dysfunction such as maternal age and history of infertility.
Fears about giving birth in early pregnancy were inversely associated with UmbARI (β = -0.33, p = 0.03, df = 51) mid- to late-pregnancy (≥20 weeks). Depressive symptoms in early pregnancy were also inversely associated with maternal systolic BP (β = -0.13, p = 0.01, df = 387) and diastolic BP (β = -0.10, p = 0.04, df = 387) during the first trimester.
While fears about giving birth in early pregnancy were associated with lower vascular resistance in the fetal-placental unit, early depressive symptoms were associated with lower maternal vascular tone. At the very least, our results support the notion that early maternal psychological distress is unlikely to account for the development of HDP later during pregnancy and provide preliminary evidence to support distinct roles of pregnancy-related anxiety and depressive symptoms in maternal-fetal vascular function.
我们旨在阐明妊娠早期心理健康症状的类型和出现时间是否独立于用于治疗这些症状的精神药物，对母婴血管功能有显著影响。
前瞻性队列研究（n = 1678）的数据用于检验妊娠16周前自我报告的分娩恐惧和抑郁症状是否与预测妊娠高血压疾病（HDP）的血管结局相关，即收缩压和舒张压（BP）；子宫动脉搏动指数（UAPI）；脐动脉阻力指数（UmbARI）；以及尿蛋白肌酐比值。使用多元线性回归模型和中介模型来检验预测因素与结局之间的关联，并控制先前确定的血管功能障碍风险因素，如产妇年龄和不孕史。
妊娠早期的分娩恐惧与妊娠中期至晚期（≥20周）的UmbARI呈负相关（β = -0.33，p = 0.03，df = 51）。妊娠早期的抑郁症状与孕早期的产妇收缩压（β = -0.13，p = 0.01，df = 387）和舒张压（β = -0.10，p = 0.04，df = 387）也呈负相关。
虽然妊娠早期的分娩恐惧与胎儿 - 胎盘单位的血管阻力降低有关，但早期抑郁症状与产妇血管张力降低有关。至少，我们的结果支持这样一种观点，即产妇早期心理困扰不太可能导致妊娠后期HDP的发生，并提供了初步证据支持妊娠相关焦虑和抑郁症状在母婴血管功能中的不同作用。
