Neonatal outcomes in offspring of women with anxiety and depression during pregnancy

Summary Background: The presence of mental disorder during pregnancy could affect the offspring.Aims: To examine the effects of anxiety disorder and depression in pregnant women on neonatal outcomes, and to compare neonatal outcomes between offspring of attendees and non-attendees in a general population-based health survey.Method: Pregnant women (n = 680) were identified from the population-based health study of Nord-TrØndelag County (HUNT-2) by linkage with the Medical Birth Registry of Norway. The women rated themselves on the Hospital Anxiety and Depression Rating Scale (HADS). Outcome variables were gestational length, birth weight, and Apgar scores.Results: HADS-defined anxiety disorder during pregnancy was associated with lower Apgar score at one minute (score < 8; odds ratio = 2.27; p = .03) and five minutes (score < 8; odds ratio = 4.49; p = .016). No confounders were identified. Anxiety disorder and depression during pregnancy was not associated with low birth weight or preterm delivery. Offspring of non-attendees had a lower birth weight (77 g; t = 3.27; p = 0.001) and a shorter gestational length (1.8 days; t = 2.76; p = 0.006) than that of offspring of attendees, a difference that may be explained by a higher load of psychosocial risk factors among the non-attendees.Conclusion: In our study that may be biased towards the healthier among pregnant women, anxiety disorder or depression during pregnancy were not strong risk factors for adverse neonatal outcomes although low Apgar score in offspring of women with anxiety disorder may indicate poor neonatal adaptation.     

高龄产妇并发妊娠期高血压疾病对围生期结局的影响

目的探讨孕高龄产妇并发妊娠期高血压疾病对围生期结局的影响。方法对43例35岁或以上的妊娠期高血压疾病孕妇（观察组）进行了回顾性分析并与同期分娩的35岁以下的妊娠期高血压疾病孕妇238例（对照组）作对照分析。结果观察组子痫前期、子痫的发生率与对照组比较差异有非常显著性（P〈0.01）;观察组胎盘早剥、HELLP综合征、妊娠高血压心脏病等严重并发症的发生率与对照组比较无显著性差异（P〉0.05）;观察组早产、胎儿生长受限、围产儿死亡的发生率比对照组高,差异有显著性（P〈0.05）;新生儿窒息、胎儿窘迫的发生率两组比较,差异无显著性（P〉0.05）,观察组剖宫产率较对照组明显增加,两组间差异有显著性（P〈0.05）。结论高龄产妇并发妊娠期高血压疾病病情重,对母儿危害大,恰当的围产期管理并适时终止妊娠是治疗成功的关键。     

多普勒超声心动图评价妊娠期妇女的左室血液动力学变化

多普勒超声心动图评价妊娠期妇女的左室血液动力学变化解放军２０８医院优生优育中心（长春，１３００６２）孙欣，钟湘华，黄春林解放军２０８医院特诊科王冬青，贾小青，阮红在怀孕期间，母体致心血管系统会发生独特的生理性变化。这方面的研究，先前的学者已有很多报道...     

甲亢孕妇妊娠结局的临床分析

目的探讨妊娠合并甲亢规范化治疗对妊娠结局的影响。方法选取四年间于我院建档并分娩、资料完整的妊娠合并甲亢患者77例,对其妊娠结局进行临床分析。结果甲亢未治疗组甲状腺激素水平明显增高,妊娠并发症增多,与治疗组相比,差异有显著性（P〈0.01）;未治疗组新生儿体重明显低于治疗组,差异有显著性（P〈0.05）;但两组的剖宫产率及新生儿甲状腺功能差异无统计学意义（P〉0.05）。结论及时诊断并规范治疗妊娠甲亢,可降低妊娠并发症发生率,改善妊娠结局。     

