Department of Obstetrics, Affiliated Hai'an Hospital of Nantong University, Nantong, China.
Department of Obstetrics, Yancheng Maternity and Child Health Hospital, Yancheng, China.
Ann Palliat Med. 2022 Mar;11(3):1048-1057. doi: 10.21037/apm-22-165.
There is no study on the impact of anemia on postpartum depression and outcomes in mothers older than 35 years, which makes the nursing of these pregnant women with anemia more difficult.
We retrospectively collected the demographic and clinical characteristics of pregnant women older than 35 years at conception between August 2014 and December 2019. Hemoglobin less than 110 g/L was defined as anemia. Postpartum depression was assessed according to Edinburgh Postnatal Depression Scale. A subgroup analysis was performed by dividing anemia into mild anemia or moderate and severe anemia. All participants were followed up for at least 3 months postpartum and their pregnancy outcomes were recorded. The existence of postpartum depression was evaluated at 4 weeks postpartum. The risk factors of anemia during the third trimester of pregnancy and the impacts of anemia on postpartum depression and pregnancy outcomes were analyzed using multivariable logistic regression analysis.
A total of 519 pregnant older than 35 years women were included in this study, including 281 without anemia and 238 with anemia. No significant difference was found in the incidence of postpartum depression between anemia and non-anemia groups (18.9% vs. 12.8%, P=0.057), while the anemia group had significantly higher incidence of preterm delivery, prolonged labor, and caesarean section. The subgroup analysis found that significantly pregnant women with older age in the moderate or severe anemia subgroup had postpartum depression than those in the mild anemia subgroup (23.2% vs. 12.5%, P=0.038). A higher rate of preterm delivery, prolonged labor, and caesarean section was recorded in the moderate or severe anemia subgroup (8.3% vs. 20.4%, P=0.012; 30.2% vs. 43.0%, P<0.001; 20.8% vs. 40.1%, P=0.002). Moderate or severe anemia, the presence of depression during the first trimester of pregnancy, unplanned pregnancy, and fewer parity were identified as risk factors of postpartum depression in pregnant women older than 35 years with anemia.
Anemia has significant impacts on pregnancy outcomes in pregnant women older than 35 years. Furthermore, moderate and severe anemia will significantly increase the incidence of postpartum depression, which should be corrected at an early stage to minimize its negative effects.
目前尚无研究探讨贫血对 35 岁以上产妇产后抑郁及其结局的影响，这使得对这些贫血孕妇的护理更加困难。
我们回顾性收集了 2014 年 8 月至 2019 年 12 月期间妊娠年龄大于 35 岁孕妇的人口统计学和临床特征。血红蛋白<110 g/L 定义为贫血。根据爱丁堡产后抑郁量表评估产后抑郁。通过将贫血分为轻度贫血或中重度贫血进行亚组分析。所有参与者均在产后至少随访 3 个月，记录其妊娠结局。在产后 4 周评估产后抑郁的存在。采用多变量逻辑回归分析方法分析妊娠晚期贫血的危险因素及贫血对产后抑郁和妊娠结局的影响。
本研究共纳入 519 例妊娠年龄大于 35 岁孕妇，其中 281 例无贫血，238 例贫血。贫血组和非贫血组产后抑郁发生率无统计学差异（18.9%比 12.8%，P=0.057），但贫血组早产、产程延长和剖宫产的发生率显著较高。亚组分析发现，中重度贫血亚组中年龄较大的孕妇产后抑郁发生率显著高于轻度贫血亚组（23.2%比 12.5%，P=0.038）。中重度贫血亚组早产、产程延长和剖宫产的发生率较高（8.3%比 20.4%，P=0.012；30.2%比 43.0%，P<0.001；20.8%比 40.1%，P=0.002）。中重度贫血、孕早期抑郁、非计划性妊娠和较少的产次被确定为妊娠年龄大于 35 岁贫血孕妇产后抑郁的危险因素。
贫血对 35 岁以上孕妇的妊娠结局有显著影响。此外，中重度贫血会显著增加产后抑郁的发生率，应尽早纠正，以尽量减少其负面影响。
