妊娠晚期孕妇焦虑和血清皮质醇水平对产后6个月婴儿气质的影响

目的探讨妊娠晚期孕妇焦虑的发生率和血清皮质醇水平对产后6个月婴儿气质的影响。方法利用贝克焦虑问卷对125名孕28周的孕妇进行焦虑调查、评估问卷中各因子的分数值;检测其血清皮质醇水平;利用小儿气质问卷调查其产后6个月婴儿的气质。结果孕妇抑郁症状焦虑的发生率为30.4%。婴儿气质:易养型为37.6%,中间型为20.0%,启动缓慢型为11.2%,难养型为3.2%;易养型婴儿孕妇妊娠晚期无焦虑状态的显著多于有焦虑状态孕妇(t=4.51,P=0.047),而难养型孕妇妊娠晚期无焦虑状态的显著少于有焦虑状态孕妇(t=6.37,P=0.008);易养型婴儿孕妇妊娠晚期皮质醇水平显著低于启动缓慢型(P=0.019)与难养型(P=0.028),中间型婴儿孕妇妊娠晚期皮质醇水平显著低于难养型(P=0.036);婴儿气质类型得分与血清皮质醇水平有相关性(t=3.131,P=0.002),与妊娠晚期孕妇贝克焦虑得分也有相关性(t=2.297,P=0.023)。结论婴儿的气质类型与妊娠晚期孕妇的焦虑情绪和其血清皮质醇有显著相关性。     

孕晚期孕妇焦虑情绪与婴儿喂养方式及气质特点的关系探讨

目的探讨孕妇焦虑情绪与其婴儿的喂养方式、气质特点的关系。方法应用焦虑自评量表和4个月，1岁婴儿气质问卷对本院558名孕晚期孕妇及其月龄6个月的婴儿进行心理测试，并调查分析孕妇的社会人口学因素、高危因素、分娩方式及婴儿喂养方式与其孕晚期焦虑情绪的关系。结果孕晚期孕妇有焦虑情绪者129名．发生率为23．12％，其中轻度、中度及重度焦虑情绪分别占45．74％、37．21％和17．05％，焦虑情绪的发生与孕妇的职业、学历、孕晚期重度高危因素及剖宫产有关．母亲孕晚期有中、重度焦虑情绪者其婴儿人工喂养率升高，气质类型中难养型、启动缓慢型增多。结论重视孕晚期孕妇的心理保健．及时调适孕妇的不良情绪．有利于优生优育．     

母亲孕期焦虑情绪对儿童早期气质影响的研究

目的 探讨母亲孕期焦虑情绪对儿童早期气质的影响.方法 采用状态-特质焦虑量表对孕妇在孕32～34周时进行测试,采用中国4～8个月婴儿气质量表以及自制的婴儿基本情况调查表,对被调查的孕妇所生的婴儿在6个月时进行气质评定和基本情况调查.按照母亲孕期是否存在焦虑情绪及程度将婴儿分组,比较不同组别婴儿在气质类型和气质维度方面的差异.结果 母亲孕期有状态焦虑情绪组的婴儿中,麻烦型和发动缓慢型的比例偏高,且状态焦虑情绪程度越重比例越高(分别为:χ2=10.91,P<0.01;χ2=8.42,P<0.05);而无状态焦虑情绪组的婴儿中,平易型的比例偏高(χ2=7.31,P<0.05).母亲孕期特质焦虑情绪对婴儿气质类型的影响无显著性差异.母亲孕期状态焦虑情绪对婴儿气质因子中的节律性、趋避性、适应性、心境和持久性得分有影响(t=2.113～5.308,P<0.01或P<0.05);母亲孕期特质焦虑情绪对活动水平、心境和持久性等因子得分有影响(t=-2.339～3.001,P<0.01或P<0.05).结论 母亲孕期焦虑情绪对儿童早期的气质类型和气质维度可产生负面影响.     

