心理干预对高危儿母亲情绪及育儿行为的影响

【目的】探讨在高危儿管理中，儿童保健医生对母亲的心理干预对母亲情绪、育儿行为及其婴儿生长发育的影响。【方法】把280例高危儿的母亲随机分为干预组（140例）和对照组（140例），干预组在对高危儿常规保健的同时，按“母亲心理干预方案”对母亲进行心理干预；对照组仅对高危儿进行常规保健。采用抑郁自评量表（SDS）进行母亲抑郁状态评估，对比两组母亲产后3个月抑郁自评标准分及参加保健情况、母乳喂养率、婴儿体格及智能发育情况。【结果】高危儿的母亲产后3个月内出现SDS标准分〉50分者59例，占21．07％;SDS标准分〉50分者，第1个月SDS标准分两组无显著差别，而干预组SDS标准分第2个月、第3个月低于对照组，差异有显著性（P〈0．05），两组6个月内母乳喂养率无显著差别（P〉0．05）;对照组6个月内流失率高于干预组（P〈0．001），6个月时，婴儿Kaup指数〈15者对照组多于干预组，≥15者干预组多于对照组，差异有显著性（P〈0．05）。【结论】高危儿的母亲产后3个月处在抑郁的高危状态，适当的心理干预可降低母亲的抑郁水平，提高高危儿保健质量，改善婴儿的营养状况，促进母婴身心健康发展。     

城乡婴儿行为及其家庭影响因素的差异分析

【目的】了解城市和农村婴儿夜醒、肠绞痛、吮指、交叉擦腿、屏气发作和睡眠不安行为的发生率，探讨不同家庭环境因素对婴儿行为的影响。【方法】采用问卷填写方法对城乡各200名婴儿行为及其家庭环境因素进行调查。调查问卷包括《婴儿环境、行为调查问卷》及父母亲自评症状量表90项。【结果】城、乡婴儿夜醒行为发生率分别为44．5％和22．0％；肠绞痛为16．0％和20．5％；吮指为42．0％和50．5％；交叉擦腿为18．5％和33．0％；屏气发作为7．5％和16．5％；睡眠不安为36．5％和26．0％。除肠绞痛外比较其它行为差异均有显著性（P〈O．05，P〈O．01）。影响婴儿行为的城乡家庭环境因素差异有显著性。【结论】不同家庭环境因素对婴儿行为的影响有所不同。加强母亲孕期自我保健意识，增进与婴儿的情感交流，减少婴儿生活环境的紧张因素，可减少婴儿上述行为的发生，有利于婴儿身心的正常发育和健康发展。     

部分农村地区婴儿辅食添加状况调查

[目的] 了解目前农村婴儿辅食添加的状况及其影响因素。[方法] 选择内蒙古、四川、陕西三省，用分层整群抽样的方法抽取611名有4-12个月婴儿的母亲，于2001年8-10月对其进行辅食添加知识和行为的问卷调查。[结果] ①婴儿平均开始添加辅食的月龄为5．6个月左右；4个月时添加1种及以上辅食的占27．3％；6个月时6种辅食全部添加的为20．5％。⑦淀粉、水果、蔬菜、鸡蛋每天添加1次及以上的占65．0％以上，而鱼／肉和豆制品每天添加1次及以上的占39．4％和42．0％。③婴儿7个月时仍末添加辅食的主要原因是婴儿不吃、母亲认为没必要或认为对这个年龄的婴儿不适宜。④71．0％的母亲接受过辅食添加的教育。其中，主要途径为媒体者占46.5％，广告小册子占40．3％，家属、邻居和朋友占24．4％，而医务人员和保健人员占23．3％。⑤影响辅食添加的因素主要为家庭年人均收入、产后恢复工作、产后工作时间、产时及孕期母乳喂养健康教育、母亲喂养知识水平、辅食添加知识来源及婴儿是否在4个月以内开始喂奶制品等。[结论] 农村婴儿辅食添加时间晚、品种少、次数少，农村妇女辅食添加知识贫乏，应加强辅食添加知识的健康教育，宣传母乳及辅食的优点，减少母乳代用品的滥用。     

