孕期综合干预对孕晚期及产后抑郁症的影响

Effects of comprehensive intervention during pregnancy on late pregnancy and postpartum depression

目的探讨孕期采取综合干预对孕晚期及产后抑郁症患病率的影响。方法选取2012年12月至2013年1月在陕西省妇幼保健院产科进行产检并住院分娩的孕妇202例,随机分为实验组与对照组两组,每组各101例。对照组进行常规产检。实验组在常规产检基础上给予以下干预措施:①孕12~20周,接诊医生对孕妇制定产检计划,并在整个孕期负责对孕妇进行详细答疑解惑;②孕20周后,孕妇接受以人际关系为主题的产前心理教育课程;③孕32周后,由助产士帮助孕妇制定分娩计划、了解分娩过程、熟悉产房环境、掌握分娩技巧。比较两组孕晚期及产后抑郁症发生情况。结果孕中期抑郁症与性格、家庭居住条件、职业压力、与父母/公婆的关系具有线性相关(OR值分别为0.429,2.141,1.445,3.476;均P<0.05)。两组孕中期抑郁症患病率无差异(x^2=0.625,P>0.05);实验组孕晚期抑郁症患病率为9.18%,低于对照组的19.59%,两组具有统计学差异(x^2=4.291,P<0.05);产后42天实验组抑郁症患病率12.5%,低于对照组的25.77%,两组具有统计学差异(x^2=5.486,P<0.05)。实验组在孕晚期及产后42天抑郁症患病率均较孕中期降低(x^2值分别为13.290和11.235,均P<0.05)。结论家庭居住条件、职业压力及与父母/公婆关系是影响孕中期抑郁症发生的主要危险因素;孕期进行系统的综合的干预可明显降低孕晚期抑郁症发生,同时有助于控制产后42天抑郁症患病率增高。

Objective To investigate the effects of comprehensive intervention during pregnancy on late pregnancy and postpartum depression.Methods From December 2012 to January 2013 202 pregnant women who took antenatal examination and delivered in Child and Maternity Health Hospital of Shaanxi Province were selected , who were randomly divided into experimental group and control group with 101 cases in each group .The control group was given conventional antenatal examination , while the experimental group accepted the following intervention measures based on conventional examination , including antenatal examination plan made by medical workers and detailed answer during the whole pregnancy at gestational 12-20 weeks, antenatal psychological education focusing on interpersonal relationship after 20 gestational weeks , and the help of midwife in making delivery plan , knowing delivery process , being familiar with the environment of delivery room and mastering delivery technique .The incidence of depression was compared between two groups .Results There was a linear correlation relationship between second trimester depression and pregnant women ＇ s personality , family living conditions , employment, and parents /in-laws relationship （ OR values was 0.429, 2.141, 1.445 and 3.476, respectively, all P〈0.05）.The difference in prevalence of depression at second trimester was not significant （χ^2 =0.625,P〉0.05）.The prevalence of depression at third trimester in the experimental group was 9.18%, which was lower than that of the control group （ 19.59%） , and the difference was statistically significant （χ^2 =4.291,P〈0.05）.At 42 days after delivery the prevalence of depression was 12.5% in the experimental group and 25.77%in the control group, and the difference was significant （χ^2 =5.486,P〈0.05）.The prevalence of depression both at third trimester and 42 days after delivery in the experimental group was lower than the control group （χ^2 value was 13.290 and 11.235, respectively, both P〈0.05）.Conclusion Family living conditions, occupation, and relationship with parents /in-laws are the major risk factors of depression in the second trimester .Comprehensive intervention during pregnancy can reduce the incidence of depression in the third trimester and help to control the increasing of depression prevalence 42 days after delivery .