Center of Research in Psychological and Somatic disorders (CoRPS), Department of Medical and Clinical Psychology, Tilburg University, Tilburg, The Netherlands.
Department of Methodology and Statistics, Tilburg University, Tilburg, The Netherlands.
BJOG. 2023 Apr;130(5):495-505. doi: 10.1111/1471-0528.17273. Epub 2022 Aug 16.
To assess the association between trajectories of comorbid anxiety and depressive (CAD) symptoms assessed in each pregnancy trimester and physiological birth.
Large longitudinal prospective cohort study with recruitment between January 2013 and September 2014.
Primary care, in the Netherlands.
Dutch-speaking pregnant women with gestational age at birth ≥37 weeks, and without multiple pregnancy, severe psychiatric disorder or chronic disease history.
Pregnancy-specific anxiety and depressive symptoms were measured prospectively in each trimester of pregnancy using the negative affect subscale of the Tilburg Pregnancy Distress Scale and Edinburgh (Postnatal) Depression Scale. Data on physiological birth were obtained from obstetric records. Multivariate growth mixture modelling was performed in MPLUS to determine longitudinal trajectories of CAD symptoms. Multiple logistic regression analysis was used to examine the association between trajectories and physiological birth.
Trajectories of CAD symptoms and physiological birth.
Seven trajectories (classes) of CAD symptoms were identified in 1682 women and subsequently merged into three groups: group 1-persistently low levels of symptoms (reference class 1; 79.0%), group 2-intermittently high levels of symptoms (classes 3, 6 and 7; 11.2%), and group 3-persistently high levels of symptoms (classes 2, 4 and 5; 9.8%). Persistently high levels of CAD symptoms (group 3) were associated with a lower likelihood of physiological birth (odds ratio 0.67, 95% confidence interval 0.47-0.95, P = 0.027) compared with the reference group (persistently low levels of symptoms), after adjusting for confounders.
This study is the first showing evidence that persistently high CAD levels, assessed in each pregnancy trimester, are associated with a lower likelihood of physiological birth.
评估在每个妊娠期间评估的共病焦虑和抑郁（CAD）症状轨迹与生理分娩之间的关联。
大型纵向前瞻性队列研究，招募时间为 2013 年 1 月至 2014 年 9 月。
荷兰初级保健。
荷兰语孕妇，出生时胎龄≥37 周，无多胎妊娠、严重精神障碍或慢性病史。
使用蒂尔堡妊娠困扰量表的负性情绪分量表和爱丁堡（产后）抑郁量表，前瞻性地测量每个妊娠期间的妊娠特异性焦虑和抑郁症状。生理分娩的数据从产科记录中获得。使用 MPLUS 在 MPLUS 中进行多变量增长混合物建模，以确定 CAD 症状的纵向轨迹。使用多变量逻辑回归分析检查轨迹与生理分娩之间的关联。
CAD 症状的轨迹和生理分娩。
在 1682 名女性中确定了 7 种 CAD 症状轨迹（类别），随后将其合并为三组：第 1 组-症状持续低水平（参考类别 1；79.0%），第 2 组-症状间歇性高水平（类别 3、6 和 7；11.2%），第 3 组-症状持续高水平（类别 2、4 和 5；9.8%）。与参考组（症状持续低水平）相比，持续高水平的 CAD 症状（第 3 组）与生理分娩的可能性降低相关（比值比 0.67，95%置信区间 0.47-0.95，P=0.027），调整混杂因素后。
这项研究首次表明，在每个妊娠期间评估的持续高水平 CAD 与生理分娩的可能性降低相关。