婴儿期营养性贫血多因素分析

【目的】了解婴儿期不同月龄贫血发生情况，探讨其影响因素，为干预提供依据。【方法】对829名首次就诊于儿童保健门诊的1～12个月婴儿的保健资料进行分析。【结果】贫血总检出率为15．56％，其中1～4个月组为9．7％，5～6月组为15．3％．7～12月组为32．1％。单因素分析显示1～4个月组母乳喂养者贫血发生率较低，母亲产前出血、妊高征、胎龄、出生体重均与婴儿贫血有关。5～12月人工喂养者贫血发生率较低，婴儿食欲与贫血发生相关；Logistic回归分析显示1～4月组、出生体重及母亲妊高征与婴儿贫血相关，5～12月组与贫血相关的因素为喂养方式和月平均身高增加量。【结论】加强围产保健，减少低出生体重儿的发生率，提倡婴儿期母乳喂养的同时注意适时、适量合理的添加辅食(其他食物)是减少婴儿期贫血的有力措施。     

母亲产后抑郁与婴儿早期发育关系队列研究

目的探讨产后抑郁与婴儿发育的关系。方法于2015年1月—2016年12月采用方便抽样法在湖南省怀化市鹤城区妇幼保健中心招募产后42 d初次建卡的母婴队列1 251对,产后42 d及产后6个月采用爱丁堡产后抑郁量表(EPDS)评定母亲抑郁症状,婴儿6个月采用年龄与发育进程问卷中文版(ASQ-C)评定婴儿发育情况,并测定体格发育指标。结果母亲产后42 d抑郁检出率为17.03%,产后6月抑郁检出率为4.32%;母亲产后42 d抑郁组的婴儿ASQ-C总分及沟通、解决问题、个人–社会3个能区得分低于非抑郁组,差异有统计学意义(P0.01),母亲当前抑郁组的婴儿粗大运动能区得分低于非抑郁组,差异有统计学意义(P0.05),母亲产后42 d及当前抑郁的2组婴儿体格发育差异均无统计学意义(P0.05),logistic回归分析显示,产后42 d母亲抑郁是6个月婴儿发育迟缓的危险因素(OR=2.655,95%CI=1.843~3.825),母亲当前抑郁症状与婴儿发育迟缓的关联无统计学意义(OR=1.776,95%CI=0.859~3.671)。结论母亲产后抑郁症状对婴儿发育有负面影响,应在孕期及产后积极开展健康指导,降低母亲抑郁症状发生。     

4～8月婴儿气质围生期影响因素的研究

【目的】探讨4～8月婴儿气质的围生期影响因素，以促进婴儿早期心理的健康发展。【方法】随机选取符合条件的133对夫妇及她们所生的婴儿作为研究对象，应用自制的相关因素问卷、艾森克个性问卷及4～8月婴儿气质问卷进行调查。【结果】平易型气质类型的影响因素主要包括母亲孕期的心情、对分娩疼痛的恐惧、孕期的工作环境以及母亲孕期是否受到精神创伤；麻烦型气质类型的影响因素主要包括母亲孕期的心情、对分娩疼痛的恐惧、孕期的睡眠时间以及母亲孕期是否受到精神创伤。影响气质维度的因素包括：母亲孕期是否受到精神创伤、母亲孕期的工作环境、母亲对胎儿性别的关注程度、母亲在孕期的看电视时间、母亲在孕期的心情、母亲在孕期的工作环境、父亲的年龄、父亲的文化程度、父母婚姻是否和谐、父母对子女的教育态度是否一致、儿童的出生情况、住房是否安静。【结论】母亲孕期的心理行为：方式影响气质的类型和维度。     

产后抑郁与婴儿气质的关系

【目的】对415例婴儿气质的影响因素进行了调查分析,探讨了产后抑郁对婴儿气质的影响。【方法】选择在海淀区妇幼保健院出生的正常健康婴儿415例,母亲有产后抑郁的212例,无产后抑郁的203例,进行婴儿的一般情况调查,并采用婴儿气质测评的方法,对婴儿气质进行评价。【结果】产后抑郁对婴儿气质有重要的影响,它对婴儿不同气质类型的影响差异显著(P<0.01),母亲没有抑郁的婴儿偏近容易型气质的可能性远远高于母亲有产后抑郁的婴儿。通过对抑郁组和正常组的婴儿气质维度得分的分析,抑郁组的活动水平得分低于正常组,节律性、趋避性、适应度、反应强度、情绪本质、持久性、注意力分散及反应阀8个维度得分则高于正常组。【结论】产后抑郁与婴儿气质有明显的相互影响,因此要预防产后抑郁,并了解婴儿气质,及早地进行有效的干预。     

