计划妊娠二胎孕妇产前抑郁、焦虑的相关危险因素分析

Analysis on related risk factors for antepartum depression and anxiety of pregnant women with the second planned pregnancy

目的分析计划妊娠二胎孕妇产前抑郁、焦虑的相关危险因素。方法选择我院产科于2015年6月~2016年6月期间收治的470例二次妊娠产妇作为观察组,选择同期在本院进行分娩的初产妇470例作为对照组。采用Beck抑郁量表评估产妇的抑郁状态,同时发放问卷调查表进行基础资料调查,对比分析两组产妇产前抑郁发生率及影响因素。结果观察组产前抑郁发生率为62.98%(296/470),高于对照组的56.17%(264/470),差异有统计学意义(P<0.05);两组产妇重度抑郁与中度抑郁评分相比,差异无统计学意义(P>0.05);观察组轻度抑郁发生率高于对照组,未发生率低于对照组,差异有统计学意义(P<0.05);与对照组产妇相比,观察组年龄>35岁、担心孩子及自身安全及胎儿出现异常等比例均高于对照组,差异有统计学意义(P<0.05)。Logistic回归分析显示,年龄>35岁、每月收入<3000元、合并妊娠期糖尿病、胎儿出现异常的产妇更容易出现产前抑郁、焦虑症状。第一胎剖宫产的产妇轻度、中度抑郁发生率均高于第一胎顺产的产妇,抑郁未发生率低于第一胎顺产的产妇,差异有统计学意义(P<0.05)。结论计划妊娠二胎产妇所承受的心理压力较大,抑郁的发生率也显著高于初产妇,尤其是年龄超过35岁、第一胎为剖宫产的产妇,应适当进行心理疏导,选择安全的妊娠时机,尽可能的获得最佳分娩结局,以利于优生优育。

Objective To analyze related risk factors for antepartum depression and anxiety of pregnant women with the second planned pregnancy. Methods 470 puerpera with the second pregnancy who were admitted to the Department of Obstetrics and Gynecology in our hospital form June 2015 to June 2016 were selected as the observation group and 470 primipara who delivery in the hospital at the same time were selected as the control group. The depressive state of primipara was assessed by Beck depression inventory and the questionnaire were given to have basic information survey. The incidence of antepartum depression and influencing factors of two groups were compared and analyzed. Results The incidence of antepartum depression of the observation group was 62.98% （296/470）, higher than that of the control group 56.17% （264/470） （P 〈 0.05）. Scores of severe depression and moderate depression of puerpera in two groups were compared and there was no statistical significance （P 〉 0.05）. The incidence of mild depression of the observation group was higher than that of control group while the incidence of non-occurrence was lower than that of the control group （P 〈 0.05）. Compared with puerpera of the control group, the ratios of aging above 35, worrying about children and self-security and abnormal fetus in observation group was higher than those of control group. Differences had statistical significance （P 〈z 0.05）. Logistic regression analysis showed that puerpera who aged above 35 with monthly income less than 3000 yuan, complicated with gestational diabetes and abnormal fetus were more likely to have antepartam depression and anxiety. Incidences of mild and moderate depression of puerpera with first cesarean section were both higher than those of puerpera with first normal delivery and a higher incidence of depression than puerpera with first normal delivery. Differences had statistical significance （P 〈 0.05）. Conclusion Pregnant women with the second planned pregnancy have greater mental stress and a significantly higher incidence of depression than that of primipara, especially for those who aged above 35 with the first cesarean section. Therefore, puerpera should get suitable psychological counseling and choose safe pregnancy time so as to get the best delivery outcome as soon as possible, which is helpful to prepotency.