Lin Emma, Wilson Elah, Kodesh Arad, Levine Stephen Z, Reichenberg Abraham, Fox Nathan, Zaks Nina, Janecka Magdalena
Cornell University, Undergraduate Studies, Ithaca, NY, USA.
Stuyvesant High School, New York, NY, USA.
Arch Womens Ment Health. 2024 Dec 4. doi: 10.1007/s00737-024-01541-2.
Substantial evidence suggests a downstream impact of maternal mental health on birth outcomes. The roles of comorbid maternal physical health and familial confounding underlying this association remain unclear.
This cohort study included a random sample of children born 1997-2008 within a health maintenance organization (HMO) in Israel, their parents, and siblings. Outcomes were ICD-9 diagnoses of neonatal adversities (birth complications and congenital anomalies) and exposures were maternal diagnoses of mental health disorders. Odds ratios (ORs) and their 95% confidence intervals for the associations between maternal mental health diagnoses and measures of neonatal adversity were calculated using logistic regression, adjusting for maternal age, child's year of birth, socioeconomic status, and maternal physical morbidity burden. We examined potential familial confounding using a negative control approach based on paternal exposure.
In our sample of 74,533 children, 6,674 (9.1%) were born after birth complications and 14,569 (19.9%) with a congenital anomaly. Maternal mental health diagnosis around pregnancy was significantly associated with these measures of neonatal adversity after adjustment for potential confounders (birth complications: OR = 1.3 (1.2-1.4), p < 0.001; congenital anomalies: OR = 1.2 (1.1-1.3), p < 0.001). These associations became attenuated and non-significant after further adjustment for maternal physical morbidity burden. In a joint model, maternal and paternal diagnosis of a mental health disorder were independently associated with neonatal adversity (birth complications: OR=1.3 (1.1-1.4), p < 0.001; OR=1.2 (1.1-1.3), p = 0.004; congenital anomalies: OR=1.2 (1.1-1.3), p < 0.001; OR=1.1 (1.0-1.2), p = 0.01).
Physical health and familial factors play a role in the associations between maternal mental health and neonatal adversity.
大量证据表明，母亲心理健康对出生结局具有下游影响。母亲身体健康合并症和家庭混杂因素在这种关联中所起的作用仍不明确。
这项队列研究纳入了1997年至2008年在以色列一家健康维护组织（HMO）出生的儿童、他们的父母和兄弟姐妹的随机样本。结局为国际疾病分类第九版（ICD - 9）诊断的新生儿不良情况（出生并发症和先天性异常），暴露因素为母亲心理健康障碍的诊断。使用逻辑回归计算母亲心理健康诊断与新生儿不良情况测量指标之间关联的比值比（OR）及其95%置信区间，并对母亲年龄、孩子出生年份、社会经济地位和母亲身体发病负担进行调整。我们使用基于父亲暴露的阴性对照方法研究潜在的家庭混杂因素。
在我们的74533名儿童样本中，6674名（9.1%）出生时伴有出生并发症，14569名（19.9%）患有先天性异常。在对潜在混杂因素进行调整后，孕期母亲心理健康诊断与这些新生儿不良情况测量指标显著相关（出生并发症：OR = 1.3（1.2 - 1.4），p < 0.001；先天性异常：OR = 1.2（1.1 - 1.3），p < 0.001）。在进一步对母亲身体发病负担进行调整后，这些关联减弱且无统计学意义。在一个联合模型中，母亲和父亲心理健康障碍的诊断均与新生儿不良情况独立相关（出生并发症：OR = 1.3（1.1 - 1.4），p < 0.001；OR = 1.2（1.1 - 1.3），p = 0.004；先天性异常：OR = 1.2（1.1 - 1.3），p < 0.001；OR = 1.1（1.0 - 1.2），p = 0.01）。
身体健康和家庭因素在母亲心理健康与新生儿不良情况的关联中起作用。