母亲心理健康状况对婴儿体格和智能发育的影响

【目的】 了解婴儿期母亲的心理健康状况,研究母亲不同的心理健康状况对婴儿体格及智能发育的影响。 【方法】 用90项症状自评量表(SCL-90)对婴儿期母亲进行问卷调查,并对婴儿进行体格及智能评估(用Gesell发育诊断量表),所收集的资料均采用t检验。 【结果】 2 000例婴儿母亲的心理问卷调查显示:6个月婴儿母亲比1岁婴儿母亲显得更为抑郁及焦虑,婴儿的体格及智能发育与母亲的心理健康状况相关。 【结论】 关心母亲的心理健康是促进婴儿体格及智能发育的重要手段。     

年龄与发育进程问卷中国常模及心理测量学特性研究

  目的  探讨产后抑郁与婴儿发育的关系。  方法  于2015年1月 — 2016年12月采用方便抽样法在湖南省怀化市鹤城区妇幼保健中心招募产后42 d初次建卡的母婴队列1 251对,产后42 d及产后6个月采用爱丁堡产后抑郁量表（EPDS）评定母亲抑郁症状,婴儿6个月采用年龄与发育进程问卷中文版（ASQ-C）评定婴儿发育情况,并测定体格发育指标。  结果  母亲产后42 d抑郁检出率为17.03 %,产后6月抑郁检出率为4.32 %;母亲产后42 d抑郁组的婴儿ASQ-C总分及沟通、解决问题、个人–社会3个能区得分低于非抑郁组,差异有统计学意义（P < 0.01）,母亲当前抑郁组的婴儿粗大运动能区得分低于非抑郁组,差异有统计学意义（P < 0.05）,母亲产后42 d及当前抑郁的2组婴儿体格发育差异均无统计学意义（P > 0.05）,logistic回归分析显示,产后42 d母亲抑郁是6个月婴儿发育迟缓的危险因素（OR = 2.655,95 % CI = 1.843～3.825） ,母亲当前抑郁症状与婴儿发育迟缓的关联无统计学意义（OR = 1.776,95 % CI = 0.859～3.671）。  结论  母亲产后抑郁症状对婴儿发育有负面影响,应在孕期及产后积极开展健康指导,降低母亲抑郁症状发生。     

双亲个性及孕母的心理行为方式对婴儿气质影响的研究

【目的】探讨双亲个性及孕母的心理行为方式对婴儿气质的影响，有助于早期采取干预措施，促进婴儿身心健康。【方法】随机选取符合条件的133对夫妇及其婴儿作为研究对象，应用自制的相关因素问卷、艾森克个性问卷及4～8月婴儿气质问卷进行调查。【结果】孕期工作环境、工作的紧张性、家庭经济条件、精神创伤、母亲的P维度分、母亲的N维度分对婴儿的气质类型有影响。母亲的N维度分对婴儿的气质维度影响较大。【结论】家长应做好孕期保健，调节自己的情绪，培养良好的个性，促进婴儿心理的发育。     

Infantile colic and the role of trait anxiety during pregnancy in relation to psychosocial and socioeconomic factors

AIMS: A study was undertaken to assess the impact of psychological, psychosocial and socioeconomic factors on the risk of having a child with infantile colic. METHODS: Psychosocial and psychological factors were assessed by self-administered questionnaires in the 17th, and by telephone interviews in the 35th-37th pregnancy weeks; infantile colic occurrence was assessed by telephone interviews at infant age 5 weeks; subjects were 1,099 mother-infant dyads. RESULTS: High trait anxiety increased the colic risk; OR 2.04 (95% CI: 1.16, 3.59), and so did affirming a perceived risk of spoiling young infants with too much physical contact; OR 1.77 (1.07, 2.91). In the final step of a multivariate model, not cohabiting with the child's father was the factor with the strongest association with colic; OR 3.48 (1.38, 8.77). Analyses of effect modification showed that high education seemed to protect from the influence of high trait anxiety. Young women were particularly high in trait anxiety, and being exposed to both these risk factors seemed to act synergistically on the risk of having a colicky infant; OR 2.41 (1.12, 5.18). CONCLUSIONS: Psychological and psychosocial factors were found to be significantly related to an increased risk for infantile colic, and these factors interacted with age, parity, social support, and educational level in a complex manner. Even though no single most important psychosocial risk factor was identified, the findings lend support to the strategy of offering special attention in terms of information and support in the maternal healthcare system to very young women, women who do not cohabit with the father, and women with high trait anxiety.     

