Department of Psychology, University of Cambridge, Cambridge, United Kingdom.
School of Psychology, University of New South Wales, Kensington, New South Wales, Australia.
JAMA Netw Open. 2023 Mar 1;6(3):e232969. doi: 10.1001/jamanetworkopen.2023.2969.
Antenatal stress is a significant risk factor for poor postpartum mental health. The association of pandemic-related stress with postpartum outcomes among mothers and infants is, however, less well understood.
To examine the association of antenatal COVID-19-related stress with postpartum maternal mental health and infant outcomes.
DESIGN, SETTING, AND PARTICIPANTS: This cohort study was conducted among 318 participants in the COVID-19 Risks Across the Lifespan study, which took place in Australia, the UK, and the US. Eligible participants reported being pregnant at the first assessment wave between May 5 and September 30, 2020, and completed a follow-up assessment between October 28, 2021, and April 24, 2022.
COVID-19-related stress was assessed with the Pandemic Anxiety Scale (score range, 0-4, with higher scores indicating greater COVID-19-related stress). The 8-item Patient Health Questionnaire (score range, 0-3, with higher scores indicating more frequent symptoms of depression) was used to measure maternal depression at each time point, and the 7-item General Anxiety Disorder scale (score range, 0-3, with higher scores indicating more frequent symptoms of anxiety) was used to measure generalized anxiety at each time point. At follow-up, postpartum distress was assessed with the 10-item Postpartum Distress Measure (score range, 0-3, with higher scores indicating greater postpartum distress), and infant outcomes (negative and positive affectivity and orienting behavior) were captured with the Infant Behavior Questionnaire (score range, 1-7, with higher scores indicating that the infant exhibited that affect/behavior more frequently).
The study included 318 women (mean [SD] age, 32.0 [4.6] years) from Australia (88 [28%]), the US (94 [30%]), and the UK (136 [43%]). Antenatal COVID-19-related stress was significantly associated with maternal postpartum distress (β = 0.40 [95% CI, 0.28-0.53]), depression (β = 0.32 [95% CI, 0.23-0.41]), and generalized anxiety (β = 0.35 [95% CI, 0.26-0.44]), as well as infant negative affectivity (β = 0.45 [95% CI, 0.14-0.76]). The findings remained consistent across a range of sensitivity analyses.
The findings of this cohort study suggest that targeting pandemic-related stressors in the antenatal period may improve maternal and infant outcomes. Pregnant individuals should be classified as a vulnerable group during pandemics and should be considered a public health priority, not only in terms of physical health but also mental health.
产前压力是产后精神健康状况不佳的一个重要危险因素。然而，大流行相关压力与母婴产后结局之间的关系还不太清楚。
研究产前 COVID-19 相关压力与产妇产后心理健康和婴儿结局的关系。
设计、地点和参与者：这项队列研究在澳大利亚、英国和美国进行的 COVID-19 风险研究中进行，共有 318 名参与者符合条件。这些参与者在 2020 年 5 月 5 日至 9 月 30 日的第一次评估波次中报告怀孕，并在 2021 年 10 月 28 日至 2022 年 4 月 24 日之间进行了随访评估。
使用大流行病焦虑量表（评分范围为 0-4，得分越高表示 COVID-19 相关压力越大）评估 COVID-19 相关压力。在每个时间点，使用 8 项患者健康问卷（评分范围为 0-3，得分越高表示抑郁症状越频繁）测量产妇抑郁情况，使用 7 项广泛性焦虑症量表（评分范围为 0-3，得分越高表示焦虑症状越频繁）测量广泛性焦虑情况。在随访时，使用产后抑郁量表（评分范围为 0-3，得分越高表示产后抑郁越严重）评估产后抑郁，使用婴儿行为问卷（评分范围为 1-7，得分越高表示婴儿更频繁地表现出该情绪/行为）评估婴儿的负面和积极的情感以及定向行为。
这项研究包括来自澳大利亚（88[28%]）、美国（94[30%]）和英国（136[43%]）的 318 名女性（平均[SD]年龄，32.0[4.6]岁）。产前 COVID-19 相关压力与产妇产后焦虑（β=0.40[95%CI，0.28-0.53]）、抑郁（β=0.32[95%CI，0.23-0.41]）和广泛性焦虑（β=0.35[95%CI，0.26-0.44]）以及婴儿的负性情感（β=0.45[95%CI，0.14-0.76]）显著相关。在一系列敏感性分析中，这些发现仍然一致。
这项队列研究的结果表明，在产前阶段针对大流行相关压力源可能会改善母婴结局。在大流行期间，应将孕妇视为弱势群体，并应将其视为公共卫生的重点，不仅要关注身体健康，还要关注心理健康。