北京海淀区851例婴幼儿气质分析

目的:探讨北京市海淀区0~3岁儿童气质特点和分布类型,为改善儿童心理行为问题提供理论依据。方法:采取随机抽样的方法,抽取北京市海淀区851名0~3岁儿童为研究对象,应用6~11个月婴儿气质量表、1~3岁儿童气质量表进行气质测查和基本情况调查。结果:①851例0~3岁儿童的气质类型为易养型占43.24%,中间偏易养型占37.6%,启动缓慢型占3.76%,中间偏难养型占4.47%,难养型占10.93%。②男童与女童相比难养型的比例明显升高(P<0.05),高年龄组儿童易养型的比例明显高于低年龄组(P<0.05)。③男女童在活动水平、趋避性、表达强度、反应域等气质维度上差异有统计学意义。结论:北京市海淀区0~3岁儿童的主要气质类型是平易型,部分气质维度在不同性别和年龄间存在差异。     

母亲孕期抑郁情绪对儿童早期气质影响的研究

【目的】 探讨母亲孕期抑郁情绪对儿童早期气质的影响,为完善孕期保健服务项目提供理论依据。 【方法】 采用自评抑郁量表(Self-rating Depression Scale,SDS)对孕妇在孕32~34周时进行测试,采用中国4~8月婴儿气质量表(Chinese Infant Temperament Scale,CITS)以及自制的婴儿基本情况调查表,对孕妇所生的婴儿在6个月时进行气质评定和基本情况调查。按照母亲孕期是否存在抑郁情绪及程度将婴儿分组,比较不同组别婴儿在气质类型和气质维度方面的差异。 【结果】 母亲孕期有抑郁情绪组的婴儿中,麻烦型和发动缓慢型的比例明显偏高,且抑郁情绪程度越重比例越高(χ²=13.99、21.36,P均＜0.01),而无抑郁情绪组的婴儿中平易型的比例偏高(χ²=11.89,P＜0.01)。母亲孕期抑郁情绪对婴儿气质因子中的活动水平、趋避性、适应性、反应强度、心境和注意分散度的得分有影响,且与抑郁程度有关(P＜0.01或＜0.05)。 【结论】 母亲孕期抑郁情绪对儿童早期的气质类型和气质维度产生负面影响。     

昆山地区12月龄幼儿气质及相关因素的研究

【目的】 了解昆山地区12月龄幼儿气质类型分布特征和影响因素,为早期行为干预提供依据。 【方法】 采用1～3岁幼儿气质问卷(CTTS)对738名在昆山市妇幼保健所门诊常规体检的12月龄幼儿进行气质测评,并用自行设计编制调查表对气质相关因素进行调查。 【结果】 幼儿气质类型构成比以中间偏易养型(56.10%)和中间偏难养型(31.44%)为主,各气质类型在性别上差异无统计学意义;男、女幼儿间活动水平差异有高度统计学意义(P<0.01);活动水平、节律性、趋避性、适应性、情绪本质、持久性、注意分散以及反应阈等气质维度,与全国常模相比差异有高度统计学意义(P<0.01);母亲生育年龄、母亲学历、母亲孕期看电视时间、看护人、看护人态度、看护人文化程度以及看护人性格等多种因素对幼儿气质维度有影响。看护人文化程度高、家庭月收入相对低家庭易养型幼儿比例高;父亲文化程度高、父亲不嗜好烟酒以及看护人态度严家庭中间偏易养型幼儿比例高;母亲生育年龄小、胎龄大、人工喂养以及母亲为干部家庭幼儿中间偏难养型比例高;母亲生育年龄大、孕期容易恐惧、母孕期每天睡眠时间偏少以及有孕期合并症记录家庭幼儿难养型比例高;父亲嗜好烟酒家庭幼儿启动缓慢型比例高。 【结论】 昆山幼儿气质类型以易养型、中间偏易养型占多数,活动水平存在男女性别差异,部分气质维度与全国常模相比差异显著,多因素综合作用影响昆山幼儿气质。     

