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母亲孕期情绪症状与学龄前儿童情绪和行为问题关系的出生队列研究
作者:陶慧慧 邵婷 倪玲玲 孙艳丽 严双琴 顾春丽 曹慧 黄锟 陶芳标 童世庐

摘要:

目的  分析学龄前儿童情绪与行为问题的生命早期影响因素,探讨母亲孕期情绪症状与学龄前儿童情绪和行为问题之间的关联。方法  基线资料来源于中国安徽出生队列(C-ABCS)中的马鞍山市出生队列。该队列于2008年10月至2010年10月在马鞍山市4家市级医疗卫生机构接受孕期保健的孕妇中招募研究对象,共计5 084名孕妇及4 669名单胎活产儿进入队列;分别采用《焦虑自评量表》和《流行病调查中心抑郁自评量表》评价孕期焦虑和抑郁症状。于2014年4月至2015年4月对队列进行随访,采用家长填写的长处与困难量表(SDQ)了解儿童情绪与行为问题发生情况,共随访有SDQ评定结果的3~6学龄前儿童3 653名。采用多因素logistic回归模型分析孕期焦虑、抑郁症状与学龄前儿童情绪和行为问题之间的关联。结果  学龄前儿童情绪症状、品行问题、多动、同伴交往异常率分别为6.3%(229/3 653)、7.5%(274/3 653)、7.6%(278/3 653)、2.8%(103/3 653);困难总分异常率为7.6% (277/3 653);亲社会行为异常率为10.9% (398/3 653);影响因子异常率为27.4% (981/3 577)。母亲孕早期焦虑、抑郁的检出率分别为2.7%(100/3 653)、4.7%(171/3 653);母亲孕中期焦虑、抑郁的检出率分别为2.0%(66/3 375)、3.6%(122/3 375)。多因素logistic回归模型分析结果显示,控制孕龄、户口、家庭收入、母亲文化程度、父亲文化程度等混杂因素,与母亲孕早、中期均无焦虑症状症状儿童的相比,母亲孕早、中期均有焦虑症状儿童情绪症状异常的风险较高,OR (95%CI)值为5.90 (2.00~17.48);与母亲孕早、中期均无抑郁症状症状儿童的相比,母亲孕早、中期均有抑郁症状儿童情绪症状异常的风险较高,OR (95%CI)值为3.07 (1.30~7.28);与母亲孕中期无焦虑症状的儿童相比,母亲孕中期有焦虑症状儿童困难总分异常的风险较高,OR(95%CI)值为2.27(1.10~4.71);与母亲孕中期无抑郁症状的儿童相比,母亲孕中期有抑郁症状儿童困难总分异常的风险较高,OR (95%CI)值为2.20(1.24~3.93);母亲孕期情绪症状与子代品行问题、多动、同伴交往和亲社会行为关联均无统计学意义(P>0.05)。结论  母亲孕期焦虑和抑郁症状对学龄前儿童情绪和行为问题有着负面的影响,积极开展孕前和孕期教育,使母亲保持健康积极的孕期情绪可能会减少或预防儿童情绪和行为问题的发生。

关键词:儿童,学龄前;情绪;怀孕期间;行为;队列研究

Abstract:

Objective  To investigate the related influencing factors of preschool children's emotional and behavioral problems in early life and explore the associations between the symptoms of depression or anxiety during pregnancy and emotional and behavioral problems in preschool children.Methods  Based on the Ma'anshan Birth Cohort Study of the China-Anhui Birth Cohort Study (C-ABCS), women were recruited at their first clinical visit between October 2008 and October 2010 in four municipal medical and health institutions of Ma'anshan City, a total of 5 084 pregnant women and 4 669 singletons live births were included in the birth cohort. Women completed measures of depressive (Self-Rating Anxiety scale) and anxious (Center for Epidemiologic Studies Depression) symptoms in pregnancy. By the age of 3-6 follow-up, 3 653 children were followed with completed information between April 2014 and April 2015, strengths and difficulties questionnaires were used to assessed offspring emotional and behavioral problems. Logistics regression was used to investigate the relationship between the symptoms of depression or anxiety during pregnancy and emotional and behavioral problems in preschool children.Results  The detected rates of emotional symptoms, conduct problems, hyperactivity and peer problems in preschool children were 6.3% (229/3 653), 7.5% (274/3 653), 7.6% (278/3 653) and 2.8% (103/3 653), while 7.6% (277/3 653) for total difficulties, 10.9%(398/3 653) for prosocial behavior and 27.4%(981/3 557) for impact respectively. Prevalence of anxiety and depression in the first trimester was 2.7%(100/3 653) and 4.7%(171/3 653) respectively, and in the second trimester was 2.0%(66/3 375) and 3.6%(122/3 375) respectively. After we controlled the confoundings of gestation age, place of residence, family income, maternal education, paternal education, premature birth and folic acid supplement before pregnancy, multinomial logistic regression analysis showed that the risk of children's emotional symptoms in maternal anxiety in both first-trimester and second-trimester group was higher than the group of no depression and anxiety symptoms, and OR(95%CI) was 5.90(2.00-17.48). Compared with whose mother no depression in both first-trimester and second-trimester, the risk of children's emotional symptoms in maternal depression in both first-trimester and second-trimester group was higher, and OR(95% CI) was 3.07 (1.30-7.28). And the risk of children's total difficulties of maternal anxiety in second-trimester was 2.27 (95%CI: 1.10-4.71) times of no anxiety in second-trimester. While the risk of children's total difficulties of maternal depression in second-trimester was 2.20 (95%CI: 1.24-3.93) times of no depression in second-trimester. Maternal emotional symptoms were not significant associations with conduct problems, hyperactivity, peer problems and prosocial behaviors (P> 0.05).Conclusion  There was a negative impact of maternal anxiety and depression symptoms during pregnancy on emotional and behavioral problems in preschool children. These findings highlight the need for additional clinical and research attention to both maternal depression and anxiety in pregnancy, which may be helpful to reduce the incidence of children's emotional and behavioral problems and act as an important measure in prevention.

