中华流行病学杂志  2020, Vol. 41 Issue (6): 834-838   PDF    
http://dx.doi.org/10.3760/cma.j.cn112338-20200118-00043
中华医学会主办。
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文章信息

岳和欣, 冯雅慧, 吴散散, 王雅文, 蔡姝雅, 石英杰, 陈云利, 湛永乐, 马良坤, 江宇.
Yue Hexin, Feng Yahui, Wu Sansan, Wang Yawen, Cai Shuya, Shi Yingjie, Chen Yunli, Zhan Yongle, Ma Liangkun, Jiang Yu
孕期妇女体力活动变化对抑郁影响的队列研究
Effects of changes in physical activities on depressive symptoms during pregnancy: a cohort study
中华流行病学杂志, 2020, 41(6): 834-838
Chinese Journal of Epidemiology, 2020, 41(6): 834-838
http://dx.doi.org/10.3760/cma.j.cn112338-20200118-00043

文章历史

收稿日期: 2020-01-18
孕期妇女体力活动变化对抑郁影响的队列研究
岳和欣1 , 冯雅慧1 , 吴散散1 , 王雅文1 , 蔡姝雅1 , 石英杰1 , 陈云利1 , 湛永乐1 , 马良坤2 , 江宇1     
1. 中国医学科学院/北京协和医学院公共卫生学院, 北京 100730;
2. 中国医学科学院/北京协和医学院北京协和医院妇产科, 北京 100730
摘要: 目的 探究孕妇在孕早-中期体力活动变化对孕中期抑郁的影响。方法 依托中国孕产妇队列研究·协和项目(2017年7月25日至2018年11月26日),将有效完成孕早、中期体力活动和抑郁情况调查的2 454名孕妇纳入研究。采用国际体力活动短问卷和爱丁堡产后抑郁量表,调查研究对象孕早期和孕中期的体力活动和抑郁情况。以孕早期是否患有抑郁作分组。采用非条件logistic回归分析孕早期不患抑郁组的孕早、中期体力活动变化对预防孕中期抑郁的作用,在孕早期抑郁组中分析孕早、中期体力活动变化对减缓孕中期抑郁的作用。结果 孕妇基线和孕中期抑郁的检出率分别为23.83%和20.57%。调整年龄、文化程度、职业、家庭年收入和孕前BMI等因素后,logistic回归结果显示,对于基线不抑郁的孕妇,孕期增加和保持充足的体力活动能够预防孕中期抑郁(OR=0.479,95% CI:0.335~0.684;OR=0.566,95% CI:0.394~0.815),但对于基线抑郁的孕妇,体力活动与减缓孕中期抑郁的相关性差异无统计学意义(P>0.05)。结论 孕期妇女增加和保持充足的体力活动对于抑郁有预防的作用,但对于孕早期已患抑郁的妇女来说,缓解效果不明显。应在鼓励孕妇加强体力活动的同时,开展抑郁筛查,以减少孕期抑郁的发生。
关键词: 体力活动    抑郁    孕期    队列研究    
Effects of changes in physical activities on depressive symptoms during pregnancy: a cohort study
Yue Hexin1 , Feng Yahui1 , Wu Sansan1 , Wang Yawen1 , Cai Shuya1 , Shi Yingjie1 , Chen Yunli1 , Zhan Yongle1 , Ma Liangkun2 , Jiang Yu1     
1. School of Public Health, Chinese Academy of Medical Science and Peking Union Medical College, Beijing 100730, China;
2. Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing 100730, China
Abstract: Objective To investigate the effect of changes in physical activities on depressive symptoms in the second trimester of pregnancy. Methods Data from the Chinese Pregnant Women Cohort Study, from July 25, 2017 to November 26, 2018, were used. Women who had effectively completed the survey of physical activity and depressive symptoms in the first and second trimesters of pregnancy, were recruited. Both International Physical Activity Questionnaire-short and Edinburgh Postnatal Depression Scale were used, respectively. Pregnant women who had completed two surveys were included in our study and were divided into two groups according to the depressive symptoms, measured at the baseline. Among the pregnant women without depressive symptoms at the baseline, logistic regression was used to analyze the effects of changes in physical activity on the prevention of depressive symptoms. Effect on the reduction of depressive symptoms was analyzed, using the same method. Results The prevalence rates of depressive symptoms were 23.83% and 20.57% in the baseline and second trimester, respectively. After adjusting for age, education level, occupation, family annual income and pre-pregnancy BMI, data from the logistic regression showed that women without depressive symptoms and with increased and adequate physical activities in the baseline, were with lower risks to develop depressive symptoms in the second trimester (OR=0.479, 95%CI: 0.335-0.684;OR=0.566, 95%CI: 0.394-0.815). Among women with depressive symptoms in the baseline survey, association between physical activity and depressive symptoms was not statistically significant (P>0.05). Conclusions Increased and adequate physical activities showed preventive effects on depressive symptoms during pregnancy, but the remission effect was not obvious in women with depressive symptoms. Pregnant women should be encouraged to increase their physical activities while screening programs should also be carried out to reduce the depressive symptoms during pregnancy.
Key words: Physical activity    Depressive symptoms    Pregnancy    Cohort study    

