Division of Neonatal-Perinatal Medicine, Department of Pediatrics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
Department of Pediatrics, Women and Infant's Hospital/Brown University, Providence, Rhode Island.
Am J Perinatol. 2024 Jul;41(10):1396-1408. doi: 10.1055/s-0043-1768132. Epub 2023 Apr 18.
To identify psychological, medical, and socioenvironmental risk factors for maternal postpartum depression (PPD) and severe psychological distress (SPD) at intensive care nursery discharge among mothers of very preterm infants.
We studied 562 self-identified mothers of 641 infants born <30 weeks who were enrolled in the Neonatal Neurobehavior and Outcomes in Very Preterm Infants Study (NOVI) conducted in nine university-affiliated intensive care nurseries. Enrollment interviews collected socioenvironmental data, depression, and anxiety diagnoses prior to and during the study pregnancy. Standardized medical record reviews ascertained prenatal substance use, maternal and neonatal medical complications. The Edinburgh Postnatal Depression Scale and Brief Symptom Inventory were administered at nursery discharge to screen for PPD and SPD symptoms, respectively.
Unadjusted analyses indicated mothers with positive screens for depression ( = 76, 13.5%) or severe distress ( = 102, 18.1%) had more prevalent prepregnancy/prenatal depression/anxiety, and their infants were born at younger gestational ages, with more prevalent bronchopulmonary dysplasia, and discharge after 40 weeks postmenstrual age. In multivariable analyses, prior depression or anxiety was associated with positive screens for PPD (risk ratio [RR]: 1.6, 95% confidence interval [CI]: 1.1-2.2) and severe distress (RR: 1.6, 95% CI: 1.1-2.2). Mothers of male infants had more prevalent depression risk (RR: 1.7, 95% CI: 1.1-2.4), and prenatal marijuana use was associated with severe distress risk (RR: 1.9, 95% CI: 1.1-2.9). Socioenvironmental and obstetric adversities were not significant after accounting for prior depression/anxiety, marijuana use, and infant medical complications.
Among mothers of very preterm newborns, these multicenter findings extend others' previous work by identifying additional indicators of risk for PPD and SPD associated with a history of depression, anxiety, prenatal marijuana use, and severe neonatal illness. Findings could inform designs for continuous screening and targeted interventions for PPD and distress risk indicators from the preconception period onward.
· Preconceptional and prenatal screening for postpartum depression and severe distress may inform care.. · Prior depression, anxiety, and neonatal complications predicted severe distress and depression symptoms at NICU discharge.. · Readily identifiable risk factors warrant continuous NICU screening and targeted interventions to improve outcomes..
确定心理、医学和社会环境风险因素，以识别极早产儿母亲在新生儿重症监护病房出院时的产后抑郁症（PPD）和严重心理困扰（SPD）。
我们研究了在 9 家大学附属新生儿重症监护病房参与新生儿神经行为和极早产儿结局研究（NOVI）的 641 名胎龄<30 周出生的自我认定母亲中的 562 名。在研究妊娠之前和期间，入组访谈收集了社会环境数据、抑郁和焦虑诊断。标准化病历审查确定了产前物质使用、母婴和新生儿医疗并发症。在新生儿重症监护病房出院时，使用爱丁堡产后抑郁量表和简明症状量表分别筛查 PPD 和 SPD 症状。
未调整分析表明，抑郁阳性筛查者（ = 76，13.5%）或严重困扰阳性筛查者（ = 102，18.1%）在妊娠前/产前有更多的抑郁/焦虑症，且她们的婴儿胎龄更小，支气管肺发育不良更常见，且在 40 周后周龄时出院。多变量分析显示，既往抑郁或焦虑与 PPD 阳性筛查（风险比 [RR]：1.6，95%置信区间 [CI]：1.1-2.2）和严重困扰阳性筛查（RR：1.6，95% CI：1.1-2.2）相关。男婴母亲的抑郁风险更高（RR：1.7，95% CI：1.1-2.4），产前大麻使用与严重困扰风险相关（RR：1.9，95% CI：1.1-2.9）。在考虑到既往抑郁/焦虑、大麻使用和新生儿医疗并发症后，社会人口统计学和产科逆境不再显著。
在极早产儿的母亲中，这些多中心研究结果通过识别与抑郁、焦虑、产前大麻使用和严重新生儿疾病相关的 PPD 和 SPD 风险的其他指标，扩展了其他人以前的工作。这些发现可以为从受孕前开始的 PPD 和困扰风险指标的连续筛查和有针对性的干预措施提供信息。