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。     

婴儿气质特点与心理行为之间关系的探讨

目的:探讨婴儿气质特点与心理行为之间的关系。方法:采用上海新华医院研制开发的儿童气质测试软件,分别对1个月～1岁共4108例婴儿进行气质问卷调查,并将所得数据进行统计学分析。结果:婴儿气质类型分布以中间偏易养型和易养型居多,男童占44.39%和29.95%,女童占44.9%和27.95%,在统计学上无差异。中间偏难养型、难养型和启动缓慢型较少,男童分别占6.68%、15.64%、3.34%,女童分别占7.83%、15.13%、4.18%,男童和女童在12个月时的活动水平、节律性、反应强度方面,男童得分高于女童,其他因素间未表现出明显的差异性。结论:气质对个性形成有一定影响,气质纬度和家庭教养环境之间存在着相互作用,气质有生物学基础,根据气质特点进行"调适",可促进婴儿健康全面发展。     

婴幼儿气质特点及类型分布调查分析

目的:为探讨0~3岁小儿气质特点,了解其心理特征,为指导婴幼儿教养,防止儿童行为问题提供理论依据。方法:选取本科门诊部0~3岁儿童251例,采用上海第二医科大学附属新华医院儿保科、信息中心联合研制开发的儿童气质软件及美国的Carey医生制定的原版儿童气质测查问卷,以家长填写问卷配以计算机录入分析结果的形式进行评估。儿童气质问卷按其使用年龄分为:①小婴儿气质问卷:适用于满1个月(30 d)~4个月婴儿。②婴儿气质问卷:适用于满5个月~11个月婴儿。③幼儿气质问卷:适用于满12个月~36个月幼儿。结果:婴幼儿气质类型分布以中间偏易养型最多占32.08%、易养型31.08%、难养型23.11%、启动缓慢型7.57%、中间偏难养型最少5.98%。不同性别及年龄的气质类型的分布无差异显著(P>0.05)。男女婴幼儿间有显著差异的气质维度为活动水平、趋避性、适应性、反应强度、坚持性5个方面。不同年龄组间9个气质维度在5~11个月年龄段中,活动水平、规律性、趋避性(接近/退缩)、反应强度几个方面有显著差异(P<0.05)。12~36个月龄段中,适应性、坚持性、注意分散度、反应阈几个方面有显著差异(P<0.05)。结论:提示中间偏易养型、易养型是0~3岁婴幼儿的主要气质类型;部分气质维度在不同性别和年龄间存在差异。     

婴幼儿气质与进食行为问题的相关研究

【目的】了解进食行为问题婴幼儿的气质类型及气质各维度的特点,探讨气质在婴幼儿进食行为问题的发生中所起的作用,为进食行为问题的干预提供相应的理论依据。【方法】采用整群随机抽样的方法,抽取6个区数个街道2～36个月的960名健康婴幼儿进行进食问卷调查及用气质问卷进行气质测定和分析,收回填写完整有效的问卷共873份,应用SPSS11.5统计软件进行分析。【结果】有进食问题的婴幼儿中易养型与中间偏易养型占43%,中间偏难养型、难养型和启动缓慢型占57%;无进食问题的婴幼儿中易养型与中间偏易养型占67.4%,中间偏难养型、难养型和启动缓慢型占32.6%,同时两组婴幼儿的气质类型构成间差异有统计学意义(χ2=19.1,P0.05);两组婴幼儿气质维度中的节律性、适应性、反应强度和注意分散度得分间差异有统计学意义(P0.05)。【结论】进食行为问题婴幼儿的气质有其独特性,对于进食行为问题婴幼儿的喂养要依据其气质类型采取相应的方法,减少不良进食行为的发生,使他们在适宜的环境中生长。     

Health Care Utilisation in the First Year of Life Among Infants of Mothers With Perinatal Depression or Anxiety

