增补叶酸与孕期抑郁相关性的队列研究

Association between folic acid supplement in peri-conceptional period and depression in pregnancy：a cohort study

目的：描述孕前半年和孕早期连续服用叶酸行为的分布特征，探讨围孕期增补叶酸对产前抑郁的保护效应。方法开展前瞻性队列研究，于2008年10月至2010年10月在马鞍山地区妇幼保健机构招募初次建册孕妇共5150人，随访至孕中期。分别于孕早期和孕中期，通过孕妇自填式问卷收集一般人口学信息，孕前半年和孕早期增补叶酸情况，采用流调中心抑郁量表（CES-D）调查孕中期抑郁发生情况。将CES-D得分≥16分者，定义为有抑郁情绪。应用单因素和多因素非条件logistic回归分析不同围孕期增补叶酸模式与孕中期抑郁的相关性。结果围孕期叶酸增补的报告率“从未服用叶酸”为27.3%、“仅孕前半年连续增补”为0.5%、“仅孕早期连续增补”为27.4%、围孕期连续增补叶酸为17.9%。孕中期（孕26～30周）抑郁的检出率为4.8%（247/5150）。单因素logistic回归分析结果显示，仅孕早期连续增补与围孕期连续增补均与孕期抑郁呈显著负相关；在调整相关协变量，多因素分析结果显示，上述两变量仍与孕期抑郁呈显著负相关，RR值分别为0.63（95%CI：0.44～0.90）和0.61（95%CI：0.39～0.95）。结论孕早期及围孕期连续性增补叶酸可能是预防孕期抑郁的潜在保护因素，应提倡在围孕期持续增补叶酸，以促进母婴健康。

Objective To describe the epidemiological characteristics on the supplement of folic acid in progestation and early pregnancy,and to probe the protective effects of supplement of folic acid in early pregnancy against pregnant depression,in Ma’anshan city,Anhui province. Methods In this cohort study,5 150 subjects who had their first antenatal examination at Ma’anshan Maternal and Child Care Centers were recruited under informed consent,from October 2008 to October 2010. All the information were collected through questionnaires in the first,second and third trimesters respectively. A“Center for Epidemiological Studies Depression Scale（CES-D）”was used to assess the mood of depression in the second questionnaire. Single factor analysis and the unconditional multivariate logistic regression were applied to analyze the association of supplement folic acid in peri-conceptional period and pregnancy depression. Results In the study,the prevalence of those who had never taken the supplement folic acid but only the supplement folic acid in progestation and supplement in the first-trimester,or supplement in the peri-conceptional period were 27.3%,0.5%,27.4%and 17.9%,respectively. The incidence of pregnancy depression was 4.8%（247/5 150）. Data from logistic regression analysis showed that,supplement of folic acid only in the first-trimester or in the peri-conceptional period were negatively associated with pregnancy depression even after adjustment for potential confounders. The adjusted odds ratio were 0.63（95%CI：0.44-0.90） and 0.61（95%CI：0.39-0.95）respectively. Conclusion Supplement of folic acid in peri-conceptional period could be a preventive factor for pregnancy depression.