母親孕產期情緒問題與嬰兒健康因子之關係

The link between maternal perinatal mood disturbances and infant health outcomes

張代佳(Tai-Chia Chang)

指導教授 ： 陳怡樺

臺北醫學大學/公共衛生暨營養學院/公共衛生學系暨研究所/碩士(2013年)

摘要

背景：嬰幼兒罹病率及死亡率一直是很重要的公共衛生議題，尤其嬰兒死亡率是評估婦幼衛生保建實行成效及代表公共衛生與醫藥進步的重要指標，其中受早產與低出生體重等不良出生結果影響占所有新生兒死亡率的六到八成，而在影響早產及低出生體重的其中重要因素為母親懷孕時的健康狀況，然而不只是母親生理因素會造成影響，近年已有許多研究證實母親孕產期的憂鬱、焦慮問題會提高新生兒早產及低出生體重的風險，且不只會對母親及出生結果有負面影響，甚至會對子女未來成長發展造成更長遠的傷害。
研究目的：(一)評估國內孕產期憂鬱焦慮情緒盛行率，(二)在孕期部分欲探討控制相關干擾因子後，母親孕期情緒與出生結果之間的關係，(三)在不同程度的婚姻調適度中，母親孕期情緒與出生結果之間的關係是否會有差異，(四)在孕產期部分欲探討控制相關干擾因子後，母親孕產期情緒與嬰兒健康之間的關係。
方法：594名婦女在孕期時填寫愛丁堡產後憂鬱量表(EPDS)、情境特質焦慮量表之情境焦慮量表(STAI-S)、婚姻調適量表分別評估孕期憂鬱、焦慮及婚姻調適度，在產後一個月後填寫追蹤問卷包括愛丁堡產後憂鬱量表(EPDS)、情境特質焦慮量表之情境焦慮量表(STAI-S)及嬰兒健康狀況，並使用多變項邏輯式迴歸進行最後結果分析。
結果：(一)孕期憂鬱盛行率為21.9%，產後憂鬱盛行率為20.7%，孕期焦慮盛行率為34.5%，產後焦慮盛行率為39.8%，(二)多變項邏輯斯迴歸分析結果顯示，在控制相關干擾因子後，孕期情緒與早產及低出生體重沒有統計上顯著關係，(三)婚姻調適度高其孕期焦慮顯著增加低出生體重的風險，(四)在控制相關干擾因子後，孕產期憂鬱會顯著增加嬰兒的體重成長不足(校正後OR=4.66，95%CI：1.75-12.37)、健康問題的風險(校正後OR=4.32，95%CI：1.41-13.30)，孕產期焦慮情形則顯著增加嬰兒的體重成長不足的風險(校正後OR=2.18，95%CI：1.00-4.73)。
結論：孕產期憂鬱焦慮可能顯著提高嬰兒生長健康問題風險，建議可納入門診常規的檢查項目中，幫助婦產科醫師快速評估孕產婦的心理情緒狀況，情緒問題程度較嚴重者能早期發現早期治療，以降低後續傷害，未來建議持續執行長期追蹤型調查，以較大樣本數進一步探討孕產期情緒與嬰兒健康之間的關係及其相關影響因子。

關鍵字

孕產期 ； 憂鬱 ； 焦慮 ； 早產 ； 低出生體重 ； 嬰兒健康

並列摘要

Background: Infant morbidity and mortality are major public health issues worldwide. Measures of infant mortality are among the best indicators of general health conditions in a population and are often used to estimate overall effects of public health implementation. About 60-80% infant mortality is attributed by adverse birth outcomes (such as preterm birth and low birth weight (LBW)). Maternal antenatal physical/psychological health is one of the important factors that may affect adverse birth outcomes. Many studies reported that maternal perinatal depression and anxiety increased the risk of preterm birth and LBW. Furthermore, maternal perinatal mental problems might negatively impact on the growth and development of their offspring.
Objectives: This study was aimed at investigating (1) the prevalence of maternal perinatal emotional disturbances, including depression and anxiety, (2) the association between maternal antenatal emotional disturbances and adverse birth outcomes, (3) the modifying effects of marital adjustment on the association between maternal antenatal emotional disturbances and adverse birth outcomes, and (4) the relationship between maternal perinatal emotional disturbances and infant health outcomes.
Material & Methods: A total of 594 pregnant women who had their antenatal visits in selected hospitals in the Taipei metropolitan area were recruited for participation. Self-reported maternal and infant health data were collected. Questionnaires of the Edinburgh Postnatal Depression Scale (EPDS), the State-Trait Anxiety Inventory- state anxiety scale (STAI-S), and the Locke-Wallace marital adjustment test were utilized to assess perinatal depression, anxiety and marital adjustment, respectively. Multivariate logistic regression model was used for analysis.
Results: We found that the prevalences of antenatal and postnatal depression were 21.9% and 20.7%, respectively, while the prevalences of antenatal and postnatal anxiety were 34.5% and 39.8%, respectively. In multivariate logistic regression analysis, we found that prenatal depression and anxiety were not significantly associated with preterm birth and LBW, after potential confounders were adjusted. However, among women with higher marital adjustment, those with higher antenatal anxiety might experience increased risks of having a LBW baby. For infant health outcomes, perinatal depression might significantly increase the risks of infant insufficient weight gain (adjusted odds ratio=4.66，95% confidence interval：1.75-12.37) and physical health problems (adjusted odds ratio=4.32，95% confidence interval：1.41-13.30), after potential confounders were considered. Moreover, perinatal anxiety might increase the risks of infant insufficient weight gain (adjusted odds ratio=2.18，95% confidence interval：1.00-4.73).
Conclusion: Perinatal depression and anxiety might impact negatively on infant’s growth and development. Our results suggest the need of recruiting perinatal depression and anxiety screening into the routine obstetric examination. With prompt detection and intervention, it is hoped that maternal health and consequent infant growth and development could be promoted effectively. Future longitudinal studies with larger sample size are in need to further clarify the relationships between perinatal maternal mental health and infant health outcomes, as well as the impact of other contributing factors.

並列關鍵字

Perinatal stage ； depression ； anxiety ； preterm birth ； low birth weight ； infant health outcomes

參考文獻

英文文獻

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