Key words: Child, preschool;Emotions;Peripartum period;Behavior;Cohort studies

发表日期:2016/2

引用本文:

图/表:

  • 10.3760/cma.j.issn.0253-9624.2016.02.006.T001:表1 学龄前儿童的情绪和行为问题发生情况[n(%)]

    10.3760/cma.j.issn.0253-9624.2016.02.006.T001:表1 学龄前儿童的情绪和行为问题发生情况[n(%)]

  • 10.3760/cma.j.issn.0253-9624.2016.02.006.T002:表2 影响学龄前儿童情绪与行为问题的单因素分析[n(%)]

    10.3760/cma.j.issn.0253-9624.2016.02.006.T002:表2 影响学龄前儿童情绪与行为问题的单因素分析[n(%)]

  • 10.3760/cma.j.issn.0253-9624.2016.02.006.T003:表3 母亲孕期焦虑、抑郁症状与学龄前儿童情绪和行为问题的多因素logistic回归模型分析结果[OR (95%CI)值]

    10.3760/cma.j.issn.0253-9624.2016.02.006.T003:表3 母亲孕期焦虑、抑郁症状与学龄前儿童情绪和行为问题的多因素logistic回归模型分析结果[OR (95%CI)值]

参考文献:

[1]ReckC, StrubenK, BackenstrassM, et al. Prevalence, onset and comorbidity of postpartum anxiety and depressive disorders[J]. Acta Psychiatr Scand, 2008, 118(6): 459-468. DOI: 10.1111/j.1600-0447.2008.01264.x.
[2]RossLE, Gilbert EvansSE, SellersEM, et al. Measurement issues in postpartum depression part 1: anxiety as a feature of postpartum depression[J]. Arch Womens Ment Health, 2003, 6(1): 51-57. DOI: 10.1007/s00737-002-0155-1.
[3]DeaveT, HeronJ, EvansJ, et al. The impact of maternal depression in pregnancy on early child development[J]. BJOG, 2008, 115(8): 1043-1051. DOI: 10.1111/j.1471-0528.2008.01752.x.
[4]PearlsteinT, HowardM, SalisburyA, et al. Postpartum depression[J]. Am J Obstet Gynecol, 2009, 200(4):357-364. DOI: 10.1016/j.ajog.2008.11.033.
[5]Van den BerghBR, MarcoenA. High antenatal maternal anxiety is related to ADHD symptoms, externalizing problems, and anxiety in 8-and 9-year-olds[J]. Child Dev, 2004, 75(4): 1085-1097. DOI: 10.1111/j.1467-8624.2004.00727.x.
[6]RobinsonM, MattesE, OddyWH, et al. Prenatal stress and risk of behavioral morbidity from age 2 to 14 years: The influence of the number, type, and timing of stressful life events[J]. Dev Psychopathol, 2011, 23(2): 507-520. DOI: 10.1017/S0954579411000241.
[7]TaoFB, HaoJH, HuangK, et al. Cohort Profile: the China-Anhui Birth Cohort Study[J]. Int J Epidemiol, 2013, 42(3): 709-721. DOI: 10.1093/ije/dys085.
[8]徐叶清,翁婷婷,严双琴,等.增补叶酸与孕期抑郁相关性的队列研究[J].中华流行病学杂志,2014,(6):641-645. DOI: 10.3760/cma.j.issn.0254-6450.2014.06.006.
[9]ZungWW. The differentiation of anxiety and depressive disorders: a biometric approach[J]. Psychosomatics, 1971, 12(6): 380-384. DOI: 10.1016/S0033-3182(71)71480-7.
[10]王征宇,迟玉芬.焦虑自评量表(SAS)[J].上海精神医学,1984,(2):73-74.
[11]RadloffLS. The CES-D Scale A Self-Report Depression Scale for Research in the General Population[J]. Applied Psychological Measurement, 1977, 1(3): 385-401.
[12]陈祉妍,章婕,吴振云,等.流调中心抑郁量表全国城市常模的建立[J].中国心理卫生杂志,2010,24(2):139-143. DOI: 10.3969/j.issn.1000-6729.2010.02.015.
[13]韦月颜,陶真兰,程虹,等.孕妇焦虑和抑郁情绪对妊娠结局的影响[J].职业与健康,2015,31(9):1213-1216.
[14]GoodmanR. The Strengths and Difficulties Questionnaire: a research note[J]. J Child Psychol Psychiatry, 1997, 38(5): 581-586. DOI: 10.1111/j.1469-7610.1997.tb01545.x.
[15]DuY, KouJ, CoghillD. The validity, reliability and normative scores of the parent, teacher and self report versions of the Strengths and Difficulties Questionnaire in China[J]. Child Adolesc Psychiatry Ment Health, 2008, 2(1):8. DOI: 10.1186/1753-2000-2-8.
[16]刘书君.长处与困难问卷(SDQ)中文版的信度和效度研究[D].成都:四川大学,2006.