女性抑郁症是重大的公共健康问题,10%~25%的女性一生中患有≥1次抑郁症[1]。产前抑郁症是一种发生在妊娠期间的轻度至重度非精神病性抑郁,高收入国家约13%的孕妇受其影响[2],中低收入国家中更是高达25%的孕妇出现症状[3]。另外,孕期抑郁症是子代抑郁的危险因素[4],可能导致幼儿期的心理问题,影响子代的学习和生活[5-6]。因此,探寻如何降低孕妇抑郁症的发病风险尤为重要。研究表明,孕妇在妊娠期间进行体力活动,有助于降低母婴慢性病的风险,促进母婴健康[7-8]。目前关于孕期体力活动与抑郁的关系多停留在同一孕期的横断面研究,而关于孕期体力活动变化对于抑郁影响的研究有限,本研究基于前瞻性队列研究数据,探究孕期妇女体力活动变化对抑郁的预防与缓解作用,旨在为孕妇的孕期体力活动指导和减少抑郁困扰提供理论参考。

对象与方法

1.研究对象:中国孕产妇队列研究·协和项目(Chinese Pregnant Women Cohort Study,CPWCS)是一项前瞻性的队列研究,2017年7月25日至2018年11月26日,CPWCS从全国15个省份的24家医院入组研究对象。纳入标准:①≥16周岁;②妊娠5~13周;③能使用电子设备在线完成问卷调查;④调查所在地的常住居民(居住≥6个月);⑤签署知情同意书。在纳入标准的基础上排除糖尿病或合并有其他心、肝、肺等重要器官疾病和精神疾病。

CPWCS在孕早期调查孕妇一般人口学信息、体力活动和抑郁情况,随访孕妇至其孕中期,调查其孕中期体力活动和抑郁情况。本研究纳入有效完成孕早、中期体力活动和抑郁情况调查的2 454名孕妇,并进一步排除患有限制体力活动的慢性病及多胎妊娠孕妇121名,最终纳入2 333名孕妇分析其体力活动与抑郁情况。本研究经北京协和医院科学研究部伦理审查委员会批准(批号:HS-1345)。

2.研究方法:

(1)一般人口学特征:采用自制孕妇一般情况调查表,收集其年龄、民族、文化程度、职业、家庭年收入、身高、孕前体重以及孕产史等信息。孕前BMI(kg/m2)根据《中华人民共和国卫生行业标准:成年人体重判定》进行分级[9]

(2)体力活动:采用已在孕产妇人群中经过验证的国际体力活动短问卷(International Physical Activity Questionnaire-short,IPAQ-s)调查研究对象体力活动情况[10]。IPAQ-s共包含7个项目,调查孕妇过去7 d的高强度体力活动、中等体力活动和步行情况,根据各项体力活动的频率及时间,计算孕妇1周体力活动的能量消耗情况,并将其体力活动水平分为高、中、低3类[11]

(3)孕期抑郁:采用爱丁堡产后抑郁量表(Edinburgh Postnatal Depression Scale,EPDS)评定孕妇抑郁的发生情况[12]。该量表共包含10个条目,总分30分,分数越高,抑郁程度越重。根据EPDS在孕期妇女产前抑郁筛查中的临界值分析研究,本研究以12/13分作为孕妇抑郁的判定标准[13-14]

3.统计学方法:本研究采用SPSS 22.0软件进行统计学分析。连续变量采用x±s描述,分类变量采用频数和百分比描述。应用χ2检验比较孕中期抑郁和不抑郁组的一般特征及体力活动的差异;本研究通过参考既往文献已确定的混杂因素[15](包括年龄、文化程度、职业、家庭年收入和孕前BMI)作为本研究的控制因素,以孕早期是否患有抑郁作为基线分组依据,将孕妇分为两组。其中在基线不患抑郁的孕妇组中,采用非条件logistic回归分析孕早、中期体力活动变化对预防孕中期抑郁的作用。在基线抑郁的孕妇组中,用同样方法分析孕早、中期体力活动变化对减缓孕中期抑郁的作用。计算调整OR值及其95%CI,检验水准为α=0.05。

结  果

1.一般情况:基线抑郁的孕妇共556例(23.83%),孕中期抑郁的孕妇共480例(20.57%)。在基线抑郁的孕妇中,有333例在孕中期得到缓解;在基线不抑郁的孕妇,有257例在孕中期出现抑郁。纳入分析的孕妇年龄(28.84±4.23)岁,范围16~45岁,其中高龄孕妇(≥35岁)占11.10%;96.04%的孕妇为汉族,文化程度为大专及本科以上占71.46%,且从事以脑力活动为主的职业较多(54.99%),超重及肥胖的孕妇占23.45%。孕早期抑郁孕妇中,孕中期抑郁和不抑郁孕妇的文化程度、职业和家庭年收入的分布不同,差异有统计学意义(P<0.05);孕早期不抑郁孕妇中,孕中期抑郁和不抑郁孕妇的孕前BMI分布不同,差异有统计学意义(P<0.05)。见表 1

