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目的探讨孕晚期炎症反应与产后抑郁症发生风险的关系。方法采用前瞻性队列研究,将于2013年6月1日至2013年10月31日纳入的600名孕产妇为研究对象;孕20周之前进行问卷调查并完成抑郁自评量表(SDS),孕33周后再次评估SDS及检测C-反应蛋白(CRP)水平,产后6周完成爱丁堡抑郁量表(EPDS)评估;采用多因素Logistic回归分析孕晚期CRP水平与产后抑郁的关系。结果产后抑郁的总发生率为20.1%;CRP水平≤8.2mg/L、8.2～12.5 mg/L、12.5～24.1 mg/L、>24.1mg/L组的孕产妇产后抑郁的发生率分别为18.9%、16.2%、22.7%、26.9%;调整孕前BMI、月平均收入、产次、孕20周前抑郁后,CRP>24.1mg/L组与CRP≤8.2mg/L组比较,产后抑郁发生风险的OR值为2.01(95%CI:1.05～3.85)。孕晚期CRP浓度每增加10mg/L,产后抑郁症发生风险增加13%。结论产后抑郁的发生水平随孕晚期CRP水平升高呈上升趋势,提示孕晚期炎症反应可能增加产后抑郁的风险。
Objective To investigate the relationship between inflammatory reaction in late pregnancy and the risk of postpartum depression. METHODS: A prospective cohort study was conducted in which 600 pregnant women were enrolled in the study from June 1, 2013 to October 31, 2013. Before the 20th week of pregnancy, a questionnaire survey was conducted and a self-rating depression scale (SDS) SDS and C-reactive protein (CRP) levels were reassessed after 33 weeks of gestation, and the Edinburgh Depression Scale (EPDS) was assessed 6 weeks postpartum. Multivariate Logistic regression was used to analyze the relationship between postpartum CRP levels and postpartum depression. Results The incidence of postpartum depression was 20.1%. The incidences of postpartum depression were 18.9% for those with CRP levels ≤ 8.2 mg / L, 8.2-12.5 mg / L, 12.5-24.1 mg / L and> 24.1 mg / L, respectively %, 16.2%, 22.7% and 26.9% respectively. After adjustment for pre-pregnancy BMI, monthly average income and delivery time, the risk of postpartum depression was lower than that of CRP> 24.1mg / L group and CRP≤8.2mg / L group OR of 2.01 (95% CI: 1.05-3.85). Each additional 10 mg / L of CRP in the third trimester increases the risk of postpartum depression by 13%. Conclusions The incidence of postpartum depression increases with the level of CRP in the third trimester, suggesting that the inflammatory response in the third trimester might increase the risk of postpartum depression.