School of Public Health, The University of Queensland, Herston, QLD, Australia.
Epidemiol Psychiatr Sci. 2024 Nov 5;33:e55. doi: 10.1017/S2045796024000374.
The role of depression in subsequent infertility, miscarriage and stillbirth remains unclear. This study aimed to examine the association of a history of depression with these adverse outcomes using a longitudinal cohort study of women across their reproductive life span.
This study used data from participants in the Australian Longitudinal Study on Women's Health who were born in 1973-1978. Participants ( = 8707) were followed up every 3 years from 2000 (aged 22-27) to 2018 (aged 40-45). Information on a diagnosis of depression was collected from each survey, and antidepressant medication use was identified through pharmaceutical prescription data. Histories of infertility, miscarriage, and stillbirth were self-reported at each survey. Time-lagged log-binomial models with generalized estimating equations were used to assess the association of a history of depression up to and including in a given survey with the risk of fertility issues in the next survey.
Women with a history of depression (excluding postnatal depression) were at higher risk of infertility [risk ratio (RR) = 1.34, 95% confidence interval (CI): 1.21-1.48], miscarriage (RR = 1.22, 95%CI: 1.10-1.34) and recurrent miscarriages (≥2; RR = 1.39, 95%CI: 1.17-1.64), compared to women without a history of depression. There were too few stillbirths to provide clear evidence of an association. Antidepressant medication use did not affect the observed associations. Estimated RRs of depression with infertility and miscarriage increased with age.
A history of depression was associated with higher risk of subsequent infertility, miscarriage and recurrent miscarriages.
抑郁在随后的不孕、流产和死产中的作用仍不清楚。本研究旨在通过对女性整个生殖生命周期的纵向队列研究，检查抑郁史与这些不良结局的关系。
本研究使用了澳大利亚女性健康纵向研究中出生于 1973-1978 年的参与者的数据。从 2000 年（22-27 岁）开始，每 3 年对参与者进行一次随访，直到 2018 年（40-45 岁）。从每次调查中收集了关于抑郁诊断的信息，并通过药物处方数据确定了抗抑郁药物的使用情况。在每次调查中，自我报告了不孕、流产和死产的病史。使用广义估计方程的时滞对数二项式模型评估了在特定调查中包含之前调查的抑郁史与下一次调查中生育问题风险的关系。
有抑郁史（不包括产后抑郁）的女性不孕的风险更高[风险比（RR）=1.34，95%置信区间（CI）：1.21-1.48]、流产（RR=1.22，95%CI：1.10-1.34）和反复流产（≥2；RR=1.39，95%CI：1.17-1.64），与没有抑郁史的女性相比。由于发生死产的数量太少，无法提供明确的关联证据。抗抑郁药物的使用并没有影响到观察到的关联。抑郁与不孕和流产的估计 RR 随着年龄的增长而增加。
抑郁史与随后不孕、流产和反复流产的风险增加有关。
