孕妇妊娠特有压力变化及其与主要妊娠结局关联的前瞻性研究

发布时间：2018-05-16 23:20

  本文选题：妊娠特有压力 + 妊娠结局　； 参考：《中国疾病预防控制中心》2017年硕士论文

【摘要】：目的 描述孕期妇女妊娠特有压力的动态变化,并探讨妊娠特有压力与主要妊娠结局的关联。方法 本研究选取在广东省珠海市妇幼保健院、山西省妇幼保健院、北京市海淀区妇幼保健院、吉林省妇幼保健院和广东省深圳市妇幼保健院首次建卡并知情同意参加《孕产妇心理状况前瞻性研究项目》的孕妇为研究对象。招募符合条件的孕妇,收集其年龄、文化程度、工作状态、婚姻状况、家庭年收入、身高、体重、孕次、本次妊娠意愿、受孕方式、孕期锻炼习惯、孕期吸烟及饮酒习惯、有无妊娠期合并症/并发症等基本情况,并在孕13周、孕24周和孕37周3次产前检查时采用妊娠压力量表(Pregnancy Stress Rating Scale,PSRS)评定孕妇妊娠特有压力症状,焦虑自评量表(Self Rating Anxiety Scale,SAS)评定孕妇焦虑症状,爱丁堡产后抑郁量表(Edinburgh Postnatal Depression Scale,EPDS)评定孕妇抑郁症状,并于产后3天记录母儿妊娠结局。2015年9月至2016年9月完整填写3份不同孕期调查表的孕妇共计1167人,随访到产后3天的单胎活产新生儿1167人。采用重复测量资料方差分析、χ2检验和广义估计方程分析妊娠特有压力的变化趋势及其影响因素;不同孕期妊娠特有压力与焦虑、抑郁的关系采用偏相关分析法;采用单因素及多因素Logistic回归分析孕妇妊娠特有压力与母儿妊娠结局的关联。结果 1167名孕妇孕早期、孕中期和孕晚期妊娠特有压力总体得分分别为15.72±11.40 分、15.08±11.68 分、14.47±11.33 分,差异有统计学意义(F=18.48,P0.001)。孕早期、孕中期、孕晚期最主要的压力来源为因素2“为确保母子健康和安全而引发的压力感”,孕早、中、晚期最主要的压力条目分别为:“担心婴儿不正常”、“担心分娩可能出现不正常的情况或剖腹产”和“担心婴儿能否安全分娩”。广义估计方程结果显示:珠海市孕妇(OR=1.71,95%CI:1.15～2.53)、对居住环境满意度一般组孕妇(OR=1.64,95%CI:1.25～2.14)、孕早期有抑郁症状组孕妇(OR=1.90,95%CI:1.36～2.67)、孕早期有焦虑症状组孕妇(OR=1.55,95%CI:1.09～2.20)、孕中期有抑郁症状组孕妇(OR=1.60,95%CI:1.08～2.36)、孕晚期有焦虑症状组孕妇(OR=2.14,95%CI:1.45～3.17)发生重度妊娠特有压力的风险较高。其他变量如年龄、文化程度、不良孕产史、家庭收入等差异无统计学意义。偏相关分析结果显示,不同孕期孕妇妊娠特有压力与焦虑或抑郁的相关系数较低。将孕妇年龄、体型、不同研究中心等作为协变量纳入多因素Logistic回归模型中,发现不同孕期孕妇妊娠特有压力与主要不良妊娠结局无统计学关联(P0.05)。将孕早、中、晚期焦虑症状、不同研究中心等作为协变量纳入多因素Logistic回归模型中,发现孕晚期重度妊娠特有压力组发生产后抑郁风险是轻中度妊娠特有压力组的1.48倍(95%CI;1.03～2.12,P= 0.034);孕早期、孕中期不同程度妊娠特有压力组间产后抑郁的发生率差异无统计学意义(P0.05)。结论 孕妇妊娠特有压力得分随妊娠进展呈下降趋势。妊娠特有压力与焦虑、抑郁相关系数较低,应针对孕早期有妊娠特有压力来源的孕妇进行特殊心理咨询与心理卫生指导。不同孕期妊娠特有压力与主要不良妊娠结局无统计学关联,尚待进一步研究证实。
[Abstract]:Objective to describe the dynamic changes of pregnancy specific pressure in pregnant women and to explore the relationship between pregnancy specific pressure and main pregnancy outcome. Methods the study was selected in Zhuhai maternal and child health care hospital in Guangdong Province, maternal and child health care hospital of Shanxi Province, Haidian District maternal and child health care hospital of Beijing City, Jilin province women and child health care hospital and Shenzhen City Maternal and child health care hospital in Guangdong province. Pregnant women were recruited to the pregnant women who were enrolled in the prospective research project of maternal psychological status. They recruited eligible pregnant women to collect their age, educational level, working status, marital status, family income, height, weight, pregnancy, pregnancy intention, pregnancy style, pregnancy exercise habits, pregnancy smoking and drinking habits, There were complications such as pregnancy complications / complications and other basic conditions. The pregnancy pressure scale (Pregnancy Stress Rating Scale, PSRS) was used to assess the symptoms of pregnancy specific stress at 13 weeks of pregnancy, 24 weeks of pregnancy and 37 weeks of pregnancy. The anxiety symptom of pregnant women and the postpartum depression in Edinburgh were assessed by the self rating Anxiety Scale (Self Rating Anxiety Scale, SAS). The table (Edinburgh Postnatal Depression Scale, EPDS) was used to assess the symptoms of depressive symptoms in pregnant women, and 1167 pregnant women with 3 different pregnancy questionnaires completed from September to September 2016 after 3 days postpartum were followed up to 1167 births of single births for 3 days postpartum. The variance