表 1 研究对象的一般特征(%)

2.体力活动情况:研究对象中,孕早期以低水平体力活动的妇女居多,占总人数的66.65%,其次是中等水平体力活动,占总人数的28.72%,仅有4.63%的孕妇有高水平的体力活动。孕中期体力活动低、中等和高水平分别占总人数的49.29%、43.42%和7.29%。根据研究对象孕早期和孕中期体力活动的情况,将研究对象的孕期体力活动分为:不足(早中孕期均为低水平)、增加(早孕期为低水平、中孕期为中-高水平)、降低(早孕期为中-高水平、中孕期为低水平)和充足(早中孕期均为中-高水平),分别占总人数的38.15%、28.50%、11.14%和22.20%。经χ2检验,在基线不抑郁的孕妇中,孕中期抑郁和不抑郁孕妇的孕期体力活动的差异有统计学意义(P<0.001),但在基线抑郁的孕妇中,两组的差异无统计学意义(P=0.264)。见表 2

表 2 研究对象孕期体力活动和孕中期抑郁情况[n(%)]

3.孕期体力活动对抑郁的影响:

(1)对预防抑郁的影响:在基线不抑郁的孕妇(n=1 777)中,以孕中期抑郁作为因变量(抑郁=1,不抑郁=0),以体力活动不足组为参照组,分析体力活动变化与孕中期抑郁的关联性。调整混杂因素后,相对于孕期体力活动不足的孕妇,孕期体力活动增加和充足的孕妇在孕中期患抑郁的可能性较低。见表 3

表 3 体力活动变化对预防孕中期抑郁的logistic回归分析

(2)对治疗抑郁的影响:在基线抑郁的孕妇(n=556)中,以孕中期抑郁作为因变量(不抑郁=1,抑郁=0),以体力活动不足组为参照组,分析孕期体力活动变化与减缓孕中期抑郁的关联性。调整混杂因素后,体力活动的变化与孕中期不抑郁的关联性均差异无统计学意义(P>0.05)。见表 4

表 4 体力活动变化对治疗孕中期抑郁的logistic回归分析
讨  论

妊娠是女性身体和心理发生剧烈变化的时期,孕期体力活动的作用也成为社会普遍关注的话题。在本研究中,孕期体力活动不足的孕妇比例较高。无论是国内外研究均显示[16-19],孕妇的孕期体力活动普遍处于较低水平。

本研究分析发现,对于孕早期不抑郁的孕妇,孕期体力活动充足和孕期体力活动增加可降低孕期抑郁的发生,与过往研究结果一致[20]。虽然体力活动发挥作用的机制尚未得到广泛证实,但已有研究发现,体力活动可以改变与抑郁症相关的神经递质和激素水平[21],且运动可通过分散注意力的活动来提高情绪,减少反省时间,促进自我效能,进而降低抑郁症的发生风险[22]。有研究认为,孕妇家务劳动的负担越重越可能出现抑郁[23],可能因为家务劳动不同于单纯的休闲活动是为了娱乐或选择而进行的,可能会造成孕妇的压力与紧张感,影响心理健康状况,进而导致发生抑郁。但也有研究称,妊娠早期的体育活动与妊娠期抑郁无关[24],上述矛盾可能与基线抑郁的风险和人种不同有关。

本研究发现,在患有孕早期抑郁的妇女中,控制已知混杂因素后,体力活动的增加和孕中期抑郁缓解的关联无统计学意义。而目前关于体力活动对抑郁缓解和治疗作用的研究结论并不一致[25-26]。抑郁症本身具有复杂性和顽固性[27],并且与多个因素相关,其治疗也往往需要从多个方面采取措施[28]。而传统临床治疗抑郁的方法可能对孕妇和子代带来副作用,并不完全适用孕妇群体[24]。这进一步提示应尽早地预防孕期抑郁的发生,及时进行抑郁筛查和相关治疗,才能真正的保障孕妇身心健康[29]

本研究存在局限性。首先,虽然控制了孕妇年龄、文化程度、家庭年收入、职业以及孕前BMI等混杂因素,但未控制孕妇的饮食信息,有研究表明,体育锻炼可以降低食欲,而热量限制可能具有防止抑郁的作用[30]。本研究的优势在于,采用了队列研究的数据,控制基线抑郁的情况下,前瞻性地分析孕期体力活动变化对孕期抑郁的影响。

综上所述,孕期妇女增加和保持充足的体力活动对于抑郁有一定预防作用,但对于孕早期已患抑郁的妇女来说,缓解效果不明显。孕妇应在孕期参与充足的体力活动,提高体力活动水平,并开展抑郁筛查,以减少孕期抑郁的发生。

利益冲突  所有作者均声明不存在利益冲突

岳和欣和冯雅慧对本文有同等贡献

Yue Hexin and Feng Yahui contributed equally to the article

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