先兆早产孕妇分娩孕周情况及其影响因素研究
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摘要
[目的]了解先兆早产孕妇分娩孕周的现状并分析分娩孕周的影响因素。[方法]采用前瞻性研究设计。纳入131例因先兆早产住院的孕妇,早产组83例,足月产组48例。采用感知压力量表(Perceived Stress Scale,PSS)和爱丁堡产后抑郁量表(Edinburgh Postpartum Depression Scale,EPDS)进行压力和产前抑郁的调查。并收集入院当天24 h内08:00、16:00和23:00的唾液进行唾液皮质醇(salivary cortisol,SC)检测。采用多重线性回归分析分娩孕周的影响因素。[结果]孕妇总体的分娩孕周为35.3(32.4,37.3)周。83例(63.4%)孕妇发生早产,早产组分娩孕周为33.3(31.5,34.8)周。孕妇总体、早产组和足月产组的PSS得分依次为(21.4±8.0)分、(22.5±7.8)分、(19.5±8.0)分。早产组PSS得分高于足月产组(t=2.128,P=0.035)。孕妇总体、早产组和足月产组的EPDS得分依次为9.0(5.0,13.0)分、12.0(6.0,14.0)分、6.5(4.0,11.0)分。早产组EPDS得分高于足月产组(Z=-2.683,P=0.007)。63名孕妇存在产前抑郁,筛查率为48.1%。多重回归分析结果显示:孕妇23:00 SC、入院孕周、医疗费用支付方式以及宫颈扩张、产次是分娩孕周的影响因素,联合解释变异量为39.2%(调整后为35.8%)。[结论]先兆早产孕妇的压力水平高,产前抑郁普遍存在。孕妇的午夜SC浓度越高,则分娩孕周可能越小。医护人员应密切关注并积极改善孕妇的心理压力和产前抑郁情绪,以帮助孕妇尽可能足月分娩。孕妇的SC对先兆早产者分娩孕周具有潜在的预测价值。
引文
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[14] 韦月颜,陶真兰,程虹,等.孕妇焦虑和抑郁情绪对妊娠结局的影响[J].职业与健康,2015,31(9):1213-1216.
[15] CHRISTIAN L M.Physiological reactivity to psychological stress in human pregnancy:current knowledge and future directions[J].Progress in Neurobiology,2012,99(2):106-116.
[2] FIELD T,DIEGO M.Cortisol:the culprit prenatal stress variable[J].The International Journal of Neuroscience,2008,118(8):1181-1205.
[3] CHENG C Y,PICKLER R H.Maternal psychological well-being and salivary cortisol in late pregnancy and early post-partum[J].Stress & Health,2010,26(3):215-224.
[4] DE W C,BUITELAAR J K.Cortisol awakening response in pregnant women[J].Psychoneuroendocrinology,2005,30(9):902-907.
[5] 干伟,张林,安振梅.唾液皮质醇的研究进展[J].中国实验诊断学,2009,13(9):1304-1306.
[6] DIEGO M A,JONES N A,FIELD T,et al.Maternal psychological distress,prenatal cortisol,and fetal weight[J].Psychosomatic Medicine,2006,68(5):747-753
[7] COHEN S T.A global measure of perceived stress[J].Journal of Health and Social Behavior,1983:385-396.
[8] COX J L,HOLDEN J M,SAGOVSKY R.Detection of postnatal depression.Development of the 10-item Edinburgh Postnatal Depression Scale[J].Br J Psychiatry,1987,150:782-786.
[9] KOZINSZKY Z,DUDAS R B.Validation studies of the Edinburgh Postnatal Depression Scale for the antenatal period[J].Journal of Affective Disorders,2015,176(Supplement C):95-105.
[10] WANG Y Q,GUO X J,LAU Y,et al.Psychometric evaluation of the mainland Chinese version of the Edinburgh Postnatal Depression Scale[J].International Journal of Nursing Studies,2009,46(6):813-823.
[11] 唐菊英,郑鹏杰,黎锋,等.唾液皮质醇参考区间的建立及其临床意义评价[J].国际检验医学杂志,2013,34(20):2678-2679.
[12] MICHAEL P,MARGARETE B,KARL-MARTIN P,et al.Maternal trait anxiety,emotional distress,and salivary cortisol in pregnancy[J].Biological Psychology,2010,83(3):169-175.
[13] LAU Y,YIN L.Maternal,obstetric variables,perceived stress and health-related quality of life among pregnant women in Macao,China[J].Midwifery,2011,27(5):668-673.
[14] 韦月颜,陶真兰,程虹,等.孕妇焦虑和抑郁情绪对妊娠结局的影响[J].职业与健康,2015,31(9):1213-1216.
[15] CHRISTIAN L M.Physiological reactivity to psychological stress in human pregnancy:current knowledge and future directions[J].Progress in Neurobiology,2012,99(2):106-116.