Infantile colic, maternal smoking and infant feeding at 5 weeks of age

BACKGROUND: Many parents seek help from health professionals because of their infants' persistent crying in the early months. The aetiology of this condition, often labelled ;;infantile colic', is still unclear. AIMS: To assess whether smoking during pregnancy, and/or smoking at infant age 5 weeks, is associated with infantile colic, and to describe how feeding at infant age 5 weeks and smoking are related to colic. METHODS: This was a community-based study, with telephone interviews in late pregnancy, and at infant age 5 weeks, covering 1,625 mother-infant dyads, i.e. 86% of the eligible population. RESULTS: Daily maternal smoking in pregnancy was related to subsequent colic, with an age-adjusted odds ratio (OR) of 1.74 (95% confidence interval 1.08-2.82). In the multivariate model, the OR was largely unaltered. The association between smoking at infant age 5 weeks and colic did not reach statistical significance. The subgroups based on smoking and infant feeding were small, but the results suggest that exclusive breast-feeding was protective against colic, including for infants of smoking mothers. CONCLUSIONS: This study presents yet another argument why smoking in pregnancy should be discouraged - some cases of infantile colic may be avoided. With regard to mothers who are not able to give up smoking, the results add some support for the conclusion that if a mother is worried about colic, she certainly should not refrain from breast-feeding even if she smokes.     

Infant crying diary: a useful aid in distinguishing between normal and excessive crying behavior

Three infant girls aged 9, 10 and 8 weeks, who cried excessively according to their parents, were referred by the general practitioner to the paediatrician. Using a crying diary it was possible to ascertain that one infant fulfilled the criteria of infantile colic. The diary showed that a second infant was not crying excessively and her mother could be reassured that her baby's behaviour was normal. The third infant proved to be suffering from an organic disease (Alpha-I antitrypsin deficiency), which had not been obvious at clinical assessment. The crying diary provided clues that warranted further investigation. The parents of all 3 infants were reassured and the crying lessened over a period of several weeks. When parents complain that their child cries excessively, it is useful to chart the amount of crying time in a diary. Registration for one week is sufficient. If the child does not suffer from an organic disease, the mainstay of treatment is to explain normal crying behaviour and that it often helps if the infant is not offered too many stimuli. Parents can be reassured that spontaneous resolution will generally occur at the age of three months.     

Reduction of crying episodes owing to infantile colic: A randomized controlled study on the efficacy of a new infant formula

OBJECTIVES: The aim of this study was to evaluate the efficacy on crying episodes owing to infantile colic of a new infant formula containing partially hydrolysed whey proteins, prebiotic oligosaccharides (OS), with a high beta-palmitic acid content. DESIGN: Prospective randomized controlled study. SETTING: Italy. SUBJECTS: Two hundred and sixty-seven formula-fed infants, aged less than 4 months, with infantile colic, were randomized to receive either the new infant formula (study treatment (ST)) or a standard formula and simethicone (6 mg/kg twice a day) (control treatment (CT)). A questionnaire was given to parents to evaluate for 14 days the daily number of colic episodes and crying time. RESULTS: Out of the 199 infants who completed the study, 96 were treated with the new formula and 103 were not treated. Infants receiving the new formula had a significant decrease in colic episodes after 1 week (2.47+/-1.94 at day 7 vs 5.99+/-1.84 at the study entry) compared to infants receiving the CT (3.72+/-1.98 at day 7 vs 5.41+/-1.88 at the study entry) (P < 0.0001). Also at day 14, the crying episodes were significantly different between the two groups of infants (1.76+/-1.60 in ST vs 3.32+/-2.06 in CT) (P < 0.0001). CONCLUSIONS: The use of a partially hydrolysed formula supplemented with fructo- and galacto-OS induces a reduction of crying episodes in infants with colic after 7 and 14 days when compared with a standard formula and simethicone.     

