探討生殖技術協助受孕婦女之周產期憂鬱—一個縱貫性研究

研究目的：周產期憂鬱影響婦女身心健康、育兒及其發展。生殖技術協助受孕週期數有上升趨勢，婦女於生殖協助受孕後，其周產期憂鬱變化是否與自然受孕婦女不同？華人婦女產後有坐月子習俗，入住產後護理機構對於生殖技術協助受孕婦女其產後憂鬱的影響為何?值得進一步探討。本研究目的分為兩部分；第一部分: (1) 探討生殖技術協助受孕婦女其懷孕3個月、6個月、9個月及產後6週的知覺壓力、社會支持、幸福感與憂鬱的關係 (2) 生殖技術協助受孕婦女周產期憂鬱變化及預測因子。第二部分: 入住產後護理機構對生殖技術協助受孕婦女產後憂鬱的影響。研究設計：採縱貫性研究方法，於中部生殖技術協助醫院及醫學中心進行收案，研究對象為妊娠第一孕期初孕婦，懷孕前無身心科及其他內科合併症，以面對面及電訪方式進行，問卷包含基本資料、知覺壓力量表(PSS)、社會支持量表(SSS)、中國人幸福感量表(CHI)與憂鬱量表(EPDS)，並於妊娠3、6、9個月及產後6週進行問卷調查。本研究共納入309為初產婦，其中155名接受生殖技術協助受孕婦女（ART組）及154名自然受孕婦女（NC組），最後108名ART組婦女及 144名NC組婦女完成研究。個案流失率於ART組及NC組分別為 30.3%及6.5%。本研究資料蒐集完成之後，經鍵入、譯碼、核對。分析方法以SPSS 17.0版套裝軟體，使用描述性統計及推論性統計；如：卡方、Student’s t-test、Spearman相關、ANOVA，並以廣義估計方程式(GEE)進行含時間因素之多變項分析周產期憂鬱變化及產後憂鬱預測因子。結果：ART組婦女產後憂鬱佔14.81 %，NC組婦女產後憂鬱佔25.69%，二者達顯著差異(p<.05)。ART組婦女與NC組婦女平均年齡分別為35.3±4.2 vs. 31.3±4.5、剖腹產比率58.3% vs. 27.8%、入住產後護理機構比率53.08% vs 46.92%，上述變項ART組婦女顯著高於 NC組婦女。在懷孕第3及第6個月，兩組的EPDS、PSS、SSS及 CHI皆未達統計顯著差異(p>.05)，兩組的平均EPDS在懷孕的第9個月分別為6.9±2.9 vs. 7.9±3.9及產後6週分別為5.2±4.0 vs. 6.6±4.7，二組達到統計顯著差異(p<.05)。以GEE分析周產期EPDS的變化，結果顯示ART組與NC組婦女EPDS的變化未達統計顯著差異（ß=.19, p=.6219），亦即沒有組別的差異。而不同懷孕階段之EPDS有明顯的差異；特別是懷孕第9個月（ß=-.99, p=.0021）及產後（ß=-.36, p<.0001）之EPDS顯著低於懷孕第3個月EPDS。在交互作用效果中；ART組婦女隨著懷孕的進程EPDS下降的程度較NC組婦女顯著，第9個月時顯著比自然受孕組平均下降1.13分，產後階段顯著比NC組平均下降1.46分。另外，ART組婦女產後入住護理機構的比率較高（53.08% vs 46.92%），ART組婦女產後入住護理機構者其產後憂鬱比率較低。結論：婦女周產期憂鬱EPDS平均分數的變化與其受孕方式無顯著差異，婦女周產期憂鬱情形於懷孕3個月（第一孕期）階段最高。入住產後護理機構對生殖技術協助受孕婦女的產後憂鬱有保護作用。本研究結果可瞭解生殖技術協助受孕婦女之周產期憂鬱特性及變化，研究結果可提供醫療照護與公共政策之參考。

