Ståhlberg Tiia, Upadhyaya Subina, Polo-Kantola Päivi, Khanal Prakash, Luntamo Terhi, Hinkka-Yli-Salomäki Susanna, Sourander Andre
Research Center for Child Psychiatry, INVEST Flagship, University of Turku, Turku, Finland.
Department of Obstetrics and Gynecology, Turku University Hospital and University of Turku, Turku, Finland.
Front Psychiatry. 2022 Jul 13;13:917299. doi: 10.3389/fpsyt.2022.917299. eCollection 2022.
Mode of delivery and well-being markers for newborn infants have been associated with later psychiatric problems in children and adolescents. However, only few studies have examined the association between birth outcomes and anxiety disorders and the results have been contradictory.
This study was a Finnish population-based register study, which comprised 22,181 children and adolescents with anxiety disorders and 74,726 controls. Three national registers were used to collect the data on exposures, confounders and outcomes. Mode of delivery, the 1-min Apgar score, umbilical artery pH and neonatal monitoring were studied as exposure variables for anxiety disorders and for specific anxiety disorders. Conditional logistic regression was used to examine these associations.
Unplanned and planned cesarean sections increased the odds for anxiety disorders in children and adolescents (adjusted OR 1.08, 95% CI 1.02-1.15 and aOR 1.12, 95% CI 1.05-1.19, respectively). After an additional adjustment for maternal diagnoses, unplanned cesarean sections remained statistically significant (aOR 1.11, 95% CI 1.04-1.18). For specific anxiety disorders, planned cesarean sections and the need for neonatal monitoring increased the odds for specific phobia (aOR 1.21, 95% CI 1.01-1.44 and aOR 1.28, 95% CI 1.07-1.52, respectively).
Birth by cesarean section increased the odds for later anxiety disorders in children and adolescents and unplanned cesarean sections showed an independent association. Further studies are needed to examine the mechanisms behind these associations.
新生儿的分娩方式和健康指标与儿童及青少年后期的精神问题有关。然而，仅有少数研究考察了出生结局与焦虑症之间的关联，且结果相互矛盾。
本研究是一项基于芬兰人群登记的研究，纳入了22181名患有焦虑症的儿童和青少年以及74726名对照。使用了三个国家登记处来收集暴露因素、混杂因素和结局的数据。将分娩方式、1分钟阿氏评分、脐动脉pH值和新生儿监测作为焦虑症及特定焦虑症的暴露变量。采用条件逻辑回归分析这些关联。
非计划剖宫产和计划剖宫产均增加了儿童及青少年患焦虑症的几率（调整后的比值比分别为1.08，95%置信区间为1.02 - 1.15和1.12，95%置信区间为1.05 - 1.19）。在对母亲诊断进行额外调整后，非计划剖宫产仍具有统计学意义（调整后的比值比为1.11，95%置信区间为1.04 - 1.18）。对于特定焦虑症，计划剖宫产和新生儿监测需求增加了患特定恐惧症的几率（调整后的比值比分别为1.21，95%置信区间为1.01 - 1.44和1.28，95%置信区间为1.07 - 1.52）。
剖宫产增加了儿童及青少年后期患焦虑症的几率，且非计划剖宫产显示出独立关联。需要进一步研究来探究这些关联背后的机制。