Background: Limited information is available on associations between maternal depression and anxiety and infant health care utilisation. Methods: We analysed data from 24 263 infants born between 1998 and 2007 who themselves and their mothers were continuously enrolled for the infant's first year in Kaiser Permanente Northwest. We used maternal depression and anxiety diagnoses during pregnancy and postpartum to categorise infants into two depression and anxiety groups and examined effect modification by timing of diagnosis (pregnancy only, postpartum only, pregnancy and postpartum). Using generalised estimating equations in multivariable log‐linear regression, we estimated adjusted risk ratios (RR) between maternal depression and anxiety and well baby visits (<5 and ≥5), up to date immunisations (yes/no), sick/emergency visits (<6 and ≥6) and infant hospitalisation (any/none). Results: Infants of mothers with perinatal depression or anxiety were as likely to attend well baby visits and receive immunisations as their counterparts (RR = 1.0 for all). Compared with no depression or anxiety, infants of mothers with prenatal and postpartum depression or anxiety, or postpartum depression or anxiety only were 1.1 to 1.2 times more likely to have ≥6 sick/emergency visits. Infants of mothers with postpartum depression only had marginally increased risk of hospitalisation (RR = 1.2 [95% confidence interval 1.0, 1.4]); 70% of diagnoses occurred after the infant's hospitalisation. Conclusions: An understanding of the temporality of the associations between maternal depression and anxiety and infant acute care is needed and will guide strategies to decrease maternal mental illness and improve infant care for this population.     

母亲孕产期高危因素与4～8个月婴儿气质类型相关性研究

目的探讨母亲孕产期高危因素与4⁸个月婴儿气质类型的相关关系。方法 2011年5月—2012年5月广州市黄埔区鱼珠街社区卫生服务中心对48个月婴儿气质类型的相关关系。方法 2011年5月—2012年5月广州市黄埔区鱼珠街社区卫生服务中心对4⁸个月婴儿160名及其母亲160名进行调查,发放160份问卷,有效问卷144份,采用孕妇生活事件量表、焦虑状态、特质问卷和抑郁状态自评量表评估母亲孕产期应激水平和情绪状态,采用自编量表调查婴儿基本情况和母孕产期并发症。采用48个月婴儿160名及其母亲160名进行调查,发放160份问卷,有效问卷144份,采用孕妇生活事件量表、焦虑状态、特质问卷和抑郁状态自评量表评估母亲孕产期应激水平和情绪状态,采用自编量表调查婴儿基本情况和母孕产期并发症。采用4⁸个月婴儿气质问卷(China infant temperament scale,CITS)调查婴儿的气质特征;计量资料采用t检验,相关性采用Pearson相关分析,对影响婴儿气质类型的母孕产期高危因素进行Logistic回归分析,P<0.05为差异有统计学意义。结果母亲孕产期焦虑状态评分(38.40±9.03)分与婴儿注意分散度评分(2.90±0.54)分呈正相关(P<0.05),母亲孕期2级客观生活事件应激水平评分(52.14±68.94)分与婴儿适应性评分(2.80±0.60)分呈负相关(P<0.05)。结论母亲孕产期高焦虑状态可能与婴儿注意分散度高有关,而高应激水平与婴儿的适应性低有关,提示母亲孕产期心理保健值得重视。     

Maternal cognitions, psychopathologic symptoms, and infant temperament as predictors of early infant feeding problems: a longitudinal study

OBJECTIVE: The current study examined the contribution of prenatal and postnatal maternal core beliefs, self-esteem, psychopathologic symptoms, and postnatal infant temperament to the prediction of infant feeding difficulties. METHOD: Ninety-nine women completed questionnaires assessing their core beliefs, psychopathology, and self-esteem during pregnancy and at 6 months postpartum. At 6 months, mothers also rated their infant's temperament and feeding, and were ob-served feeding their infants. RESULTS: Maternal reports of child feeding difficulties were predicted by higher levels of emotional deprivation and entitlement core beliefs and lower levels of self-sacrifice and enmeshment core beliefs during pregnancy. Postnatal social isolation core beliefs, lower maternal self-esteem, and more difficult infant temperament added significantly to the variance explained by prenatal factors. Maternal core beliefs, self-esteem, psychopathology, and infant temperament failed to significantly predict independent observations of child food refusal. CONCLUSION: Maternal cognitions are implicated in the development of maternal reports of feeding difficulty.     