關鍵字

生殖技術協助；自然受孕；周產期憂鬱；知覺壓力；社會支持；幸福感；產後護理機構

並列摘要

Objectives: Depression during perinatal period affects women’s physical and mental health, childcare and their development. The number of artificial reproductive technology (ART) cycles has an upward trend. After artificial reproduction technology, is the mood changes during the perinatal period different from that of a naturally conceived woman? Chinese women have the tradition of postpartum confinement after childbirth, What is the impact of a postpartum care institution on postpartum depression for women conceived with ART? It is worth exploring further. The purpose of this research includes the followings: the first, is to explore the relationship between perceived stress, social support, well-being, and depression in pregnant women at gestational age of 3 months, 6 months, 9 months and 6 weeks after delivery. The second is to evaluate the effect of postpartum care institutions on postpartum depression of pregnant women after ART. Study design: The longitudinal research method was adopted, and the cases were collected at a specialized ART hospital and the Medical Center in central Taiwan. The participants were recruited at the first trimester of pregnancy. Before pregnancy, there is no psychosomatic and other medical complications by face-to-face and telephone interviews. The questionnaire contains basic information, Perception Stress Scale (PSS), Social Support Scale (SSS), Chinese Happiness Inventory (CHI) and Edinburgh Perinatal Depression Scale (EPDS). Questionnaire surveys at 3, 6, and 9 months of pregnancy and 6 weeks after delivery. A total of 309 primiparas were included in this study, 155 women received by ART, and 154 naturally conceived women (NC). Finally, 108 women in the ART group and 144 women in the NC group completed the study. The case loss rate in the ART group and the NC group were 30.3% and 6.5%. The analysis method is based on SPSS version 17.0 software package, use descriptive statistics and inferential statistics, such as: Chi-square, Student’s t-test, Spearman correlation, ANOVA, and use the Generalized Estimation Equation (GEE) to analyze the change of depression in the perinatal period and the predictive factors of depression in the postpartum period. Results：The occurrence rate of postpartum depression in the ART group is 14.81%, and NC group accounted for 25.69% at a significant difference between the two groups (p<.05). The average age of women in the ART group and the women in the NC group was 35.3±4.2 vs. 31.3±4.5, caesarean section rate 58.3% vs. 27.8%, admission to postpartum care institutions 53.08% vs. 46.92, the above variables in the ART group were significantly higher than those in the NC group. In the third and sixth months of pregnancy, the EPDS, PSS, SSS and CHI of the two groups did not reach statistically significant differences (p>.05). The average EPDS of the two groups at the 9th month of pregnancy was 6.9±2.9 vs. 7.9±3.9 respectively, and 6 weeks postpartum were 5.18±4.0 vs. 6.6±4.7 (p<.05). Using GEE to analyze changes in EPDS during the perinatal period, the results showed that the EPDS of women in the ART group and the NC group did not reach statistically significant difference (β = .19, p = .6219). There are obvious differences in EPDS at different stages of pregnancy; especially in the 9th month of pregnancy (ß=-.99, p=.0021), and postpartum (ß=-2.36, p<.0001). The postpartum EPDS is significantly lower than that in the third month of pregnancy. In the interaction effect, the degree of EPDS decline in the ART group with the progress of pregnancy was more significant than that of naturally conceived. At 9 months of pregnancy, the EPDS score in the ART group was significantly lower than the naturally conceived group by an average of 1.13 points; furthermore, at the postpartum period, by an average of 1.46 points. In addition, women in the ART group had a higher rate of admission to postpartum care institutions after delivery (53.08% vs 46.92%). Women in the ART group who were admitted to postpartum care institutions after childbirth a had lower rate of postpartum depression. Conclusion：There is no significant difference at the average EPDS score of women during the perinatal period between the ART and the nature conceived groups. Women’s depression during the perinatal period is highest in the 3rd month of pregnancy (first trimester). Staying in a postpartum care institutions has a protective effect on postpartum depression of pregnant women in the ART group. The results of this study can clarify the characteristics and changes of perinatal depression in women who are pregnant with ART. The research results can provide evidence for determining medical care and public policy.

並列關鍵字

assisted reproductive technologies ； naturally conceived ； perinatal depression ； perceived stress ； social support ； happiness ； postpartum care institutions