Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada.
Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada.
PLoS One. 2022 Jun 22;17(6):e0270158. doi: 10.1371/journal.pone.0270158. eCollection 2022.
While depression and anxiety are common in women and men of reproductive age, preconception interventions to optimize the health of individuals with mental illness before pregnancy is limited and focuses primarily on psychotropic medication management. Comparing individuals with depression, anxiety, and comorbidity to those with neither condition, we identified areas of preconception care optimization related to psychosocial risk factors, general physical health, medication use, and uptake of high-risk health behaviours. We also investigated differences in preconception health care use, attitudes, and knowledge.
We conducted a nationwide survey of 621 women (n = 529) and men (n = 92) across Canada who were planning a pregnancy within five years, including those with lifetime or current depression (n = 38), anxiety (n = 55), and comorbidity (n = 104) and those without mental illness (n = 413). Individuals with depression, anxiety, and comorbidity were compared to individuals without mental illness using logistic regression, adjusted for age, sex, and education level.
Individuals with a lifetime or current mental illness were significantly more likely to have several risk factors for suboptimal reproductive and perinatal outcomes, including increased rates of obesity, stress, fatigue, loneliness, number of chronic health conditions, and medication use. Further, they were more likely to have high-risk health behaviours including increased substance use, internet addiction, poorer eating habits, and decreased physical activity. By assessing depression, anxiety, or both separately, we also determined there was variation in risk factors by mental illness type.
Our nationwide study is one of the first and largest to examine the preconception care needs of women and men with a lifetime or current mental illness who are pregnancy-planning. We found this population has many important reproductive and perinatal risk factors that are modifiable via preconception interventions which could have a significant positive impact on their health trajectories and those of their future children.
虽然抑郁和焦虑在育龄期的女性和男性中很常见，但在怀孕前对有精神疾病的个体进行干预以优化其健康的孕前干预措施有限，主要集中在精神药物管理上。通过比较患有抑郁、焦虑和共病的个体与没有这些疾病的个体，我们确定了与心理社会风险因素、一般身体健康、药物使用以及高风险健康行为的采用有关的孕前保健优化领域。我们还研究了孕前保健使用、态度和知识方面的差异。
我们对加拿大全国范围内计划在五年内怀孕的 621 名女性（n=529）和男性（n=92）进行了一项全国性调查，其中包括有终身或当前抑郁（n=38）、焦虑（n=55）和共病（n=104）的个体，以及没有精神疾病的个体（n=413）。使用逻辑回归对有抑郁、焦虑和共病的个体与没有精神疾病的个体进行比较，调整了年龄、性别和教育水平。
有终身或当前精神疾病的个体有几个不利于生殖和围产期结局的风险因素的可能性显著增加，包括肥胖、压力、疲劳、孤独、慢性健康状况数量和药物使用增加。此外，他们更有可能采取高风险的健康行为，包括增加物质使用、网络成瘾、不良饮食习惯和减少体育活动。通过单独评估抑郁、焦虑或两者，我们还确定了不同精神疾病类型的风险因素存在差异。
我们的全国性研究是首次也是最大的研究之一，旨在研究有终身或当前精神疾病的计划怀孕的女性和男性的孕前保健需求。我们发现，该人群有许多重要的生殖和围产期风险因素，这些因素可以通过孕前干预措施来改变，这对他们的健康轨迹和他们未来孩子的健康有重大积极影响。
