不同心理干预对不同程度妊娠期糖尿病孕妇及家属焦虑、抑郁症状的效果评价

目的：探讨不同心理干预方法对改善不同程度妊娠期糖尿病（GDM）孕妇和家属焦虑、抑郁症状及对妊娠结局的影响。方法：选取2013年4月—2014年11月在上海市第一妇婴保健院（我院）建卡并住院分娩的GDM孕妇及家属（患者丈夫或母亲）各300例，整个孕期用饮食治疗和运动治疗后血糖满意者为GDM A1（251例）；如果需要加用胰岛素治疗者为GDM A2（49例）。根据心理干预方式随机分为集体干预组、面对面（face to face）干预组和无心理干预的对照组，孕期心理干预共6次，对比分析干预前（初次诊断GDM后1周内），干预后（孕36周，产后48 h内，产后42 d）各组GDM患者和家属的焦虑自评量表（SAS）和抑郁自评量表（SDS）评分和妊娠结局。结果：第1次评估时无论是GDM A1还是GDM A2，3组孕妇及家属SAS、SDS评分比较差异无统计学意义（均P＞0.05）。干预后与干预前比较，GDM A1、GDM A2孕妇及家属SAS、SDS评分在集体干预组、面对面干预组差异有统计学意义（均P＜0.01）。干预后的集体干预组和面对面干预组的GDM A1和GDM A2孕妇及家属SAS、SDS评分均低于对照组，而且集体干预组低于面对面干预组，差异有统计学意义（均P＜0.01）。3组GDM孕妇的妊娠结局差异无统计学意义（P＞0.05），但干预组母体并发症和剖宫产率呈降低趋势。结论：心理干预能有效改善GDM孕妇及家属的焦虑、抑郁症状，集体干预更有利于改善患者及家属的焦虑、抑郁症状，值得临床推广。

Effect of Different Psychological Intervention on the Anxiety and Depression Symptoms in Different Degrees of GDM Women and Their Families

Objective∶To analyze the influence of different psychological intervention on anxiety, depression and pregnancy outcomes in different degrees of gestational diabetes mellitus (GDM) women and their families. Methods∶300 GDM women and their families (their husband or mother) who accepted regular inspection and delivered at Shanghai First Maternity and Infant Hospital from April 2013 to November 2014 were randomly divided into a collective intervention group, a face to face psychological intervention group and a control group according to the intervention mode. Psychological intervention during pregnancy were six times, the GDM patients in each group were divided into GDM A1 (who were treated with diet therapy and exercise therapy) and GDM A2 (who need insulin therapy), compared the SAS, SDS scores and pregnancy outcome of GDM A1 and GDM A2 and their family members in each group before intervention (a week after the initial diagnosis of GDM), after intervention (36 weeks of pregnancy, 48 hours postpartum. 42 days postpartum). Results∶The SAS and SDS scores of GDM women and their families in three groups were no significant difference before intervention (all P>0.05). After psychological intervention, the SAS and SDS scores of GDM A1 and GDM A2 patients and their families in the collective intervention group and the face to face psychological intervention group were less than the scores of before intervention (both P<0.01), meanwhile the SAS and SDS scores in the collective intervention group and the face to face psychological intervention group were less than that in control group (P<0.01), and the SAS and SDS scores in collective intervention group were less than face to face psychological intervention group, the difference was significant (both P<0.01).There was no significant difference in the pregnancy outcome of the three groups (P>0.05). But, the incidence of maternal complications and the rate of caesarean section in the intervention group had the trend of lower. Conclusions∶Psychological intervention can effectively improve GDM women and their families the symptoms of anxiety and depression, and the collective intervention was more conductive to the improvement of the symptoms of anxiety and depression of GDM patients and their families, it is worth in clinical promotion.