子痫前期患者胎盘血流异常的高危因素及围产儿预后

目的 探求子痫前期患者胎盘血流异常的高危因素及其对围产儿预后的影响.方法 回顾性分析255例子痫前期患者的临床资料,其中脐血流S/D比值≥3.0者82例,脐血流S/D比值<3.0者173例.B超检测脐动脉S/D比值,联合患者血压、血液流变学指标及围产儿预后进行相关性分析.结果 子痫前期患者脐血流异常组母体血压及血液流变学指标较脐血流正常者有显著升高,母体血压、血液红细胞压积及D二聚体与脐血流S/D比值具有显著正相关性.子痫前期组胎儿宫内生长受限发生率及新生儿窒息率较正常对照组均有显著升高,子痫前期脐血流异常组较脐血流正常组胎儿宫内生长受限发生率及新生儿窒息率亦有显著升高.结论 子痫前期患者血压增高及血液高凝是胎儿脐血流异常的高危因素,胎儿脐血流异常者易出现围产儿预后不良,对于多种高危因素并存时应积极治疗必要时终止妊娠.     

妊娠合并膈疝一例及文献复习

目的 报道1例临床少见的妊娠合并膈疝病例的临床诊治过程,结合文献复习,总结该病的临床表现、诊断特点及治疗时机,为妊娠合并膈疝的诊治提供依据。方法 回顾分析空军军医大学附属唐都医院1例26岁经产妇妊娠合并膈疝患者的临床资料。在PubMed、中国知网及万方数据库中,以“妊娠”“膈疝”和“diaphragmatic hernia & pregnancy”为关键词,检索到1968年1月—2018年12月期间报道的妊娠合并膈疝患者计60例。结合本例诊治过程,分析患者发病年龄、发病时孕周、主要临床症状、膈疝发生部位、疝出器官、修补时机及母婴预后等临床特征。结果 61例妊娠合并膈疝患者发病年龄20~38岁,平均27.5岁;发病时孕周为20~39周,平均32.4周。61例患者中,表现为腹部剧烈疼痛42例(68.9%)、呕吐38例(62.3%)、呼吸困难35例(57.4%)、胸痛19例(31.1%)。72.1%(44/61)的患者膈疝发生部位位于左侧,疝出器官以结肠(68.9%,42/61)和胃(63.9%,39/61)居多。结合患者临床表现与孕周,41.0%(25/61)选择在产前及产时修补,37.7%(23/61)选择于产后修补。母婴病死率分别为13.1%(8/61)和16.4%(10/61)。结论 妊娠合并膈疝的发病时间集中于孕中晚期,其临床表现无明显特异性,应结合患者临床症状及孕周决定修补和分娩时机。若不能及时诊断与处理,母婴预后较差。     

正常体重指数孕妇孕期体重增长与妊娠结局的关系

目的总结2009年1月至2010年1月我院产检的正常体重指数孕妇妊娠期体重增长的情况,并对其妊娠结局按不同体重增长情况进行分析,得出体重增长与妊娠结局的关系。方法对2009年1月至2010年1月在我院检查及分娩单胎的1382名正常体重指数的孕妇进行分析,按2009年Institute of Medicine(IOM)体重增长指南将孕妇进行分组,分为过少增长、正常增长及过多增长组,并随访妊娠结局。结果 1382名正常体重指数的孕妇体重过少增长、正常增长及过多增长的比率分别为11.43%、37.63%、50.94%。体重增长情况与孕妇受教育程度及社会职务存在相关性,三组妊娠结局进行比较,剖宫产率、妊娠期高血压(PIH)、巨大儿、低体重儿的发生率存在显著性差异,而妊娠期糖尿病(GDM)、产后出血的发生率无显著性差异。结论尽管孕前体重指数正常,仍有超过一半的孕妇体重增长超过标准,且过多或过少的体重增长均会导致不良的妊娠结局,故妊娠期提供正确的体重增长指导对正常孕妇仍很重要。     

The Pregnancy Depression Scale (PDS): a screening tool for depression in pregnancy

Depression in pregnancy can be underdiagnosed as a consequence of the symptoms being misattributed to “normal pregnancy.” There are currently no validated clinician-rated scales that assess for depression specifically during pregnancy. We sought to develop a brief, convenient screening tool to identify depression in pregnant women in the community setting. Prospective mood data using the 28-item Hamilton Depression Rating Scale (HDRS) were collected monthly in 196 pregnant women with a history of a major depressive disorder. These data were analyzed to delineate those HDRS items associated (elevated) with normal pregnancy vs. those indicative of a pregnant woman meeting diagnostic criteria for a major depressive episode. Endorsement of symptoms on seven items of the HDRS were highly predictive of having a major depressive episode during pregnancy. We present a well-validated, brief scale to screen pregnant women for clinical depression. Whether this study will generalize to women who do not have a history of major depression remains to be studied.     