[17]BeydounH, SaftlasAF. Physical and mental health outcomes of prenatal maternal stress in human and animal studies: a review of recent evidence[J]. Paediatr Perinat Epidemiol, 2008, 22(5): 438-466. DOI: 10.1111/j.1365-3016.2008.00951.x.
[18]LuomaI, TamminenT, KaukonenP, et al. Longitudinal study of maternal depressive symptoms and child well-being[J]. J Am Acad Child Adolesc Psychiatry, 2001, 40(12): 1367-1374. DOI: 10.1097/00004583-200112000-00006.
[19]TeyhanA, GalobardesB, HendersonJ. Child allergic symptoms and mental well-being: the role of maternal anxiety and depression[J]. J Pediatr, 2014, 165(3): 592-599 e5. DOI: 10.1016/j.jpeds.2014.05.023.
[20]LeechSL, LarkbyCA, DayR, et al. Predictors and correlates of high levels of depression and anxiety symptoms among children at age 10[J]. J Am Acad Child Adolesc Psychiatry, 2006, 45(2): 223-230. DOI: 10.1097/01.chi.0000184930.18552.4d.
[21]KorhonenM, LuomaI, SalmelinR, et al. Maternal depressive symptoms: associations with adolescents' internalizing and externalizing problems and social competence[J]. Nord J Psychiatry, 2014, 68(5): 323-332. DOI: 10.3109/08039488.2013.838804.
[22]Van den BerghBR, Van CalsterB, SmitsT, et al. Antenatal maternal anxiety is related to HPA-axis dysregulation and self-reported depressive symptoms in adolescence: a prospective study on the fetal origins of depressed mood[J]. Neuropsychopharmacology, 2008, 33(3): 536-545. DOI: 10.1038/sj.npp.1301450.
[23]SkouterisH, WertheimEH, RallisS, et al. Depression and anxiety through pregnancy and the early postpartum: an examination of prospective relationships[J]. J Affect Disord, 2009, 113(3): 303-308. DOI: 10.1016/j.jad.2008.06.002.
[24]FieldT, DiegoM, Hernandez-ReifM, et al. Comorbid depression and anxiety effects on pregnancy and neonatal outcome[J]. Infant Behav Dev, 2010, 33(1): 23-29. DOI: 10.1016/j.infbeh.2009.10.004.
[25]IbanezG, CharlesMA, ForhanA, et al. Depression and anxiety in women during pregnancy and neonatal outcome: data from the EDEN mother-child cohort[J]. Early Hum Dev, 2012, 88(8): 643-649. DOI: 10.1016/j.earlhumdev.2012.01.014.
[26]LeisJA, HeronJ, StuartEA, et al. Associations between maternal mental health and child emotional and behavioral problems: does prenatalmental health matter?[J]. J Abnorm Child Psychol, 2014, 42(1): 161-171. DOI: 10.1007/s10802-013-9766-4.
[27]SandmanCA, DavisEP, BussC, et al. Exposure to prenatal psychobiological stress exerts programming influences on the mother and herfetus[J]. Neuroendocrinology, 2012, 95(1): 7-21. DOI: 10.1159/000327017.
[28]DipietroJA. Maternal stress in pregnancy: considerations for fetal development[J]. J Adolesc Health, 2012, 51(2Suppl): S3-S8. DOI: 10.1016/j.jadohealth.2012.04.008.
[29]SandmanCA, DavisEP, BussC, et al. Exposure to prenatal psychobiological stress exerts programming influences on the mother and her fetus[J]. Neuroendocrinology, 2012, 95(1): 7-21. DOI: 10.1159/000327017.
[30]VedharaK, MetcalfeC, BrantH, et al. Maternal mood and neuroendocrine programming: effects of time of exposure and sex[J]. J Neuroendocrinol, 2012, 24(7): 999-1011. DOI: 10.1111/j.1365-2826.2012.02309.x.

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