Benzakour Lamyae, Gayet-Ageron Angèle, Epiney Manuella
Department of Psychiatry, Geneva University Hospitals, 1205 Geneva, Switzerland.
Faculty of Medicine, University of Geneva, 1206 Geneva, Switzerland.
Healthcare (Basel). 2024 Apr 30;12(9):927. doi: 10.3390/healthcare12090927.
Due to a higher risk of maternal complications during pregnancy, as well as pregnancy complications such as stillbirth, SARS-CoV-2 contamination during pregnancy is a putative stress factor that could increase the risk of perinatal maternal mental health issues. We included women older than 18 years, who delivered a living baby at the Geneva University Hospitals' maternity wards after 29 weeks of amenorrhea (w.a.) and excluded women who did not read or speak fluent French. We compared women who declared having had COVID-19, confirmed by a positive PCR test for SARS-CoV-2, during pregnancy with women who did not, both at delivery and at one month postpartum. We collected clinical data by auto-questionnaires between time of childbirth and the third day postpartum regarding the occurrence of perinatal depression, peritraumatic dissociation, and peritraumatic distress during childbirth, measured, respectively, by the EPDS (depression is score > 11), PDI (peritraumatic distress is score > 15), and PDEQ (scales). At one month postpartum, we compared the proportion of women with a diagnosis of postpartum depression (PPD) and birth-related posttraumatic stress disorder (CB-PTSD), using PCL-5 for CB-PTSD and using diagnosis criteria according DSM-5 for both PPD and CB-PTSD, in the context of a semi-structured interview, conducted by a clinician psychologist. Off the 257 women included, who delivered at the University Hospitals of Geneva between 25 January 2021 and 10 March 2022, 41 (16.1%) declared they had a positive PCR test for SARS-CoV-2 during their pregnancy. Regarding mental outcomes, except birth-related PTSD, all scores provided higher mean values in the group of women who declared having been infected by SARS-CoV-2, at delivery and at one month postpartum, without reaching any statistical significance: respectively, 7.8 (±5.2, 8:4-10.5) versus 6.5 (±4.7, 6:3-9), = 0.139 ***, for continuous EPDS scores; 10 (25.0) versus 45 (21.1), = 0.586 *, for dichotomous EPDS scores (≥11); 118 (55.7) versus 26 (63.4), = 0.359 *, for continuous PDI scores; 18.3 (±6.8, 16:14-21) versus 21.1 (±10.7, 17:15-22), 0.231 ***, for dichotomous PDI scores (≥15); 14.7 (±5.9, 13:10-16) versus 15.7 (±7.1, 14:10-18), = 0.636 ***, for continuous PDEQ scores; 64 (30.0) versus 17 (41.5), = 0.151 *, for dichotomous PDEQ scores (≥15); and 2 (8.0) versus 5 (3.6), = 0.289 *, for postpartum depression diagnosis, according DSM-5. We performed Chi-squared or Fisher's exact tests, depending on applicability for the comparison of categorical variables and Mann-Whitney nonparametric tests for continuous variables; < 0.05 was considered as statistically significant. Surprisingly, we did not find more birth-related PTSD as noted by the PCL-5 score at one month postpartum in women who declared a positive PCR test for SARS-CoV-2:15 (10.6) versus no case of birth related PTSD in women who were infected during pregnancy ( = 0.131 *). Our study showed that mental outcomes were differently distributed between women who declared having been infected by SARS-CoV-2 compared to women who were not infected. However, our study was underpowered to explore all the factors associated with psychiatric issues during pregnancy, postpartum, depending on the exposure to SARS-CoV-2 infection during pregnancy. Future longitudinal studies on bigger samples and more diverse populations over a longer period are needed to explore the long-term psychic impact on women who had COVID-19 during pregnancy.
由于孕期孕产妇并发症风险较高，以及诸如死产等妊娠并发症，孕期感染严重急性呼吸综合征冠状病毒2（SARS-CoV-2）是一个假定的应激因素，可能会增加围产期孕产妇心理健康问题的风险。我们纳入了年龄超过18岁、停经29周后在日内瓦大学医院产科病房分娩活婴的女性，并排除了不会读写或说法语不流利的女性。我们将孕期经SARS-CoV-2核酸检测阳性确诊感染过新冠病毒的女性与未感染的女性在分娩时及产后1个月进行了比较。我们在分娩至产后第三天通过自动问卷收集临床数据，以分别通过爱丁堡产后抑郁量表（EPDS，抑郁评分>11）、围产期创伤应激量表（PDI，围产期创伤应激评分>15）和围产期解离问卷（PDEQ，量表）来测量围产期抑郁、围产期创伤解离和分娩时的围产期应激情况。在产后1个月，我们在临床心理学家进行的半结构化访谈背景下，使用创伤后应激障碍量表（PCL-5）评估与分娩相关的创伤后应激障碍（CB-PTSD），并根据《精神疾病诊断与统计手册》第5版（DSM-5）的诊断标准评估产后抑郁（PPD），比较诊断为产后抑郁和与分娩相关的创伤后应激障碍的女性比例。在2021年1月25日至2022年3月10日期间于日内瓦大学医院分娩的257名女性中，41名（16.1%）宣称其孕期SARS-CoV-2核酸检测呈阳性。关于心理结局，除了与分娩相关的创伤后应激障碍外，在分娩时及产后1个月，所有评分在宣称感染SARS-CoV-2的女性组中均提供了更高的平均值，但均未达到任何统计学显著性：连续EPDS评分分别为7.8（±5.2，8:4 - 10.5）与6.5（±4.7，6:3 - 9），P = 0.139 ***；二分法EPDS评分（≥11）为10（25.0）与45（21.1），P = 0.586 *；连续PDI评分为118（55.7）与26（63.4），P = 0.359 *；二分法PDI评分（≥15）为18.3（±6.8，16:14 - 21）与21.1（±10.7，17:15 - 22），P = 0.231 ***；连续PDEQ评分为14.7（±5.9，13:10 - 16）与15.7（±7.1，14:10 - 18），P = 0.636 ***；二分法PDEQ评分（≥15）为64（30.0）与17（41.5），P = 0.151 *；根据DSM-5诊断的产后抑郁为2（8.0）与5（3.6），P = 0.289 *。我们根据分类变量比较的适用性进行卡方检验或费舍尔精确检验，对连续变量进行曼-惠特尼非参数检验；P < 0.05被认为具有统计学显著性。令人惊讶的是，在产后1个月通过PCL-5评分发现，宣称SARS-CoV-2核酸检测呈阳性的女性中与分娩相关的创伤后应激障碍并不比孕期感染的女性更多：15例（10.6%）与孕期感染女性中无分娩相关创伤后应激障碍病例（P = 0.131 *）。我们的研究表明，宣称感染SARS-CoV-2的女性与未感染的女性之间心理结局的分布有所不同。然而，我们的研究样本量不足，无法探究孕期、产后与精神问题相关的所有因素，具体取决于孕期是否暴露于SARS-CoV-2感染。未来需要对更大样本、更多样化人群进行更长时间的纵向研究，以探究孕期感染新冠病毒对女性的长期心理影响。