Anxiety, depression and saliva cortisol in women with a medical disorder during pregnancy

Anxiety and depression during pregnancy increase the risk for an adverse pregnancy outcome and neurodevelopmental problems in the child. The aim of this study was to investigate anxiety and depression in women with a medical disorder of pregnancy compared with control antenatal women, and any association with saliva cortisol. One hundred and twenty pregnant women (60 with a known medical disorder and 60 without, mean gestation 32 weeks) completed five self-rating questionnaires (Spielberger State and Trait Anxiety, Edinburgh Postnatal Depression Scale (EPDS), the Adult Wellbeing Scale and a Life Events Questionnaire). Diurnal saliva samples were obtained from 39 women with a medical disorder and 50 controls for cortisol analysis. The medical disorders group were significantly more anxious and depressed than the controls (mean (SD)) state anxiety 40.0 (11.5) vs. 31.6 (8.8), p = 0.00; trait anxiety 39.4 (9.5) vs. 35.2 (9.2), p = 0.02; adult wellbeing 15.9 (7.5) vs. 12.3 (7.5) p = 0.01; and EPDS 9.6 (5.4) vs. 5.9 (4.8), p = 0.00). There was no difference in the life events scores between the groups. The subgroup of women suffering from hyperemesis gravidarum had particularly high EPDS scores, (16.2 (3), n = 5, p = 0.00) compared with controls. There were no significant differences in the cortisol levels between the groups. Some women with a medical disorder during pregnancy showed considerably elevated levels of anxiety and depression. Health professionals need to be aware that these women need extra psychological support.     

妊娠期妇女生殖道假丝酵母菌病与妊娠不良结局分析

目的探讨妊娠期妇女生殖道假丝酵母菌病对妊娠不良结局的影响。方法回顾性分析2011年1月-2014年2月在我院住院孕产妇共2500例,进行阴道分泌物细菌培养,对白色念珠菌培养阳性组与正常对照组的妊娠结局进行分析,以探讨妊娠合并生殖道假丝酵母菌病与围产期并发症的关系。结果在2500例围产期妇女中,无致病菌组（对照组）为1300例,假丝酵母菌培养阳性组（感染组）为350例,总患病率为14%,其中有症状组200例（57.14%）,无症状组为150例（42.86%）。有症状感染组、无症状感染组、对照组的胎膜早破的发生率分别为22.5%、9.33%、8.15%,早产率分别为9.5%、4%、3%,绒毛膜羊膜炎率分别为23%、8.67%、7.38%,产褥感染率分别为7.5%、4%、3.54%,新生儿黄疸的发生率分别为21%、10.67%、11.54%,新生儿窒息率分别为2%、2.67%、2.31%,低体重儿的发生率分别为1.5%、1.33%、1.92%。有症状的妊娠期妇女生殖道假丝酵母菌病与无症状组及对照组相比较,胎膜早破、早产、绒毛膜羊膜炎、产褥感染、新生儿黄疸的发生率均有显著升高,新生儿窒息率及低体重儿的发生率无显著性差异。结论孕期对有症状的生殖道假丝酵母菌病的治疗是有重要意义的。     

Symptoms associated with the DSM IV diagnosis of depression in pregnancy and post partum

Pregnancy and the postpartum may affect symptoms of depression. However it has not yet been tested how the symptoms used for the DSM IV diagnosis of depression discriminate depressed from non depressed women perinatally. A modified version of the Structured Clinical Interview for DSM IV (SCID interview) was used that allowed assessment of all associated DSM IV symptoms of depression with depressed and non depressed women in pregnancy and the postpartum period. Loss of appetite was not associated with depression either ante or postnatally. The antenatal symptom pattern was different from the postnatal. The sensitivity of the symptoms ranged from 0.7% to 51.6%, and specificity from 61.3% to 99.1%. The best discriminating symptoms were motor retardation/agitation and concentration antenatally, and motor retardation/agitation, concentration and fatigue postnatally. Depression in pregnancy and postpartum depression show significantly different symptom profiles. Appetite is not suitable for the diagnosis of depression in the perinatal period.     

