| 摘要: | 近年來憂鬱症的盛行率日漸增加，有20％的孕婦患有憂鬱症，但關於憂鬱症或其藥物治療對於婦女懷孕時造成相關後續合併症現象，研究結果仍不一致，且多是西方國家的研究，以亞洲女性為主的大樣本研究仍付之闕如。因此本研究以全民健康保險資料庫2005年至2013年的資料，針對患有憂鬱症懷孕婦女探討生產結果和憂鬱症的相關。
自健保資料庫共鑑別了5,064位憂鬱症懷孕婦女以及20,024位無憂鬱症懷孕婦女。憂鬱症世代與非憂鬱症世代皆追蹤至其生產, 探討憂鬱症和婦女生產結果的相關, 和探討孕期憂鬱症用藥和婦女生產結果的相關。
本研究發現憂鬱症世代與非憂鬱症世代相較，憂鬱症婦女患有其他身體疾病的情形較為普遍，並且絕大多數的個案在懷孕期間未使用抗憂鬱劑。研究結果顯示憂鬱症婦女在懷孕期間，會增加妊娠劇吐、流產、胎位不正、剖腹產以及子宮內胎兒死亡等事件的發生。而年齡的分層分析結果顯示25歲至34歲的憂鬱症婦女有較高的妊娠劇吐、流產、胎位不正以及剖腹產的風險。
此外，研究結果也發現懷孕婦女使用抗鬱劑並未增加發生產科併發症的風險。而孕期憂鬱症使用抗鬱劑的婦女其出現產後憂鬱的風險較未使用者高 (風險比= 5.38 (95% CI:3.75~7.71)，該風險並且會隨著年紀增加而增高。
本研究結果對於孕婦以及臨床醫護人員有重要的意義。在擬定懷孕婦女的孕期照護計畫時，孕婦及臨床人員須衡量憂鬱症藥物治療帶來的利弊得失與憂鬱症不治療帶來的可能不良後果。而憂鬱症的疾病嚴重度、共病以及生產併發症的三者間的可能機制仍待未來研究進一步探討。
The prevalence of depression has increased in recent years, up to approximately 20% of pregnant women have been reported as cases with depressive disorders. However, findings on adverse events for pregnant women with and without depression and with and without using antidepressants are inconsistent and most of studies were conducted in Western countries. Information from a population-based study with large size of samples for Asian women on these issues is limited. In the present study, we used large insurance claims data from the 2005–2013 to investigate whether pregnant women with depression is associated with adverse obstetric outcomes and neonatal outcomes during pregnancy and after delivery.
From the insurance claims data of 1,000,000 insured population, we identified 5,064 pregnant women with depression and 20,024 pregnant women without the diagnosis of depression. Both cohorts were followed until babies were born to evaluate birth outcomes and complications, and the effectiveness of medications for the care of depression.
In the present study, we observed that the baseline comorbidities were more prevalent in the depression cohort than in the non-depressed cohort, and the vast majority of depressed women were untreated during pregnancy. This study demonstrated that incident events of hyperemesis, abortion, malpresentation, Cesarean Section, and intrauterine fetal death were higher in women with depression during pregnancy than those without depression. Depressed women aged 25 to 34 had higher risks of hyperemesis, abortion, malpresentation and Cesarean Section in the age stratified analysis.
In the comparison between women with and without antidepressant medication, our data failed to show that depressed women with antidepressant medications were at an increased risk of complications, compared with those without the medications. However, among the childbearing age depressed women, the antidepressant medication users were at a higher risk of postnatal depression than none users (Odds ratio = 5.38 (95% confidence interval = 3.75-7.71). The odds ratio of postnatal depression in antidepressant medication users increased with age.
These findings have important clinical implications for pregnant women and health care professionals in prenatal and postnatal cares. Depressed women and clinicians must weigh risks and benefits of treatment options against the consequence associated with untreated illness. The underlying mechanisms on severity of depression, comorbidities, and obstetric outcomes still require further explorations. |
