Li Junqing, Fan Wenna, Wang Xiang, Hou Xuetao, Chen Zhijing, Lv Min
Department of Ultrasound, Jinan Second Maternal and Child Health Hospital, Jinan, China.
Department of Ultrasound, Linyi Maternal and Child Health Hospital, Linyi, China.
Alpha Psychiatry. 2024 Sep 1;25(5):648-655. doi: 10.5152/alphapsychiatry.2024.241682. eCollection 2024 Sep.
This study aims to explore the relationship between maternal mental health during early pregnancy and the risk of spontaneous abortion (SA), especially in the context of the Coronavirus disease 2019 pandemic.
We conducted a prospective cohort study involving 4088 pregnant women at a maternal-child health hospital in China from January to December 2022. During the first trimester, we assessed depression, anxiety, and stress levels using the Depression, Anxiety, and Stress Scale (DASS-21). Pregnancy outcomes were monitored, and univariate and multiple logistic analyses were performed to identify the risk factors. These factors were then used to develop a nomogram model.
Significant differences were found in maternal age, number of embryonic arrests, history of abortion, assisted reproduction, and environmental exposure between the SA group (n = 302) and the normal pregnancy group (n = 3786). After adjusting for potential confounders, higher scores on the DASS-21 subscales were independently associated with an increased risk of SA: Depression (OR [Odds Ratio] = 1.54, 95% CI [Confidence Interval]: 1.39-1.71, < .001), Anxiety (OR = 1.61, 95% CI: 1.44-1.80, < .001), and Stress (OR = 1.69, 95% CI: 1.31-2.20, < .001). The model achieved a concordance index of 0.87 (95% CI: 0.86-0.90) and demonstrated a well-fitted calibration curve, indicating its good clinical applicability.
Our findings indicate that mental health conditions are significantly associated with an increased risk of SA. The nomogram model also demonstrated strong predictive accuracy, indicating its potential usefulness in clinical settings.
本研究旨在探讨孕早期母亲心理健康与自然流产（SA）风险之间的关系，尤其是在2019年冠状病毒病大流行的背景下。
我们在中国一家妇幼保健院对4088名孕妇进行了一项前瞻性队列研究，研究时间为2022年1月至12月。在孕早期，我们使用抑郁、焦虑和压力量表（DASS-21）评估抑郁、焦虑和压力水平。监测妊娠结局，并进行单因素和多因素逻辑分析以确定危险因素。然后使用这些因素建立列线图模型。
自然流产组（n = 302）和正常妊娠组（n = 3786）在母亲年龄、胚胎停育次数、流产史、辅助生殖和环境暴露方面存在显著差异。在调整潜在混杂因素后，DASS-21分量表得分较高与自然流产风险增加独立相关：抑郁（比值比[OR]=1.54，95%置信区间[CI]：1.39-1.71，P<0.001）、焦虑（OR = 1.61，95%CI：1.44-1.80，P<0.001）和压力（OR = 1.69，95%CI：1.31-2.20，P<0.001）。该模型的一致性指数为0.87（95%CI：0.86-0.90），并显示出拟合良好的校准曲线，表明其具有良好的临床适用性。
我们的研究结果表明，心理健康状况与自然流产风险增加显著相关。列线图模型也显示出很强的预测准确性，表明其在临床环境中的潜在用途。