Mental Health of Mothers of Infants with Neonatal Abstinence Syndrome and Prenatal Opioid Exposure

Background

The prevalence of opioid use during pregnancy is increasing. Two downstream effects are neonatal abstinence syndrome (NAS), a postnatal withdrawal syndrome, and long-term prenatal opioid exposure (LTPOE) without documented withdrawal symptoms in the infant. Mental health characteristics of mothers of infants with NAS and LTPOE have not been described.

Methods

Using linked maternal and infant Medicaid claims and birth certificate data, we analyzed 15,571 infants born to Medicaid-insured women 15–24 years old in a mid-Atlantic city from 2007 to 2010. Pairwise comparisons with multinomial logistic regression, adjusting for maternal and infant covariates, were performed. We compared four mental health conditions among mothers of infants with NAS, infants with LTPOE without NAS, and controls: depression, anxiety, bipolar disorder, and schizophrenia.

Results

The prevalence of depression among mothers of infants with NAS, infants with LTPOE, and controls was 26, 21.1, and 5.5% respectively. Similar results were found for anxiety. In multivariable analysis, mothers of infants with NAS and LTPOE had approximately twice the depression risk as controls, while mothers of infants with LTPOE had 2.2 times the bipolar disorder risk and 4.6 times the schizophrenia risk as controls. The overall risk of mental health conditions in mothers of infants with NAS and LTPOE was similar.

Discussion

Mothers of infants with LTPOE who did not develop NAS are at similarly high risk for mental health conditions as mothers of infants with NAS, and both are at higher risk than controls. Therefore, those mothers of infants who did not develop symptoms of NAS despite LTPOE may be a vulnerable population that needs additional mental health support in the post-partum period.

     

Hurricane Katrina-Related Maternal Stress,Maternal Mental Health,and Early Infant Temperament

To investigate temperament in infants whose mothers were exposed to Hurricane Katrina and its aftermath, and to determine if high hurricane exposure is associated with difficult infant temperament. A prospective cohort study of women giving birth in New Orleans and Baton Rouge, LA (n = 288) in 2006–2007 was conducted. Questionnaires and interviews assessed the mother’s experiences during the hurricane, living conditions, and psychological symptoms, 2 months and 12 months postpartum. Infant temperament characteristics were reported by the mother using the activity, adaptability, approach, intensity, and mood scales of the Early Infant and Toddler Temperament Questionnaires, and “difficult temperament” was defined as scoring in the top quartile for three or more of the scales. Logistic regression was used to examine the association between hurricane experience, mental health, and infant temperament. Serious experiences of the hurricane did not strongly increase the risk of difficult infant temperament (association with three or more serious experiences of the hurricane: adjusted odds ratio (aOR) 1.50, 95% confidence interval (CI) 0.63–3.58 at 2 months; 0.58, 0.15–2.28 at 12 months). Maternal mental health was associated with report of difficult infant temperament, with women more likely to report having a difficult infant temperament at 1 year if they had screened positive for PTSD (aOR 1.82, 95% confidence interval (CI) 0.61–5.41), depression, (aOR 3.16, 95% CI 1.22–8.20) or hostility (aOR 2.17, 95% CI 0.81–5.82) at 2 months. Large associations between maternal stress due to a natural disaster and infant temperament were not seen, but maternal mental health was associated with reporting difficult temperament. Further research is needed to determine the effects of maternal exposure to disasters on child temperament, but in order to help babies born in the aftermath of disaster, the focus may need to be on the mother’s mental health.     

