妊娠中晚期孕妇合并焦虑/抑郁的影响因素及对子代神经发育的影响

Concomitant anxiety/depression of women in the second and third trimesters of pregnancy: influencing factors and impact on neurodevelopment of offspring

目的探讨影响妊娠中晚期孕妇焦虑/抑郁发生的因素,并分析妊娠中晚期孕妇发生焦虑/抑郁对子代神经发育的影响。方法选择生理指标正常的980例孕妇为研究对象,并于妊娠中晚期采用抑郁自评量表和焦虑自评量表对其进行心理评估。在子代出生4个月内,采用婴儿神经国际测量(INFANIB)量表评估其神经行为状态,计算异常儿发生率;在子代出生后6个月、12个月及24个月采用Gesell发育诊断量表评估神经发育水平。比较产前焦虑/抑郁孕妇(研究组)与无产前焦虑/抑郁孕妇(对照组)的社会人口学资料,以及子代神经行为状态和神经发育水平。结果 (1)980例孕妇中,108例孕妇存在产前焦虑/抑郁,检出率为11.02%(108/980)。(2)与对照组相比,研究组孕妇的孕期压力更大,夫妻关系、婆媳关系更差,遭受家庭暴力、有自杀倾向、遭遇应激事件的比例更高,受教育水平较低(均P<0.05)。(3)研究组神经行为状态异常儿发生率为46.2%(54/117),高于对照组的8.0%(75/943)(P<0.05)。在出生后6个月、12个月和24个月,研究组子代的适应行为、大运动行为、精细动作行为、语言行为、个人-社交行评分均低于对照组(均P<0.05)。结论社会关系和家庭关系可能是导致妊娠中晚期孕妇出现产前焦虑/抑郁的主要原因,且产前焦虑/抑郁不利于子代婴幼儿时期的神经发育。

Objective To explore the factors influencing the incidence of anxiety/depression in women in the second and third trimesters of pregnancy, and to analyze the impact of the occurrence of anxiety/depression of women in the second and third trimesters of pregnancy on the neurodevelopment of their offspring.Methods A total of 980 pregnant women with normal physiological indices were selected as research subjects, and received a psychological assessment in the second and third trimesters of pregnancy with the application of the Self-Rating Depression Scale and the Self-Rating Anxiety Scale. Within four months after the offspring′s birth, their neurobehavioral state was assessed using the Infant Neurological International Battery(INFANIB) scale, and the incidence rate of abnormal child was calculated;six, 12 and 24 months after the offspring′s birth, their neurodevelopmental level was assessed using the Gesell Development Diagnostic Scale. The socio-demographic data as well as their offspring′s neurobehavioral state and neurodevelopmental level were compared between pregnant women with prenatal anxiety/depression(study group) and pregnant women without prenatal anxiety/depression(control group).Results(1) Among the 980 pregnant women, 108 had prenatal anxiety/depression, with a detection rate of 11.02%(108/980).(2) Compared with the control group, pregnant women in the study group had more pressure during pregnancy, worsened marriages, more in-laws fights, higher proportions of cases sustaining domestic violence, cases harboring suicide attempt, and cases experiencing stress events, and a lower educational level(all P<0.05).(3) The incidence rate of abnormal neurobehavioral child in the study group was higher than that in the control group(46.2%[54/117] vs 8.0%[75/943], P<0.05). Six, 12 and 24 months after birth, the offspring in the study group exhibited lower scores for adaptive behavior, gross motor behavior, fine motor behavior, verbal behavior, and personal-social behavior in comparison with the control group(all P<0.05). Conclusion Social relationship and family relationship might be the major causes leading to prenatal anxiety/depression in women in the second and third trimesters of pregnancy, and prenatal anxiety/depression does harm to their offspring′s neurodevelopment through infancy.