Tan Hon Sen, Guinn Nicole R, Fuller Matthew E, Habib Ashraf S
Department of Women's Anaesthesia, KK Women's and Children's Hospital, Singapore, Singapore.
Department of Anesthesiology, Center for Blood Conservation, Duke University Medical Center, Durham, NC, USA.
Arch Gynecol Obstet. 2022 Nov;306(5):1477-1484. doi: 10.1007/s00404-022-06417-3. Epub 2022 Feb 7.
Determine if intravenous iron for antenatal anemia is associated with reduced incidence of postnatal depression (PND) within 12 months.
This retrospective cohort study included adult women with antenatal anemia (hemoglobin value of < 11.0 g/dL within 3 months before delivery). PND was defined as Edinburgh Postnatal Depression Scale (EPDS) or Patient Health Questionnaire-9 (PHQ-9) ≥ 10. Data on intravenous iron, lowest hemoglobin concentration, EPDS and PHQ-9 scores, insurance status, history of anxiety, depression, chronic pain, and substance use, obstetric complications, labor analgesia, and mode of delivery were obtained. Standardized mean difference (SMD) was estimated and multivariable logistic regression models were constructed with adjustment for potential confounders with absolute SMD of ≥ 0.1.
Data from 3988 women were analyzed. The 368 (9.2%) women who received intravenous iron therapy had lower antenatal hemoglobin levels, were more likely to be African American or single/widowed women, and more commonly had Medicaid coverage, repeat cesarean delivery, and history of depression compared to those who did not receive intravenous iron therapy. Unadjusted analysis showed women who received intravenous iron had higher incidence of PND (18.5%) than those who did not (13.4%) (p = 0.008). Multivariable analysis showed no significant association between intravenous iron and PND incidence (aOR 1.21, 95%CI 0.89-1.63, p = 0.232), although history of depression (aOR 2.42, 95%CI 1.91-3.08, p < 0.001), higher gravidity (aOR 1.09, 95%CI 1.02-1.17, p = 0.016), and Medicaid insurance (aOR 1.44, 95%CI 1.16-1.80, p = 0.001) were independently associated with PND.
Intravenous iron for antenatal anemia was not associated with significant change in the incidence of PND.
确定产前贫血静脉补铁是否与产后12个月内产后抑郁（PND）发病率降低相关。
这项回顾性队列研究纳入了产前贫血的成年女性（分娩前3个月内血红蛋白值<11.0g/dL）。PND定义为爱丁堡产后抑郁量表（EPDS）或患者健康问卷-9（PHQ-9）≥10。获取了静脉补铁、最低血红蛋白浓度、EPDS和PHQ-9评分、保险状况、焦虑、抑郁、慢性疼痛和物质使用史、产科并发症、分娩镇痛和分娩方式的数据。估计标准化均值差（SMD），并构建多变量逻辑回归模型，对绝对SMD≥0.1的潜在混杂因素进行调整。
分析了3988名女性的数据。与未接受静脉补铁治疗的女性相比，接受静脉补铁治疗的368名（9.2%）女性产前血红蛋白水平较低，更有可能是非裔美国女性或单身/丧偶女性，且更常见有医疗补助、重复剖宫产和抑郁史。未经调整的分析显示，接受静脉补铁治疗的女性PND发病率（18.5%）高于未接受治疗的女性（13.4%）（p = 0.008）。多变量分析显示，静脉补铁与PND发病率之间无显著关联（调整后比值比1.21，95%置信区间0.89 - 1.63，p = 0.232），尽管抑郁史（调整后比值比2.42，95%置信区间1.91 - 3.08，p < 0.001）、较高的孕次（调整后比值比1.09，95%置信区间1.02 - 1.17，p = 0.016）和医疗补助保险（调整后比值比1.44，95%置信区间1.16 - 1.80，p = 0.001）与PND独立相关。
产前贫血静脉补铁与PND发病率的显著变化无关。
