产前抑郁与妊娠期糖尿病相关性队列研究
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摘要
目的探讨产前抑郁症状与妊娠期糖尿病(GDM)的关系,研究抑郁症状能否作为GDM预防的风险因素。方法将2016年1—9月在广东省妇幼保健院产科首次产检并接受抑郁症状评估的1 554名孕妇(孕20周前)纳入调查,追踪随访到24～28周行糖耐量试验(OGTT),根据其结果及医生诊断为GDM,比较有、无抑郁症状组孕妇GDM的发病率,logistic回归分析产前抑郁症状与GDM发病的相关性,并分析影响GDM发病的风险因素。结果 GDM发病率为17.7%,抑郁症状组孕妇GDM发病率(18.5%)高于非抑郁组(17.3%),但2组发病率差异无统计学意义(χ~2=0.3,P=0.57)。logistic回归分析发现产前抑郁与GDM发病无关(OR=1.1,95% CI=0.82～1.43),高龄(OR=1.7,95% CI=1.2～2.3)、孕前体质指数(BMI)(OR=1.7,95% CI=1.2～2.3)、早产史(OR=2.8,95% CI=1.3～6.0)、GDM史(OR=7.6,95% CI=3.9～14.9)、糖尿病家族史(OR=2.1,95% CI=1.1～4.0)是GDM发病的风险因素。结论产前抑郁症状与中晚期妊娠期糖尿病发病无相关性,高龄、孕前BMI、早产史、GDM史、糖尿病家族史是GDM发病的风险因素。
Objective To investigate the relationship between antenatal depression symptoms and gestational diabetes mellitus(GMD) and whether antenatal depression symptoms is a risk factor for the incidence of GMD. Methods We enrolled 1 554 pregnant women taking their first prenatal examination(before 20-week of the gestation) at Guangdong Provincial Women and Children Hospital between January and September 2016. For all the participants, depressive symptoms during early pregnancy were assessed with the 10-item Edinburgh Postnatal Depression Scale(EPDS) and a 75-g oral glucose tolerance test(OGTT) was conducted to diagnose GDM in a follow-up survey between 24-and 28-week of gestation. We compared the difference in the incidence of GMD between the participants with and without depressive symptoms and explored the associations of antenatal depression symptoms with GDM and influence factors of GDM using logistic regression analysis. Results The incidence of GDM was 17.7% among all the participants and the incidence was unsignificantly higher among the participants with antenatal depression symptoms than among those without the symptoms(18.5% vs. 17.3%; χ~2 = 0.3, P = 0.57). The results of logistic regression analysis revealed that prenatal depression was not associated with GDM(odds ratio [OR] = 1.1, 95% confidence interval [95% CI]: 0.82 – 1.43); while, age(OR = 1.7, 95% CI:1.2 – 2.3), high pre-pregnancy body mass index(BMI) of ≥ 24.0 kg/m2(OR = 1.7, 95% CI: 1.2 – 2.3), history of preterm delivery(OR = 2.8, 95% CI: 1.3 – 6.0), GDM history(OR = 7.6, 95% CI: 3.9 – 14.9), and family history of diabetes(OR =2.1, 95% CI: 1.1 – 4.0) were significant risk factors of GDM. Conclusion Gestational diabetes mellitus incidence is not correlated with prenatal depression symptoms but significantly influenced by age, pre-pregnancy BMI, histories of preterm delivery and GDM, and family history of diabetes.