Why are they having infant colic? A nested case–control study

Yalç?n SS, Örün E, Mutlu B, Madenda? Y, Sinici ?, Dursun A, Özkara HA, Üstünyurt Z, Kutluk ?, Yurdakök K. Why are they having infant colic? A nested case–control study. Paediatric and Perinatal Epidemiology 2010; 24: 584–596. We aimed to analyse infant (birth characteristics, feeding type, faecal enzyme activities) and environmental (maternal smoking, nutrition and psychological status, mother–child bonding, family structure, support for the mother, familial atopy) risk factors for infant colic and to follow infants with respect to physical growth, sleeping status up to 8 months of age in a nested case–control study. 660 mothers who delivered at Dr Zekai Tahir Burak Maternity Hospital, were enrolled within 3–72 h post delivery. Each infant with inconsolable persistent crying and four matched infants with no crying episodes were invited by phone to Hacettepe University Ihsan Do?ramac? Children's Hospital at 30–45 days post partum. At 40–55 days, we examined the infants and gave mothers a questionnaire, including crying characteristics of the infants; 47 infants were diagnosed with colic and 142 as non‐colic. When the infants were 7–8 months old, another interview was done. The colic group had higher proportions of less‐educated (≤8 years) and smoking mothers, extended family and families with domestic violence than the non‐colic group. The colic group of mothers had significantly higher rates of ‘impaired bonding’ in the Postpartum Bonding Questionnaire, higher scores on the Edinburgh Postnatal Depression Scale, higher scores for hostility subscales of the Brief Symptom Inventory and a more irregular sleep pattern than the non‐colic group. No differences were revealed for faecal enzyme activities. At 7–8 months, the colic group was shorter than the non‐colic group. Colic was associated with various perinatal factors (maternal education, smoking habits, cheese consumption, hostility scores and domestic violence) and having colic in infancy negatively affected the sleeping pattern and the height of the infant.     

Excessively crying infant in the family: mother-infant,father-infant and mother-father interaction

METHOD: We studied mother-infant, father-infant and mother-father interaction in 32 families with an excessively crying infant and in 30 control families. The group with excessive criers was divided further into subgroups of severe colic (n=13) and moderate colic (n=19). The three dyads of the family were video-recorded when the infants were an average of 5 weeks old. The assessment was carried out during the infant's feeding, nappy change and discussion between the parents. During the assessment, only four infants were crying. The Parent Child Early Relational Assessment Scale and the Beavers Scale were used. RESULTS: The main findings suggest that both parents of colicky infants had less optimal parent-child interaction compared with the control parents. The problems in the interaction were most pronounced between the fathers and infants in the severe colic group. The father-infant interaction was less optimal in 13 items of 65 (20%) in the severe colic group, in one item of 65 (2%) in the moderate colic group and in none of the items in the control group. The mother-infant interaction was less optimal in six items out of 65 (9%) in the severe colic group, in three items out of 65 (5%) in the moderate colic, and in none of the items in the control group. Severely colicky infants were also less competent in interacting with their parents. In addition, interaction between the parents was more often dysfunctional in the severe colic group. CONCLUSIONS: The problems in early family interaction may threaten the well-being of families with excessively crying infants and they therefore deserve special attention from the health care professionals.     

Reducing the maternal dietary intake of indigestible and slowly absorbed short‐chain carbohydrates is associated with improved infantile colic: a proof‐of‐concept study

Background

To investigate if a low fermentable oligo‐, di‐ and mono‐saccharides and polyols (FODMAP) diet consumed by breastfeeding mothers may be associated with reduced symptoms of infantile colic.

Methods

Exclusively breastfeeding mothers and their typically‐developing healthy infants who met the Wessel Criteria for infantile colic were recruited from the community, to this single‐blind, open‐label, interventional study. After a 3‐day qualifying period, mothers were provided a low FODMAP 7‐day diet. On days 5, 6 and 7 mothers completed a Baby Day Diary. At baseline and at the end of the 7‐day dietary intervention, breast milk was analysed for FODMAP content and infant faecal samples for pH .

