Division of Maternal-Fetal Medicine, Women and Infants Hospital of Rhode Island, Alpert Medical School of Brown University, Providence, Rhode Island.
Department of Obstetrics and Gynecology, New York Medical College, Valhalla, New York.
Am J Perinatol. 2023 Jul;40(10):1047-1053. doi: 10.1055/a-2051-2433. Epub 2023 Mar 9.
Pregnancies complicated by perinatal mood disorders or a history of mental health disorder are at increased risk for complications including postpartum depression/anxiety. Patients' perceived control over childbirth is known to be an important factor for development of postpartum depression/anxiety. It is unclear whether women with preexisting and/or current depression and/or anxiety have different perceptions of control during childbirth compared with those without these comorbidities. This study aimed to evaluate the association between a current and/or prior diagnosis of depression and/or anxiety and scores on the Labour Agentry Scale (LAS), a validated tool evaluating patient's experience of control over their labor and delivery.
This is a cross-sectional study of nulliparous patients admitted at term to a single center. Participants completed the LAS after delivery. A trained researcher performed detailed chart reviews for all participants. Participants were identified as having a current or historical diagnosis of depression/anxiety by self-report confirmed by chart review. Scores on the LAS were compared between those with versus without a diagnosis of depression/anxiety prior to admission for delivery.
A total of 73 (44.8%) of the 149 participants held a current and/or prior diagnosis of depression and/or anxiety. Baseline demographics were similar between those with and without depression/anxiety. Mean scores on the LAS (range: 91-201) were significantly lower for those with depression/anxiety than those without a prior diagnosis (150.0 vs. 160.5, < 0.01). Even after controlling for mode of delivery, admission indication, anesthesia, and Foley balloon usage, participants with anxiety and depression had scores that were on average 10.4 points lower on the LAS (95% confidence interval: -19.25, -1.62).
Participants with a current and/or prior diagnosis of depression and/or anxiety scored lower on the LAS as compared with those without psychiatric diagnoses. Patients with psychiatric diagnoses may benefit from increased education and support during childbirth.
· Control over childbirth is an important factor in the development of postpartum depression/anxiety.. · Patients with a prior or current diagnosis of anxiety and depression have lower labor agentry scores.. · These differences remained significant even when controlling for confounders such as delivery mode..
患有围产期情绪障碍或精神健康障碍的妊娠，其并发症风险增加，包括产后抑郁/焦虑。患者对分娩的控制感是产后抑郁/焦虑发展的一个重要因素。目前尚不清楚是否患有先前和/或当前抑郁和/或焦虑的女性与没有这些合并症的女性相比，在分娩期间对控制感有不同的看法。本研究旨在评估当前和/或先前诊断为抑郁和/或焦虑与分娩能力量表（LAS）评分之间的关系，该量表是评估患者对分娩体验的控制感的有效工具。
这是一项单中心的、对足月入院的初产妇的横断面研究。参与者在分娩后完成 LAS。一位经过培训的研究人员对所有参与者进行了详细的图表回顾。通过图表回顾确认自我报告，确定参与者是否存在当前或既往抑郁/焦虑诊断。比较有和无产前抑郁/焦虑诊断的参与者的 LAS 评分。
在 149 名参与者中，共有 73 名（44.8%）存在当前和/或既往抑郁和/焦虑的诊断。有和无抑郁/焦虑的参与者的基线人口统计学特征相似。患有抑郁和/或焦虑的参与者的 LAS 平均得分（范围：91-201）明显低于无先前诊断的参与者（150.0 比 160.5，<0.01）。即使在校正了分娩方式、入院指征、麻醉和 Foley 球囊使用后，患有焦虑和抑郁的参与者的 LAS 评分仍平均低 10.4 分（95%置信区间：-19.25，-1.62）。
与无精神科诊断的参与者相比，当前和/或既往诊断为抑郁和/或焦虑的参与者的 LAS 得分较低。患有精神科诊断的患者在分娩期间可能受益于增加教育和支持。
对分娩的控制感是产后抑郁/焦虑发生的一个重要因素。
有先前或当前焦虑和抑郁诊断的患者的劳动代理评分较低。
即使控制了分娩方式等混杂因素，这些差异仍然显著。
