Sakowicz Allie, Allen Emma, Alvarado-Goldberg Mayán, Grobman William A, Miller Emily S
Department of Obstetrics and Gynecology, Wake Forest University School of Medicine, Winston-Salem, North Carolina; the Northwestern University Feinberg School of Medicine and the Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, Illinois; and the Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, The Ohio State University, Columbus, Ohio.
Obstet Gynecol. 2023 Apr 1;141(4):810-817. doi: 10.1097/AOG.0000000000005125. Epub 2023 Mar 9.
To evaluate whether, among pregnant people referred for mental health care, improvement in antenatal depression symptoms before delivery was associated with a reduction in preterm birth.
This retrospective cohort study included all pregnant people referred to a perinatal collaborative care program for mental health care who delivered between March 2016 and March 2021. Those referred to the collaborative care program had access to subspecialty mental health treatment, including psychiatric consultation, psychopharmacotherapy, and psychotherapy. Depression symptoms were monitored with the self-reported PHQ-9 (Patient Health Questionnarie-9) screens in a patient registry. Antenatal depression trajectories were determined by comparing the earliest prenatal PHQ-9 score after collaborative care referral with the score closest to delivery. Trajectories were categorized as improved, stable, or worsened according to whether PHQ-9 scores changed by at least 5 points. Bivariable analyses were performed. A propensity score was generated to control for confounders that were significantly different on bivariable analyses according to trajectories. This propensity score was then included in multivariable models.
Of the 732 pregnant people included, 523 (71.4%) had mild or more severe depressive symptoms (PHQ-9 score 5 or higher) on their initial screen. Antenatal depression symptoms improved in 256 (35.0%), remained stable in 437 (59.7%), and worsened in 39 (5.3%); the corresponding incidence of preterm birth was 12.5%, 14.0%, and 30.8%, respectively ( P =.009). Compared with those with a worsened trajectory, pregnant people who had an improved antenatal depression symptom trajectory had a significantly decreased odds of preterm birth (adjusted odds ratio 0.37, 95% CI 0.15-0.89).
Compared with worsened symptoms, an improved antenatal depression symptom trajectory is associated with decreased odds of preterm birth for pregnant people referred for mental health care. These data further underscore the public health importance of incorporating mental health care into routine obstetric care.
评估在因心理健康问题接受转诊的孕妇中，分娩前产前抑郁症状的改善是否与早产风险降低相关。
这项回顾性队列研究纳入了2016年3月至2021年3月期间因心理健康问题转诊至围产期协作护理项目并分娩的所有孕妇。转诊至协作护理项目的孕妇可获得专科心理健康治疗，包括精神科会诊、心理药物治疗和心理治疗。通过患者登记册中自我报告的PHQ-9（患者健康问卷-9）筛查来监测抑郁症状。通过比较协作护理转诊后最早的产前PHQ-9评分与最接近分娩时的评分来确定产前抑郁轨迹。根据PHQ-9评分是否至少变化5分，将轨迹分为改善、稳定或恶化。进行了双变量分析。生成倾向评分以控制双变量分析中根据轨迹有显著差异的混杂因素。然后将该倾向评分纳入多变量模型。
在纳入的732名孕妇中，523名（71.4%）在初次筛查时存在轻度或更严重的抑郁症状（PHQ-9评分5分或更高）。256名（35.0%）孕妇的产前抑郁症状得到改善，437名（59.7%）保持稳定，39名（5.3%）恶化；相应的早产发生率分别为12.5%、14.0%和30.8%（P = 0.009）。与轨迹恶化的孕妇相比，产前抑郁症状轨迹改善的孕妇早产几率显著降低（调整后的优势比为0.37，95%置信区间为0.15 - 0.89）。
与症状恶化相比，产前抑郁症状轨迹改善与因心理健康问题接受转诊的孕妇早产几率降低相关。这些数据进一步强调了将心理健康护理纳入常规产科护理的公共卫生重要性。