Objective To investigate the relationship between antenatal depression symptoms and gestational diabetes mellitus(GMD) and whether antenatal depression symptoms is a risk factor for the incidence of GMD. Methods We enrolled 1 554 pregnant women taking their first prenatal examination(before 20-week of the gestation) at Guangdong Provincial Women and Children Hospital between January and September 2016. For all the participants, depressive symptoms during early pregnancy were assessed with the 10-item Edinburgh Postnatal Depression Scale(EPDS) and a 75-g oral glucose tolerance test(OGTT) was conducted to diagnose GDM in a follow-up survey between 24-and 28-week of gestation. We compared the difference in the incidence of GMD between the participants with and without depressive symptoms and explored the associations of antenatal depression symptoms with GDM and influence factors of GDM using logistic regression analysis. Results The incidence of GDM was 17.7% among all the participants and the incidence was unsignificantly higher among the participants with antenatal depression symptoms than among those without the symptoms(18.5% vs. 17.3%; χ~2 = 0.3, P = 0.57). The results of logistic regression analysis revealed that prenatal depression was not associated with GDM(odds ratio [OR] = 1.1, 95% confidence interval [95% CI]: 0.82 – 1.43); while, age(OR = 1.7, 95% CI:1.2 – 2.3), high pre-pregnancy body mass index(BMI) of ≥ 24.0 kg/m2(OR = 1.7, 95% CI: 1.2 – 2.3), history of preterm delivery(OR = 2.8, 95% CI: 1.3 – 6.0), GDM history(OR = 7.6, 95% CI: 3.9 – 14.9), and family history of diabetes(OR =2.1, 95% CI: 1.1 – 4.0) were significant risk factors of GDM. Conclusion Gestational diabetes mellitus incidence is not correlated with prenatal depression symptoms but significantly influenced by age, pre-pregnancy BMI, histories of preterm delivery and GDM, and family history of diabetes.
引文
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[16]郭秀静,王玉琼,陈静.爱丁堡产后抑郁量表在成都地区产妇中应用的效能研究[J].中国实用护理杂志,2008,25(1):4-6.
[17]何瑛,何国平.430例产妇产后抑郁发生及相关因素的研究[J].中华现代护理杂志,2011,17:1539-1541.
[18]Tendais I,Costa R,Conde A,et al.Screening for depression and anxiety disorders from pregnancy to postpartum with the EPDS and STAI[J].Spanish Journal of Psychology,2014,17(7):1-9.
[19]谢幸,苟文丽.妇产科学[M].8版.北京:人民卫生出版社,2013:230-231.
[20]Enqberq E,Stach-Lempinen B,Sahrakorpi N,et al.A crosssectional study of antenatal depressive symptoms in women at high risk for gestational diabetes mellitus[J].Journal of Psychosomatic Research,2015,79(6):646-650.
[21]Ertel KA,Silveira,M,Pekow P,et al.Prenatal depressive symptoms and abnormalities of glucose tolerance during pregnancy among Hispanic women[J].Archives of Women's Mental Health,2014,17(1):65-72.
[22]Kim C,Brawarsky P,Jackson RA,et al.Changes in health status experienced by women with gestational diabetes and pregnancyinduced hypertensive disorders[J].J Women's Health,2005,14(8):729-736.
[23]Morrison C,McCook JG,Bailey BA.First trimester depression scores predict development of gestational diabetes mellitus in pregnant rural Appalachian women[J].J Psychosom Obstet Gynaecol,2016,37(1):21-25.
[24]Bowers K,Laughon SK,Kim S,et al.The association between a medical history of depression and gestational diabetes in a large multi-ethnic cohort in the United States[J].Paediatr Perinat Epidemiol,2013,27(4):323-328.
[25]Tabák AG,Akbaraly TN,Batty GD,et al.Depression and type 2diabetes:a causal association?[J].The Lancet Diabetes and Endocrinology,2014,2(3):236-245.
[26]Roos C,Lidfeldt J,Agardh CD,et al.Insulin resistance and selfrated symptoms of depression in Swedish women with risk factors for diabetes:the Women′s Health in the Lund Area study[J].Metabolism,2007,56(6):825-829.
[27]Silva N,Atlantis E,Ismail K.A review of the association between depression and insulin resistance:pitfalls of secondary analyses or a promising new approach to prevention of type 2 diabetes?[J].Curr Psychiatry Rep,2012,14(1):8-14.
[2]Kampmann U,Madsen LR,Skajaa GO,et al.Gestational diabetes:a clinical update[J].World J Diabetes,2015,6(8):1065-1072.
[3]陈友,江芳华,徐丛荣,等.新诊断标准下妊娠糖尿病筛查分析[J].国际检验医学杂志,2013,34(22):3083-3084.
[4]HAPO Study Cooperative Research Group,Metzger BE,Lowe LP,et al.Hyperglycemia and adverse pregnancy outcomes[J].N Engl JMed,2008,358(19):1991-2002.
[5]Byrn MA,Penckofer S.Antenatal depression and gestational diabetes:a review of maternal and fetal outcomes[J].Nurs Women's Health,2013,17(1):22-33.
[6]Malcolm J.Through the looking glass:gestational diabetes as a predictor of maternal and offspring long-term health[J].Diabetes Metab Rev,2012,28(4):307-311.
