母亲孕期抑郁与2岁儿童行为问题关系的前瞻性队列研究

目的 探讨母亲孕期抑郁与2岁儿童行为问题之间的关系。方法 基于2012年4-12月开展的上海闵行出生队列（Shanghai-Minhang Birth Cohort Study）,以491对母亲和儿童为研究对象,使用"流行病调查中心抑郁量表"在孕中、晚期以及产后6和12个月对母亲抑郁状况进行评估,并使用"儿童行为量表"调查2岁儿童神经行为发育状况。运用log-binominal回归模型分析母亲孕期抑郁和2岁儿童行为问题关联,并在无产后抑郁症状的母亲中进行敏感性分析。结果 在调整母亲孕期年龄、分娩孕周、家庭人均月收入、父母文化程度和儿童性别后,显示母亲孕中期有抑郁症状的子代情感反应和内向化行为问题发生风险增加,RR值（95% CI）分别为2.61（1.36~4.99）和1.94（1.22~3.08）。母亲孕晚期有抑郁症状的子代情感反应、退缩行为、攻击行为、内向化和外向化行为问题的发生风险也增加,RR值（95% CI）分别为6.46（3.09~13.53）、2.42（1.16~5.02）、2.93（1.45~5.94）、1.79（1.01~3.16）和2.56（1.49~4.42）倍。在无产后抑郁症状的母亲中进行分析,结果显示母亲孕期有抑郁症状的子代情感反应、攻击行为、内向化及外向化行为问题的发生风险没有明显变化。结论 母亲孕期抑郁可能会增加儿童行为异常的发生风险,应加强孕妇妊娠期间心理健康监测,以降低儿童行为问题发生,促进母婴健康。

A prospective cohort study on the relationship between maternal prenatal depressive symptoms and children's behavioral problems at 2 years old

Objective To explore the associations between maternal and prenatal depressive symptoms and children''s behavioral problems at 2 years old. Methods In the present study, a total of 491 mother-child pairs were selected from the Shanghai-Minhang Birth Cohort Study (S-MBCS) which was conducted in Maternal and Child Health Hospital of Minhang District in Shanghai between April and December, 2012. Data from the Center for Epidemiologic Studies on Depression was gathered to assess the maternal depressive symptoms in the second and third trimester of pregnancy, as well as at 6 months and 12 months postpartum. Neurodevelopment at 2 years was assessed, using the Child Behavior Checklist. We used generalized linear models with a log-link function and a Binomial distribution to estimate the risk ratios (RRs) and 95% CIs, on children''s behavioral problems at 2 years of age. Sensitivity analyses were performed among participants without postpartum depressive symptoms. Results After adjustment on factors as maternal age, gestation week, average monthly income per person, parental education and children''s gender etc., maternal depression in second trimester of pregnancy was found associated with higher risk of both developing emotional (RR=2.61, 95% CI:1.36-4.99) and internalizing problems (RR=1.94, 95% CI:1.22-3.08). However, maternal depression in third trimester was found to be associated with higher risks of developing emotional (RR=6.46, 95% CI:3.09-13.53), withdrawn (RR=2.42, 95% CI:1.16-5.02), aggressive (RR=2.93, 95% CI:1.45-5.94), internalizing (RR=1.79, 95% CI:1.01-3.16) or externalizing problems (RR=2.56, 95% CI:1.49-4.42). In sensitivity analysis, antenatal maternal depression was found positively associated with children''s emotional, internalizing and externalizing problems and the differences all statistically significant. Conclusions Maternal depression during pregnancy might increase the risks of children''s behavioral problems. In order to decrease the incidence of children''s behavioral problems and promoting both maternal and child health status, monitoring program regarding maternal mental health care should be strengthened.