马鞍山市孕妇妊娠相关焦虑变化及其影响因素的纵向研究

Course and risk factors of maternal pregnancy-related anxiety across pregnancy in Ma'anshan city

目的探讨孕期妊娠相关焦虑的动态变化,分析妊娠相关焦虑的影响因素。方法收集马鞍山市妇幼保健院孕妇一般人口统计学指标和孕期暴露资料,采用自编的《妊娠相关焦虑量表》评定孕妇不同妊娠时期的妊娠相关焦虑状况,并运用广义估计方程分析妊娠相关焦虑的影响因素。结果 990名孕妇孕早期、中期、晚期妊娠相关焦虑问卷总得分分别为（20.3±4.9）、（19.6±4.6）和（18.9±4.4）,差异有统计学意义（F=63.10,P〈0.001）。孕早期、中期、晚期妊娠相关焦虑检出率分别为21.0%、17.7%和13.6%,差异有统计学意义（χ^2=18.74,P〈0.001）。广义估计方程结果显示,孕妇高中文化程度（OR=1.36,95%CI 1.05-1.75）、家庭人均月收入〈2500元（OR=1.33,95%CI 1.01-1.75）、意外妊娠（OR=2.60,95%CI 2.05-3.29）、有流产史（OR=1.30,95%CI 1.06-1.60）、孕期阴道流血（OR=1.61,95%CI1.22-2.12）、孕期发热（OR=1.69,95%CI 1.17-2.46）和孕期营养剂使用（OR=1.43,95%CI 1.08-1.88）是妊娠相关焦虑的危险因素。结论孕妇妊娠相关焦虑随着妊娠进展呈下降趋势;妊娠相关焦虑的发生与孕妇的文化程度、家庭经济状况、意外妊娠、流产史、阴道流血及发热等因素相关。

Objective To explore the prevalence, trends and related influencing factors of pregnancy-related anxiety throughout pregnancy. Methods A total of 990 pregnant women at the maternal and child health centers of Ma＇ anshan participated in all three surveys. Data on demographic characteristic and exposure factors during pregnancy were collected. The Pregnancy-related Anxiety Questionnaire was used to assess the anxiety symptoms. Generalized estimating equations （GEE） was used to evaluate the related influencing factors of pregnancy-related anxiety. Results The mean score of the pregnancy-related anxiety were 20.3 ±4.9, 19.6 ±4. 6, 18.9 ±4.4 for the first, second and third trimester, respectively. Pregnancy-related anxiety showed a significant difference among the three trimesters （F = 63.10, P 〈 0. 001 ）. Prevalence of pregnancy-related anxiety were 21.0% , 17.7% and 13.6% , respectively, at the first, second and third trimester. Results from GEE analysis indicated that maternal education of senior high school（ OR = 1.36,95% CI 1.05 - 1.75） lower family monthly income（ OR = 1.33,95% CI 1.01 - 1.75 ） , unplanned pregnancy （ OR = 2.60,95% CI 2.05 - 3.29 ）, history of miscarriage（ OR = 1.30,95% CI 1.06 - 1.60 ）, vaginal bleeding（ OR = 1.61,95% CI 1.22 - 2. 12）, fever （OR = 1.69, 95% CI 1.17 - 2.46） and use of nutritional supplementation during pregnancy （ OR = 1.43, 95% CI 1.08 - 1.88 ） significantly increased the risk of pregnancy-related anxiety. Conclusion Pregnancy-related anxiety appeared a decrease from the first to third trimester. Maternal education, economic situation, unplanned pregnancy, history of miscarriage, and adverse physiological symptoms such as vaginal bleeding and fever were associated with the risk of pregnancy- related anxiety.