[7]Renn BN,Feliciano L,Segal DL.The bidirectional relationship of depression and diabetes:a systematic review[J].Clin Psychol Rev,2011,31(8):1239-1246.
[8]Lustman PJ,Penckofer S,Clouse R.Recent advances in understanding depression in adults with diabetes[J].Current Diabetes Reports,2007,7(2):114-122.
[9]Mezuk B,Eaton WW,Albrecht S,et al.Depression and type 2diabetes over the lifespan:a meta-analysis[J].Diabetes Care,2008,31(12):2383-2390.
[10]Nouwen A,Winkley K,Twisk J,et al.Type 2 diabetes mellitus as a risk factor for the onset of depression:a systematic review and meta-analysis[J].Diabetologia,2010,53(12):2480-2486.
[11]Musselman DL,Betan E,Larsen H,et al.Relationship of depression to diabetes types 1 and 2:epidemiology,biology,and treatment[J].Biological Psychiatry,2003,54(3):317-329.
[12]Berge LI,Riise T.Comorbidity between type 2 diabetes and depression in the adult population:directions of the association and its possible pathophysiological mechanisms[J].International Journal of Endocrinology,2015,2015(2015):1-7.
[13]Gavin NI,Gaynes BN,Lohr KN,et al.Perinatal depression:a systematic review of prevalence and incidence[J].Obstet Gynecol,2005,106:1071-1083.
[14]Kozhimannil KB,Pereira MA,Harlow BL.Association between diabetes and perinatal depression among low-income mothers[J].JAMA,2009,301(8):842-847.
[15]Mautner E,Greimel E,Trutnovsky G,et al.Quality of life outcomes in pregnancy and postpartum complicated by hypertensive disorders,gestational diabetes,and preterm birth[J].JPsychosom Obstet Gynaecol,2009,30(4):231-237.
[16]郭秀静,王玉琼,陈静.爱丁堡产后抑郁量表在成都地区产妇中应用的效能研究[J].中国实用护理杂志,2008,25(1):4-6.
[17]何瑛,何国平.430例产妇产后抑郁发生及相关因素的研究[J].中华现代护理杂志,2011,17:1539-1541.
[18]Tendais I,Costa R,Conde A,et al.Screening for depression and anxiety disorders from pregnancy to postpartum with the EPDS and STAI[J].Spanish Journal of Psychology,2014,17(7):1-9.
[19]谢幸,苟文丽.妇产科学[M].8版.北京:人民卫生出版社,2013:230-231.
[20]Enqberq E,Stach-Lempinen B,Sahrakorpi N,et al.A crosssectional study of antenatal depressive symptoms in women at high risk for gestational diabetes mellitus[J].Journal of Psychosomatic Research,2015,79(6):646-650.
[21]Ertel KA,Silveira,M,Pekow P,et al.Prenatal depressive symptoms and abnormalities of glucose tolerance during pregnancy among Hispanic women[J].Archives of Women's Mental Health,2014,17(1):65-72.
[22]Kim C,Brawarsky P,Jackson RA,et al.Changes in health status experienced by women with gestational diabetes and pregnancyinduced hypertensive disorders[J].J Women's Health,2005,14(8):729-736.
[23]Morrison C,McCook JG,Bailey BA.First trimester depression scores predict development of gestational diabetes mellitus in pregnant rural Appalachian women[J].J Psychosom Obstet Gynaecol,2016,37(1):21-25.
[24]Bowers K,Laughon SK,Kim S,et al.The association between a medical history of depression and gestational diabetes in a large multi-ethnic cohort in the United States[J].Paediatr Perinat Epidemiol,2013,27(4):323-328.
[25]Tabák AG,Akbaraly TN,Batty GD,et al.Depression and type 2diabetes:a causal association?[J].The Lancet Diabetes and Endocrinology,2014,2(3):236-245.
[26]Roos C,Lidfeldt J,Agardh CD,et al.Insulin resistance and selfrated symptoms of depression in Swedish women with risk factors for diabetes:the Women′s Health in the Lund Area study[J].Metabolism,2007,56(6):825-829.
[27]Silva N,Atlantis E,Ismail K.A review of the association between depression and insulin resistance:pitfalls of secondary analyses or a promising new approach to prevention of type 2 diabetes?[J].Curr Psychiatry Rep,2012,14(1):8-14.