各孕期及产后焦虑状况自然转归情况及影响因素分析

Natural outcomes and influencing factors of anxiety status in Chinese pregnant and parturient women during pregnancy and postpartum

目的了解我国孕产妇在孕早、中、晚期及产后的焦虑状态转归情况,并分析焦虑状态的影响因素,为有针对性地改善我国孕产妇焦虑状况提供参考依据。方法 2015年8月至2016年10月选取中国孕产妇心理健康队列研究的5个项目现场(山西省妇幼保健院、吉林省妇幼保健院、广东省珠海市及深圳市妇幼保健院、北京市海淀区妇幼保健院)的1 210名孕产妇为研究对象,通过自填式问卷和Zung氏焦虑自评量表(SAS)调查获得队列中孕产妇一般人口学特征和焦虑得分等相关信息,并对其孕产期焦虑状况转归情况进行分析。结果研究对象在孕早、中、晚期和产后焦虑状态检出率分别为19.9%、11.1%、10.5%和10.0%,呈下降趋势且差异有统计学意义(χ^(2)=87.315,P<0.01);在孕早期发生焦虑的研究对象中,11.6%在整个研究过程均呈现焦虑状态,而在孕早期不存在焦虑状态的研究对象中,88.2%在整个研究过程均为无焦虑状态;多因素Logistic回归分析结果显示,丈夫支持力度一般、孕早期存在可疑抑郁或抑郁是影响孕产期始终焦虑状况的危险因素,孕早期睡眠情况较好是影响孕产期始终焦虑状况的保护因素,其OR值和95%CI分别为4.710(1.333~16.645)、29.471(7.769~111.793)和0.178(0.054~0.583),P<0.05。结论孕期焦虑状态检出率较高,孕早期发生焦虑的孕产妇,后续在孕中、晚期及产后发生焦虑的风险高于孕早期无焦虑者。孕产期焦虑状况与丈夫支持力度、妇女孕早期抑郁及睡眠情况相关。

Objective To investigate natural outcomes of anxiety status of pregnant and parturient women in early, middle, late and postpartum stages, and to analyze influencing factors of anxiety, so as to provide reference basis for improving maternal anxiety in China.Methods From August 2015 to October 2016,1 210 pregnant women in 5 project sites(Shanxi Provincial Maternal and Child Health Hospital, Jilin Provincial Maternal and Child Health Hospital, Zhuhai Municipal Maternal and Child Health Hospital of Guangdong Province, Shenzhen Municipal Maternal and Child Health Hospital of Guangdong Province, Haidian District Maternal and Child Health Hospital of Beijing) were selected as study subjects.Through self-filled questionnaire and Zung′s Self-Rating Anxiety Scale(SAS) survey, the general demographic characteristics and anxiety scores of the pregnant and parturient women in the cohort were obtained, and natural outcomes of anxiety were analyzed.Results The detection rates of anxiety in early, middle, late pregnancy and postpartum stages in the subjects were 19.9%,11.1%,10.5% and 10.0% respectively, showing a gradual decreasing trend and the difference was statistically significant(χ^(2)=87.315,P<0.01).11.6% of the subjects with anxiety in the first trimester of pregnancy lasted anxiety throughout the study process, while 88.2% of the subjects without anxiety during the first trimester of pregnancy didn′t last anxiety throughout the study process.Multivariate logistic regression analysis showed that average support from husband, suspected depression or depression in early pregnancy were risk factors affecting anxiety during pregnancy and postpartum, while better sleep in early pregnancy was a protective factor affecting anxiety during pregnancy and postpartum, the OR values(95%CI) were 4.710(1.333~16.645),29.471(7.769~111.793) and 0.178(0.054~0.583) respectively, all P<0.05.Conclusion The detection rate of anxiety state during pregnancy is higher.Those pregnant women with anxiety in early pregnancy have a higher risk of anxiety in their middle pregnancy, late pregnancy and postpartum than those without anxiety in early pregnancy.Anxiety during pregnancy is related to strength of husband support, depression and sleep condition in their early pregnancy.