孕期父母心理因素对1个月婴儿气质影响的追踪研究

【目的】 追踪调查孕期父母的心理因素对出生后1个月婴儿气质的影响,促进婴儿身心健康成长。 【方法】 募集在上海某中心城区医院定期产前检查的孕28周孕妇,通过问卷、访谈等方式了解孕期父母的心理因素,追踪出生后1个月的婴儿气质特征,分析两者间的相关性。 【结果】 小婴儿的气质维度中仅适应性有性别差异;准爸爸在妻子孕期的状态焦虑和特质焦虑程度、准妈妈的心理健康状态、准父母的婚姻满意度在一定程度上影响了1个月龄小婴儿的气质特征。 【结论】 孕期父母的心理因素能够影响婴儿气质,应注意加强孕期准父母的心理健康保健,以促进儿童的身心健康成长。     

Infant Temperament and Maternal Anxiety and Depressed Mood in the Early Postpartum Period

Although difficult infant temperament has been associated with maternal postpartum anxiety and depressed mood in later infancy, the emergence of this association in the early postpartum period has not been explored. In a survey study of 296 mothers of healthy term newborns during the first postpartum month, the relationship of infant temperament with maternal anxiety and depressed mood was explored. Maternal ratings of infant temperament were measured by the Early Infancy Temperament Questionnaire. Postpartum anxiety was measured by the State Scale of the State-Trait Anxiety Inventory and depressed mood by the Beck Depression Inventory. The State Scale and Beck Depression Inventory correlated positively with ratings of infant activity, rhythmicity, approach, distractibility, and overall temperamental difficulty. In addition, the State Scale correlated positively with ratings of adaptability and intensity. In regression analyses, controlling for other factors, ratings of overall temperamental difficulty were independently associated with both State Scale and Beck Depression Inventory scores. Associations of difficult infant temperament with maternal postpartum anxiety and depressive symptoms emerge early in the postpartum period. These associations are independent of other known contributors to postpartum mood.     

Infant temperament and maternal anxiety and depressed mood in the early postpartum period

Although difficult infant temperament has been associated with maternal postpartum anxiety and depressed mood in later infancy, the emergence of this association in the early postpartum period has not been explored. In a survey study of 296 mothers of healthy term newborns during the first postpartum month, the relationship of infant temperament with maternal anxiety and depressed mood was explored. Maternal ratings of infant temperament were measured by the Early Infancy Temperament Questionnaire. Postpartum anxiety was measured by the State Scale of the State-Trait Anxiety Inventory and depressed mood by the Beck Depression Inventory. The State Scale and Beck Depression Inventory correlated positively with ratings of infant activity, rhythmicity, approach, distractibility, and overall temperamental difficulty. In addition, the State Scale correlated positively with ratings of adaptability and intensity. In regression analyses, controlling for other factors, ratings of overall temperamental difficulty were independently associated with both State Scale and Beck Depression Inventory scores. Associations of difficult infant temperament with maternal postpartum anxiety and depressive symptoms emerge early in the postpartum period. These associations are independent of other known contributors to postpartum mood.     

母亲抑郁对6、14月龄婴儿气质评估的影响

目的:探讨母亲抑郁倾向对母亲报告的婴儿气质是否有影响。方法:采用母亲问卷报告让269位母亲在婴儿6、14个月时报告婴儿气质及其自身的抑郁程度。结果:婴儿从6～14个月气质具有稳定性,6个月时高、中、低抑郁型的母亲报告的婴儿活动性水平差异有统计学意义,但是14个月时没有出现。6、14个月时高、中、低抑郁性母亲均报告的婴儿受限后水平差异有统计学意义。结论:母亲抑郁倾向对婴儿气质确实存在影响,高抑郁性母亲报告的婴儿气质存在偏差。