妊娠期肝内胆汁淤积症围生儿缺氧机理的研究

目的探讨妊娠期肝内胆汁淤积症(ICP)围生儿缺氧的可能机理.方法分别用放免法、生化法及原子吸收法测定ICP组及对照组母儿血甘胆酸(CG)、红细胞膜三磷酸腺苷酶(ATPase)活性及细胞内离子浓度,统计各组围生儿缺氧率.结果 ICP组母儿CG水平显著高于对照组(P＜0.01),母血CG值显著高于新生儿血;红细胞膜ATPase活性明显低于对照组(P＜0.01),并与CG水平呈负相关 (Na -K -ATPase:rs=-0.498,P＜0.01;Ca2 -ATPase:rs=-0.443,P＜0.05);红细胞内Na 、Ca2 浓度明显高于对照组(P＜0.01);围生儿缺氧的发生率明显高于对照组(P＜0.05).结论 ICP围生儿血清内高浓度的胆汁酸影响其红细胞的结构与功能,可能是ICP围生儿缺氧的机理之一.     

Depression in medical students: Cluster symptoms and management

Background

Rates of depression among medical students have been shown to be high and related to year of study and other factors. We report on cluster of symptoms related to depression and their association with other difficulties in specific domains.

Methods

481 (Response rate=79.8%) medical students completed a questionnaire about areas of difficulty in the medical school (studies, leisure, colleagues, professors, and patients), and Beck Depression Inventory (BDI). We studied correlation among areas of difficulty and clusters of BDI along with year in the course.

Results

Two areas which contributed most difficulty were studies and leisure. The significant associations for studies were seen between somatic cluster of depressive symptoms and the level of the course. Difficulties associated with leisure activities and with colleagues were correlated with the affective cluster of symptoms of depression. Activities related to clinical matters especially working with patients in the internship year were associated with somatic clusters. The different associations confirmed that rather than relying on scores emphasis should be placed on clusters of symptoms.

Limitations

Sample from a single medical school.

Conclusions

Although the clusters are associated with specific difficulties, it is important that educators and health professionals are aware of streesors the medical students face. The correlations if confirmed in future studies with qualitative factors could guide the development of more specific therapeutic or curriculum interventions.     

江苏地区中孕期妇女巨细胞病毒感染率及感染状态与不良妊娠结局的关系

目的江苏省中孕期妇女的巨细胞病毒（cytomegalovirus,CMV）血清流行率,探讨母孕期感染状态与不良妊娠结局的相关性。方法根据2002-2004年江苏省12个市县17661例孕妇的新生儿结局,527例有不良妊娠结局的孕妇纳入病例组,同时随机选取496例正常妊娠结局的孕妇为正常对照。检测孕妇妊娠15～20周外周血CMV IgG、IgM和IgG亲合力指数（avidity index,AI）。结果1023例孕妇的CMV IgG阳性率为98.7％,其中病例组和对照组孕妇阳性率分别为99.4％和98.0％（P=0.039）。病例组孕妇活动感染率,即CMV IgG＋／IgM＋,明显高于正常对照组（3.8％vs.1.6％,P=0.033）。CMV IgG AI检测结果显示,对照组孕妇AI均大于30%,说明无原发感染,而病例组孕妇5例（0.9％）AI〈30％,提示原发感染（P=O.084）,这5例母亲的新生儿均出现不良妊娠结局,包括新生儿死亡、头颅畸形和化脓性脑膜炎各1例,生长发育迟缓2例。多因素回归分析表明,母孕期CMV活动性感染是不良妊娠结局的独立危险因素（aOR 8.65,95％CI 1.85～40.41,P=0.006）。此外,母亲低学历和有既往不良妊娠史亦增加妊娠不良结局的发生风险。结论CMV感染在江苏地区孕妇人群中普遍存在。尽管仅少部分孕妇在孕期发生活动性感染,但仍是造成妊娠不良结局的独立危险因素。因此,应监测孕妇CMV感染状态并正确进行胎儿或新生儿感染风险的评估。     

