Wu Fang-Fang, Xu Hong
Department of Gynaecology and Obstetrics, Suzhou Ninth People's Hospital (Suzhou Ninth Hospital Affiliated to Soochow University), Suzhou 215200, Jiangsu Province, China.
World J Psychiatry. 2024 Dec 19;14(12):1868-1875. doi: 10.5498/wjp.v14.i12.1868.
Pre-eclampsia has long been proven to be an independent risk factor for postpartum depression (PPD). Excessive increase in body mass index (BMI) during pregnancy is an important factor inducing pre-eclampsia. Increased blood pressure is the main symptom of patients with pre-eclampsia. However, whether there is a correlation between BMI and blood pressure variability during pregnancy and PPD occurrence in pregnant women with pre-eclampsia remains unclear.
To investigate the relationship between BMI, blood pressure variability, and PPD in pregnant women with pre-eclampsia.
Using a cross-sectional survey research, 201 pregnant women with pre-eclampsia who were treated and delivered in Suzhou Ninth People's Hospital from May 2016 to June 2024 were selected as this study's subjects. At 42 days after delivery, the subjects were re-examined in the hospital's outpatient department. The Edinburgh Postnatal Depression Scale (EPDS) was used to evaluate whether PPD symptoms, divided the subjects into two groups: The PPD and non-PPD groups. We analyzed clinical data, changes in BMI during pregnancy, and blood pressure variability in the two groups. The Pearson method was used to test the correlation between BMI increase, blood pressure variability during pregnancy, and EPDS score in patients with pre-eclampsia. Logistic regression analysis was performed to explore whether increased BMI and blood pressure variability during pregnancy are influencing factors for PPD occurrence in patients with pre-eclampsia.
Of the 201 pre-eclamptic women who underwent an outpatient review 42 days after delivery, 37 had PPD symptoms based on the EPDS scale evaluation, resulting in an incidence rate of 18.41% (37/201). The differences between the PPD and non-PPD groups in terms of age, educational level, place of residence, reproductive history, gestational age, mode of delivery, newborn gender, and newborn birth weight were not statistically significant ( > 0.05). The gestational BMI increase, 24-hour systolic blood pressure (SBP) variability, and 24-hour diastolic blood pressure (DBP) variability in the PPD group were significantly higher than those in the non-PPD group; the differences were statistically significant ( < 0.001). Pearson correlation analysis showed that BMI increase, SBP variability, and DBP variability during pregnancy correlated positively with the EPDS score of pregnant women with pre-eclampsia ( = 0.349, 0.336, and 0.241; < 0.001). Logistic regression analysis showed that a high increase in BMI during pregnancy [odds ratio (OR) = 4.614, 95% confidence interval (CI): 1.749-12.170, = 0.002], large variability in 24-hour SBP (OR = 2.910, 95%CI: 1.322-6.404, = 0.008), and large variability in 24-hour DBP (OR = 2.347, 95%CI: 1.138-4.831, = 0.021) were factors affecting PPD occurrence in patients with pre-eclampsia.
Increased BMI and blood pressure variability during pregnancy can increase the risk of PPD in patients with pre-eclampsia. Strengthening pregnancy guidance and controlling fluctuations in BMI and blood pressure variability during pregnancy within a reasonable range can help reduce the risk of PPD in patients with pre-eclampsia.
长期以来，子痫前期一直被证明是产后抑郁症（PPD）的独立危险因素。孕期体重指数（BMI）过度增加是诱发子痫前期的重要因素。血压升高是子痫前期患者的主要症状。然而，子痫前期孕妇孕期BMI与血压变异性和PPD发生之间是否存在相关性仍不清楚。
探讨子痫前期孕妇BMI、血压变异性与PPD之间的关系。
采用横断面调查研究，选取2016年5月至2024年6月在苏州第九人民医院接受治疗并分娩的201例子痫前期孕妇作为本研究对象。产后42天，在医院门诊对研究对象进行复查。采用爱丁堡产后抑郁量表（EPDS）评估是否存在PPD症状，将研究对象分为两组：PPD组和非PPD组。分析两组的临床资料、孕期BMI变化及血压变异性。采用Pearson法检验子痫前期患者BMI增加值、孕期血压变异性与EPDS评分之间的相关性。进行Logistic回归分析，探讨孕期BMI增加和血压变异性是否为子痫前期患者PPD发生的影响因素。
在201例子痫前期孕妇产后42天进行门诊复查中，根据EPDS量表评估，37例有PPD症状，发生率为18.41%（37/201）。PPD组和非PPD组在年龄、文化程度、居住地、生育史、孕周、分娩方式、新生儿性别和新生儿出生体重方面的差异无统计学意义（P>0.05）。PPD组孕期BMI增加值、24小时收缩压（SBP）变异性和24小时舒张压（DBP）变异性均显著高于非PPD组；差异有统计学意义（P<0.001）。Pearson相关分析显示，子痫前期孕妇孕期BMI增加值、SBP变异性和DBP变异性与EPDS评分呈正相关（r=0.349、0.336和0.241；P<0.001）。Logistic回归分析显示，孕期BMI大幅增加[比值比（OR）=4.614，95%置信区间（CI）：1.749-12.170，P=0.002]、24小时SBP变异性大（OR=2.910，95%CI：1.322-6.404，P=0.008）和24小时DBP变异性大（OR=2.347，95%CI：1.138-4.831，P=0.021）是子痫前期患者PPD发生的影响因素。
孕期BMI增加和血压变异性增加会增加子痫前期患者发生PPD的风险。加强孕期指导，将孕期BMI和血压变异性波动控制在合理范围内，有助于降低子痫前期患者发生PPD的风险。