analysis, chi square test and the 2 test were used. The generalized estimation equation was used to analyze the change trend of pregnancy specific stress and its influencing factors; the relationship between pregnancy specific stress and anxiety and depression was analyzed by partial correlation analysis. The correlation between pregnancy specific stress and pregnancy outcome of pregnant women was analyzed by single factor and multiple factor Logistic regression. Results 1167 pregnant women were pregnant and middle pregnancy. The total score of endemic pressure in the late pregnancy was 15.72 + 11.40, 15.08 + 11.68 and 14.47 + 11.33. The difference was statistically significant (F=18.48, P0.001). The most important source of stress in the early pregnancy, middle pregnancy and late trimester of pregnancy was 2 "the stress caused by the health and safety of mother and child", the most important pressure in the early pregnancy, middle and late period. The results of the generalized estimation equation showed: pregnant women in Zhuhai (OR=1.71,95%CI:1.15 to 2.53), pregnant women (OR=1.64,95%CI:1.25 to 2.14) and early pregnancy were pregnant (OR=1.64,95%CI:1.25 to 2.14). In the group of depressive symptoms (OR=1.90,95%CI:1.36 to 2.67), there were pregnant women in the early pregnancy (OR=1.55,95%CI:1.09 to 2.20), and in the middle of the pregnancy (OR=1.60,95%CI:1.08 to 2.36). The risk of severe pregnancy stress in pregnant women with anxiety symptoms (OR=2.14,95%CI:1.45 to 3.17) was higher. Other variables, such as age, were higher. There was no significant difference in cultural degree, bad pregnancy history, family income, etc. partial correlation analysis showed that the correlation coefficient between pregnancy specific stress and anxiety or depression in pregnant women of different pregnancy was lower. The maternal age, body shape, and different research centers were incorporated into the multifactorin Logistic regression model as co variables, and pregnant women in different pregnancy pregnancy were found to be pregnant with pregnancy induced pregnancy. There was no statistical correlation between the endemic pressure of pregnancy and the major adverse pregnancy outcomes (P0.05). The risk of postpartum depression in the group of severe pregnancy specific stress in the late trimester was 1.48 times as much as that of the mild and moderate pregnancy stress group (95%CI; 1.03 ~ 1.03), and the early pregnancy, middle and late anxiety symptoms and different research centers were incorporated into the multifactor regression model as covariate. 2.12, P= 0.034): there was no significant difference in the incidence of postpartum depression among different pregnancy stress groups in the early trimester of pregnancy (P0.05). Conclusion the score of pregnancy specific stress in pregnant women decreased with the progression of pregnancy. The correlation coefficient of pregnancy specific stress and anxiety and depression was lower. Special psychological counseling and psychological hygiene guidance for women. There is no statistical correlation between the stress of pregnancy in different pregnancy and the outcome of major bad pregnancy. Further research has yet to be confirmed.
【学位授予单位】：中国疾病预防控制中心
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R715.3

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