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威望 旺
钢镚 分
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方法部分介绍了
1.研究对象的基本信息及纳入标准:武汉市内居住至少两年;市内医院分娩并在市内休养;怀孕前无精神障碍史;无出生缺陷的单胎活产。
2.数据收集方式:武汉市妇幼保健中心电子围产期保健信息系统(EPHCIS);社区卫生服务中心(CHSC)调查问卷;抑郁和焦虑的暴露由孕妇自我感觉。
3.统计分析:描述性统计;卡方检验低出生体重与抑郁、焦虑之间关联;二元Logistic回归分析模拟抑郁、焦虑与低出生体重之间管理;分层分析检查早产的影响;选择的混杂因素:母亲年龄,受教育程度,家庭收入,新生儿性别,妊娠史,既往流产史,体重增加量,被动吸烟史,阴道出血,尿液或阴道感染和妊娠并发症(心脏病或肝脏疾病或高血压)。
【Methods】
Study design and study population
The present study is a nested case control study from a population-based birth cohort study that was designed to evaluate adverse birth outcomes including PTB and LBW. The study was conducted in the seven inner city districts of Wuhan, China, from June 10, 2011, to June 9, 2013. For the purpose of this analysis, cases consist of every pregnant woman in the cohort who had a newborn with LBW. The control group was comprised of mothers from a previous case control study of this cohort, which was a random sample from the cohort of women who had either a PTB or a LBW baby. The cases and controls were required to meet the following criteria: (1) to have lived in the seven inner city districts of Wuhan for at least 2 years, (2) to have given birth in a hospital located in the inner city and rested in the inner city following delivery, (3) to not have a history of mental disorders prior to pregnancy, and (4) to have a singleton live birth without any birth defects.
The study extracted cases and controls from the Electronic Perinatal Health Care Information System (EPHCIS) of the Wuhan Medical and Health Center for Women and Children (WMHCWC). The EPHCIS has been running as a three-level service network for the health of women and children for more than 10 years. It collects electronically all clinical perinatal information from all pregnant women in Wuhan including data from antepartum examinations, intrapartum condition, and postpartum visits for both the mother and the child. Cases and controls were sampled three times per month. All births from the 1st day to the 10th day of the month were sampled on the 20th day of that month, all births from the 11th day to the 20th day of the month were sampled on the last day of that month, and all births from the 21st day to the last day of month were sampled on the 10th day of the next month.
Birth-related data
The main outcome, LBW, was defined as a newborn weight below 2500 g. The newborn weight was weighed by obstetric nurses in the delivery room and was recorded into EPHCIS within 24 h of the baby’s birth. Gestational age was calculated from prenatal care records, which is determined by the date of the last menstrual period (LMP) and/or ultrasound during the first trimester. Other conditions including methods of delivery, newborn height, vaginal bleeding, and other data related to the mother and the newborn during delivery were entered into EPHCIS.
Main exposure and other covariates
The primary exposure variable and covariates were collected by questionnaires administered by doctors or nurses of the community health service centers (CHSCs) during their routine prenatal care and postpartum home visits with pregnant mothers. The questionnaires were developed by a study group consisting of trained and certified nurses and physicians and were completed within 3 months of delivery. The information collected included maternal demographics, socioeconomic status, gravidity, parity, miscarriage, abortion history, age at first birth, history of stillbirth or birth defects, weight before pregnancy, weight at birth, history of maternal medical conditions, family disease history, working status, smoking and passive smoking, alcohol consumption, nutrition, level and nature of physical activity, medicine use history, stressors, anxiety, depression, social support, and others.
The exposure for this study was self-reported symptoms of depression and anxiety during pregnancy. Mothers responded with “yes” or “no” on two questions about how they felt during their pregnancy: one that asked if they felt depressed and a second that asked if they felt anxious. They were coded as positive for depression or anxiety if they said yes to either item or positive for depression comorbid anxiety if they said yes to both items.
The WMHCWC was responsible for setting up the database, managing programs, controlling quality, and gathering data. Researchers from the DWCHCHs obtained questionnaire data from their governed CHSCs, entered this information into the database, and then uploaded it to the WMHCWC.
Statistical analysis
Descriptive analyses were used to characterize the participants and their exposures. Chi-squared analysis was used to test possible bivariate associations between the variables and LBW as well as depression or/and anxiety during pregnancy. A binary logistic regression analysis was used to model the relationship of depression or/and anxiety during pregnancy and LBW. In order to examine the moderating effects of PTB, stratified analyses were conducted. In all analyses, odd ratios (ORs) with 95% confidence intervals (CIs) were calculated. All t tests were two tailed and p values below 0.05 were considered statistically significant. Epidata 3.02 was used to enter the data from the questionnaires and SAS version 9.2 (SAS Statistical Institute, Inc., Cary, NC) was used for statistical analysis.
Data were also collected on factors hypothesized to confound the association between mental disorders and LBW. Based on our previous study and the published literatures, we selected the following factors to investigate as potential confounding variables: maternal age, educational attainment, household income, newborn sex, gravidity, previous miscarriage, weight gain, passive smoking, vaginal bleeding, urinary or vaginal infection, and pregnancy complications (heart disease or liver disease or hypertension). The weight gain data was determined by measuring actual height and weight gain during pregnancy and then categorizing weight gain based on pre-pregnancy BMI and the IOM’s 2009 gestational weight gain by BMI category guidelines (Haugen et al. 2014). |
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