Pre- and perinatal complications and risk for bipolar disorder: a retrospective study

Background: Many studies have reported that obstetric complications are risk factors for schizophrenia, but few studies have examined whether complications increase risk for bipolar disorder. Methods: Bipolar-disorder probands and their adult siblings were diagnosed using DSM-III-R criteria. Obstetrical data from maternal reports were scored, blind to diagnosis, applying published scales that take into account number and severity of complications. Results: Obstetric complication scores were significantly worse in probands than siblings without mood disorders. Limitations: Probands had relatively severe symptoms; research using more heterogeneous samples is needed. Conclusion: Results suggest obstetric complications are etiologically significant in bipolar disorder.     

灭滴灵阴道用药对细菌性阴道病晚孕妇女不良妊娠结局的预防效果

目的：探讨灭滴灵治疗细菌性阴道病对不良妊娠结局是否有改善作用。方法：在产科门诊对用阴道分泌物涂片革兰氏染色Ｎｕｇｅｎｔ诊断标准孕２８－３２周妇女进行细菌性阴道病筛查,对检出的患者随机分为二组;观察组５２例,未给予治疗;治疗组５０例,采用灭滴灵阴道用药治疗,必要时再次治疗。     

Obstetric care provider engagement in a perinatal depression screening program

To investigate obstetric care provider attitudes toward perinatal depression screening and factors associated with variable screening rates. Provider attitudes about depression screening were investigated via structured interviews (open-ended and rating scale questions) and analyzed using qualitative content analysis. Most providers (86%) found screening effective at identifying women at risk for perinatal depression (average rating of 8.7 on 10-point analog scale). However, 95% overestimated their own screening rates and 67% inaccurately thought they achieved universal screening. Providers not directly involved in their office-based screening process demonstrated lower average screening rates (37%) than those who maintained active involvement (59%; p = 0.07). Obstetric care providers support perinatal depression screening in the context of a program that assumes responsibility for processing screens, conducts assessments of at-risk women and provides referrals to mental health professionals. Provider participation in screening and tying screening to routine obstetric outpatient activities such as glucose tolerance testing are associated with higher screening rates. Presented in part at the annual meeting of the American College of Obstetrics & Gynecology, San Diego, CA, May 2007.     

孕期产前检查质量与妊娠结局分析

目的分析孕妇产前检查状况与妊娠不良结局的关系。方法对2009年在复旦大学附属金山医院住院分娩的孕妇1747例临床资料进行回顾性分析。结果①研究对象中总体产前检查率为69.3%,而流动户口人员产前检查率明显低于与本地户口人员产前检查率,差异有显著性(P<0.05)。②进行规范的产前检查可以降低子痫前期、过期妊娠、早产、FGR、羊水异常及新生儿窒息的发生率(P<0.05)。结论产前检查可改善妊娠结局,目前我国仍然存在部分孕妇没有进行规范的产前检查,应该加产前检查措施的落实。     

Characterizing the nature of worry in a sample of perinatal women with generalized anxiety disorder

Prevalence of perinatal anxiety disorders continues to grow, with estimates greater than those of postpartum depression. Generalized anxiety disorder (GAD) is the most commonly reported perinatal anxiety disorder, yet very little is known about the worry content experienced during the perinatal period in those with GAD. This study investigated worry content and frequency in a sample of perinatal women (n = 20) and age‐matched nonperinatal women (n = 20) diagnosed with GAD. Participants completed the Penn State Worry Questionnaire (PSWQ) to assess worry severity, in addition to providing their current top worries. Mean scores on the PSWQ in both samples exceeded a clinical cut‐off score of 65, and thematic analyses revealed that perinatal women experienced significantly greater parental‐themed worries compared with the nonperinatal GAD sample (p < .05). Capturing the unique content of worry for perinatal woman will assist clinicians in identifying treatment targets and may enhance treatment outcome.