辅助生殖和自然受孕女性围产期心理健康的差异:一项前瞻性队列研究

Comparison of perinatal psychological distress between women conceiving spontaneously and through assisted reproductive technology:a longitudinal and prospective cohort study

目的比较辅助生殖技术(assisted reproductive technology,ART)受孕的女性和自然受孕的女性在围产期心理健康状况的差异。方法基于一项前瞻性的中国国家出生队列建设,将2017年3月至2021年3月期间于上海交通大学医学院附属国际和平妇幼保健院分娩的2693名研究对象纳入本次分析。根据受孕方式将研究对象分为辅助生殖(ART组,n=733)和自然受孕(natural conception,NC,记为NC组,n=1960)。在妊娠早期(<14周)、妊娠中期(22~26周)及妊娠晚期(30~34周),均采用流行病学研究中心抑郁量表(Center for Epidemiologic Studies Depression Scale,CESD)、焦虑自评量表(Self-rating Anxiety Scale,SAS)和压力知觉量表(Perceived Stress Scale,PSS)评估妊娠期心理健康状况;在产后6周,采用爱丁堡产后抑郁量表(Edinburgh Postnatal Depression Scale,EPDS)评估产后的心理健康状况。logistic回归分析孕产妇心理健康状况相关的影响因素。结果logistic回归结果显示,与NC组的女性相比,ART组的女性在妊娠期和产后发生抑郁症状的风险均降低:妊娠早期(aOR=0.81,95%CI:0.66~0.99,P=0.043)、妊娠中期(aOR=0.73,95%CI:0.60~0.90,P=0.003)、妊娠晚期(aOR=0.82,95%CI:0.68~1.00,P=0.045)、产后6周(aOR=0.57,95%CI:0.43~0.75,P<0.001)。同时,ART组的女性在妊娠期感受到的压力明显低于NC组(妊娠早期,P<0.001;妊娠中期,P<0.001;妊娠晚期,P=0.001)。而两组之间的女性在妊娠期焦虑症状的差异均无统计学意义(均P>0.05)。结论与自然受孕的女性相比,ART助孕的女性在围产期发生心理健康问题的风险较低。

Objective To compare the perinatal mental health status of women conceived through assisted reproductive technology(ART)and women conceived naturally.Methods In a prospective China National Birth Cohort study,2693 pregnant women were enrolled in the International Peace Maternity and Child Health Hospital,Shanghai Jiao Tong University,School of Medicine from March 2017 to March 2021.They were divided into ART group(n=733)and natural conception(NC group,n=1960)according to the mode of conception.Mental health was assessed in the first trimester(<14 weeks),the second trimester(22-26 weeks),and the third trimester(30-34 weeks)as well as 6 weeks after delivery.Antenatally,mental health status was assessed by using the Center for Epidemiologic Studies Depression Scale(CESD),Self-rating Anxiety Scale(SAS),and Perceived Stress Scale(PSS).Postpartum depressive symptoms were assessed using the Edinburgh Postnatal Depression Scale(EPDS).Logistic regression was used to analyze maternal mental health related factors.Results Logistic regression results showed that women in the ART group were less likely to experience depressive symptoms compared with those in the NC group in the first trimester(aOR=0.81,95%CI:0.66-0.99),the second trimester(aOR=0.73,95%CI:0.60-0.90),the third trimester(aOR=0.82,95%CI:0.68-1.00)and 6 weeks after delivery(aOR=0.57,95%CI:0.43-0.75).Meanwhile,women in the ART group felt significantly less stress during pregnancy than women in the NC group(the first trimester,P<0.001;the second trimester,P<0.001;the third trimester,P=0.001).However,the difference in women's anxiety symptoms during pregnancy was not found to be significant between the two groups(all P>0.05).Conclusion Women who conceived through ART have lower risks of perinatal mental health problems than those who conceived spontaneously.