Results

Eighteen breastfeeding mothers (aged 27–40 years) adhered (100%) to the low FODMAP diet. Infants were of gestational age 37–40.3 weeks and aged 2–17 weeks. At entry, crying durations were a mean [95% CI ] of 142 [106–61] min and fell by 52 [178–120] min (P = 0.005; ancova ). Combined crying‐fussing durations fell by 73 [301–223] min (n = 13; P = 0.007), as did crying episodes (P = 0.01) and fussing durations (P = 0.011). Infant sleeping, feeding, or awake‐and‐content durations did not change. Infant faecal pH did not change. Breast milk lactose content was stable and other known FODMAP s were not detected. At end of study, mothers reported their baby ‘is much more content’ and ‘can be put down without crying’.

Conclusions

Maternal low FODMAP diet may be associated with a reduction in infant colic symptoms. A randomized controlled study is warranted to determine if a maternal low FODMAP diet is effective in reducing symptoms.

     

The Association Between Gestational Diabetes Mellitus and Recreational Physical Activity

We aimed to investigate the association of recreational physical activity before pregnancy with gestational diabetes mellitus (GDM). A cross-sectional study was performed using self-reported data from the Pregnancy Risk Assessment and Monitoring System. The study population included 1,052 self-reported GDM cases and 10,351 non-GDM controls. Recreational physical activity in the 3 months before pregnancy was recalled in postpartum structured interviews. Compared to women exercising less than 1 day per week, women who exercised >5 days per week in the 3 months before pregnancy had a 31% lower odds of GDM (adjusted odds ratio [aOR]: 0.69; 95% confidence interval [CI]: 0.46, 1.03). Women who exercised 1–4 days per week had a 7% lower odds of GDM (aOR: 0.93; 95%CI: 0.72, 1.19). We did not observe statistically significant associations between pre-pregnancy physical activity and GDM risk. However, the magnitude and direction of association are consistent with previous observational studies. These studies collectively suggest a role of physical activity in GDM prevention.     

精神心理因素对肺癌发病影响的研究

[目的]探讨四川地区原发性肺癌的独立危险因素,重点分析精神心理因素对肺癌发病的影响程度。[方法]纳入原发性肺癌患者404名,按性别相同、年龄±2岁1︰2匹配选取健康人群808例。对所有参与者进行问卷调查后建立数据库,采用单因素和多因素Logistic回归进行分析。[结果]单因素分析发现24个暴露因素与肺癌发病有关;多因素分析显示主动及被动吸烟史、血缘亲属肿瘤家族史、住宅3km内有大型排污工厂、10年内有搬入新近(﹤3月)装修房屋居住史及精神心理因素,包括工作强度很大(OR=4.76,95%CI:2.24～10.10)、较大(OR=5.39,95%CI:3.05～9.54)、有一定强度(OR=3.74,95%CI:2.09～6.74)、睡眠质量差(OR=2.17,95%CI:1.47～3.24)、性格急躁(OR=2.05,95%CI:1.47～2.85)、缺乏解压途径(OR=1.90,95%CI:1.36～2.67)为主要独立危险因素。[结论]四川地区肺癌的发生与多种暴露因素有关。对现代肺癌人群来说,精神心理因素已成为了不可忽视的致病原因之一。     

Psychiatric disorders in pregnant and puerperal women

The most frequently occurring pre- and postpartum psychiatric disorders are depression and, to a lesser degree, panic disorder and psychosis. Apart from the negative effects on the psychological well-being of the mother, these psychiatric disorders may also result in obstetric complications and an impaired mother-infant relationship. In order to prevent these negative effects, mothers who are at risk for major psychiatric disorders need to be identified early, preferably before or during pregnancy. The most important risk factor is a history of psychiatric disorders. Obstetric risk factors for depression are unplanned or unwanted pregnancy, pregnancy-related hypertension, emergency caesarean section and early discharge from the hospital. Other factors are low socioeconomic status, recent life event, negative self-image, little social support, immigration in the last 5 years, feelings of loss of control during pregnancy and feeding problems with the child. For treatment, pregnant or puerperal women with a possible psychiatric disorder based on the presence of a serious risk factor, such as a previously experienced psychiatric disorder (related to pregnancy or not), serious current psychiatric symptoms or long-time use of psychoactive drugs, should be referred preferably to a combined psychiatric/obstetric clinic or, if unavailable, to a psychiatrist in a general hospital.