發(fā)布時(shí)間：2018-05-16 23:20

  本文選題：妊娠特有壓力 + 妊娠結(jié)局��； 參考：《中國(guó)疾病預(yù)防控制中心》2017年碩士論文

【摘要】：目的 描述孕期婦女妊娠特有壓力的動(dòng)態(tài)變化,并探討妊娠特有壓力與主要妊娠結(jié)局的關(guān)聯(lián)。方法 本研究選取在廣東省珠海市婦幼保健院、山西省婦幼保健院、北京市海淀區(qū)婦幼保健院、吉林省婦幼保健院和廣東省深圳市婦幼保健院首次建卡并知情同意參加《孕產(chǎn)婦心理狀況前瞻性研究項(xiàng)目》的孕婦為研究對(duì)象。招募符合條件的孕婦,收集其年齡、文化程度、工作狀態(tài)、婚姻狀況、家庭年收入、身高、體重、孕次、本次妊娠意愿、受孕方式、孕期鍛煉習(xí)慣、孕期吸煙及飲酒習(xí)慣、有無(wú)妊娠期合并癥/并發(fā)癥等基本情況,并在孕13周、孕24周和孕37周3次產(chǎn)前檢查時(shí)采用妊娠壓力量表(Pregnancy Stress Rating Scale,PSRS)評(píng)定孕婦妊娠特有壓力癥狀,焦慮自評(píng)量表(Self Rating Anxiety Scale,SAS)評(píng)定孕婦焦慮癥狀,愛(ài)丁堡產(chǎn)后抑郁量表(Edinburgh Postnatal Depression Scale,EPDS)評(píng)定孕婦抑郁癥狀,并于產(chǎn)后3天記錄母兒妊娠結(jié)局。2015年9月至2016年9月完整填寫3份不同孕期調(diào)查表的孕婦共計(jì)1167人,隨訪到產(chǎn)后3天的單胎活產(chǎn)新生兒1167人。采用重復(fù)測(cè)量資料方差分析、χ2檢驗(yàn)和廣義估計(jì)方程分析妊娠特有壓力的變化趨勢(shì)及其影響因素;不同孕期妊娠特有壓力與焦慮、抑郁的關(guān)系采用偏相關(guān)分析法;采用單因素及多因素Logistic回歸分析孕婦妊娠特有壓力與母兒妊娠結(jié)局的關(guān)聯(lián)。結(jié)果 1167名孕婦孕早期、孕中期和孕晚期妊娠特有壓力總體得分分別為15.72±11.40 分、15.08±11.68 分、14.47±11.33 分,差異有統(tǒng)計(jì)學(xué)意義(F=18.48,P0.001)。孕早期、孕中期、孕晚期最主要的壓力來(lái)源為因素2“為確保母子健康和安全而引發(fā)的壓力感”,孕早、中、晚期最主要的壓力條目分別為:“擔(dān)心嬰兒不正�！薄ⅰ皳�(dān)心分娩可能出現(xiàn)不正常的情況或剖腹產(chǎn)”和“擔(dān)心嬰兒能否安全分娩”。廣義估計(jì)方程結(jié)果顯示:珠海市孕婦(OR=1.71,95%CI:1.15～2.53)、對(duì)居住環(huán)境滿意度一般組孕婦(OR=1.64,95%CI:1.25～2.14)、孕早期有抑郁癥狀組孕婦(OR=1.90,95%CI:1.36～2.67)、孕早期有焦慮癥狀組孕婦(OR=1.55,95%CI:1.09～2.20)、孕中期有抑郁癥狀組孕婦(OR=1.60,95%CI:1.08～2.36)、孕晚期有焦慮癥狀組孕婦(OR=2.14,95%CI:1.45～3.17)發(fā)生重度妊娠特有壓力的風(fēng)險(xiǎn)較高。其他變量如年齡、文化程度、不良孕產(chǎn)史、家庭收入等差異無(wú)統(tǒng)計(jì)學(xué)意義。偏相關(guān)分析結(jié)果顯示,不同孕期孕婦妊娠特有壓力與焦慮或抑郁的相關(guān)系數(shù)較低。將孕婦年齡、體型、不同研究中心等作為協(xié)變量納入多因素Logistic回歸模型中,發(fā)現(xiàn)不同孕期孕婦妊娠特有壓力與主要不良妊娠結(jié)局無(wú)統(tǒng)計(jì)學(xué)關(guān)聯(lián)(P0.05)。將孕早、中、晚期焦慮癥狀、不同研究中心等作為協(xié)變量納入多因素Logistic回歸模型中,發(fā)現(xiàn)孕晚期重度妊娠特有壓力組發(fā)生產(chǎn)后抑郁風(fēng)險(xiǎn)是輕中度妊娠特有壓力組的1.48倍(95%CI;1.03～2.12,P= 0.034);孕早期、孕中期不同程度妊娠特有壓力組間產(chǎn)后抑郁的發(fā)生率差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05)。結(jié)論 孕婦妊娠特有壓力得分隨妊娠進(jìn)展呈下降趨勢(shì)。妊娠特有壓力與焦慮、抑郁相關(guān)系數(shù)較低,應(yīng)針對(duì)孕早期有妊娠特有壓力來(lái)源的孕婦進(jìn)行特殊心理咨詢與心理衛(wèi)生指導(dǎo)。不同孕期妊娠特有壓力與主要不良妊娠結(jié)局無(wú)統(tǒng)計(jì)學(xué)關(guān)聯(lián),尚待進(jìn)一步研究證實(shí)。
[Abstract]:Objective to describe the dynamic changes of pregnancy specific pressure in pregnant women and to explore the relationship between pregnancy specific pressure and main pregnancy outcome. Methods the study was selected in Zhuhai maternal and child health care hospital in Guangdong Province, maternal and child health care hospital of Shanxi Province, Haidian District maternal and child health care hospital of Beijing City, Jilin province women and child health care hospital and Shenzhen City Maternal and child health care hospital in Guangdong province. Pregnant women were recruited to the pregnant women who were enrolled in the prospective research project of maternal psychological status. They recruited eligible pregnant women to collect their age, educational level, working status, marital status, family income, height, weight, pregnancy, pregnancy intention, pregnancy style, pregnancy exercise habits, pregnancy smoking and drinking habits, There were complications such as pregnancy complications / complications and other basic conditions. The pregnancy pressure scale (Pregnancy Stress Rating Scale, PSRS) was used to assess the symptoms of pregnancy specific stress at 13 weeks of pregnancy, 24 weeks of pregnancy and 37 weeks of pregnancy. The anxiety symptom of pregnant women and the postpartum depression in Edinburgh were assessed by the self rating Anxiety Scale (Self Rating Anxiety Scale, SAS). The table (Edinburgh Postnatal Depression Scale, EPDS) was used to assess the symptoms of depressive symptoms in pregnant women, and 1167 pregnant women with 3 different pregnancy questionnaires completed from September to September 2016 after 3 days postpartum were followed up to 1167 births of single births for 3 days postpartum. The variance analysis, chi square test and the 2 test were used. The generalized estimation equation was used to analyze the change trend of pregnancy specific stress and its influencing factors; the relationship between pregnancy specific stress and anxiety and depression was analyzed by partial correlation analysis. The correlation between pregnancy specific stress and pregnancy outcome of pregnant women was analyzed by single factor and multiple factor Logistic regression. Results 1167 pregnant women were pregnant and middle pregnancy. The total score of endemic pressure in the late pregnancy was 15.72 + 11.40, 15.08 + 11.68 and 14.47 + 11.33. The difference was statistically significant (F=18.48, P0.001). The most important source of stress in the early pregnancy, middle pregnancy and late trimester of pregnancy was 2 "the stress caused by the health and safety of mother and child", the most important pressure in the early pregnancy, middle and late period. The results of the generalized estimation equation showed: pregnant women in Zhuhai (OR=1.71,95%CI:1.15 to 2.53), pregnant women (OR=1.64,95%CI:1.25 to 2.14) and early pregnancy were pregnant (OR=1.64,95%CI:1.25 to 2.14). In the group of depressive symptoms (OR=1.90,95%CI:1.36 to 2.67), there were pregnant women in the early pregnancy (OR=1.55,95%CI:1.09 to 2.20), and in the middle of the pregnancy (OR=1.60,95%CI:1.08 to 2.36). The risk of severe pregnancy stress in pregnant women with anxiety symptoms (OR=2.14,95%CI:1.45 to 3.17) was higher. Other variables, such as age, were higher. There was no significant difference in cultural degree, bad pregnancy history, family income, etc. partial correlation analysis showed that the correlation coefficient between pregnancy specific stress and anxiety or depression in pregnant women of different pregnancy was lower. The maternal age, body shape, and different research centers were incorporated into the multifactorin Logistic regression model as co variables, and pregnant women in different pregnancy pregnancy were found to be pregnant with pregnancy induced pregnancy. There was no statistical correlation between the endemic pressure of pregnancy and the major adverse pregnancy outcomes (P0.05). The risk of postpartum depression in the group of severe pregnancy specific stress in the late trimester was 1.48 times as much as that of the mild and moderate pregnancy stress group (95%CI; 1.03 ~ 1.03), and the early pregnancy, middle and late anxiety symptoms and different research centers were incorporated into the multifactor regression model as covariate. 2.12, P= 0.034): there was no significant difference in the incidence of postpartum depression among different pregnancy stress groups in the early trimester of pregnancy (P0.05). Conclusion the score of pregnancy specific stress in pregnant women decreased with the progression of pregnancy. The correlation coefficient of pregnancy specific stress and anxiety and depression was lower. Special psychological counseling and psychological hygiene guidance for women. There is no statistical correlation between the stress of pregnancy in different pregnancy and the outcome of major bad pregnancy. Further research has yet to be confirmed.
【學(xué)位授予單位】：中國(guó)疾病預(yù)防控制中心
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R715.3

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