Relationships of social support with depression, anxiety and pregnancy outcome in patients with gestational diabetes mellitus in the second and third trimesters
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摘要:目的
探讨妊娠糖尿病(GDM)患者孕中晚期社会支持水平与抑郁、焦虑及妊娠结局的关系。
方法采用纵向研究设计方法, 通过社会支持评定量表(SSRS)、抑郁自评量表(SDS)、焦虑自评量表(SAS)等工具对2020年7月—2022年3月于扬州市妇幼保健院定期产检的孕中晚期GDM患者进行调查，并随访统计其妊娠结局。
结果211例GDM患者孕中晚期社会支持总分为(38.39±6.17)分，处于中等水平; 102例患者发生不良妊娠结局。线性回归分析显示，孕妇的工作情况显著影响社会支持总分(P < 0.05), 家庭居住地、孕期家庭经济支持情况影响客观支持评分(P < 0.05), 产次影响主观支持评分(P < 0.05), 工作情况、丈夫学历、孕期家庭经济支持影响对支持的利用度评分(P < 0.05)。相关性分析结果显示，客观支持、对支持的利用度、总社会支持与产后出血呈负相关(r=-0.194、-0.240、-0.203, P < 0.05); SDS评分与分娩出巨大儿呈正相关(r=0.258, P < 0.05)。二元Logistic回归分析显示，对支持的利用度是产后出血的保护因素(OR=0.440, 95%CI: 0.264~0.734, P=0.002), 抑郁(OR=2.118, 95%CI: 1.088~4.125, P=0.027)、孕前体质量指数(OR=1.223, 95%CI: 1.096~1.364, P < 0.001)是GDM患者分娩巨大儿的危险因素，丈夫学历是GDM患者分娩巨大儿的保护因素(OR=0.268, 95%CI: 0.120~0.595, P=0.001)。
结论GDM患者孕中晚期社会支持水平与抑郁、焦虑情绪密切相关，提升孕中晚期社会支持水平是改善GDM患者妊娠结局的潜在干预策略。
Abstract:ObjectiveTo explore the relationships of social support with depression, anxiety and pregnancy outcome in patients with gestational diabetes mellitus (GDM) in the second and third trimester of pregnancy.
MethodsA longitudinal study was conducted to investigate the patients diagnosed with GDM in Yangzhou Maternal and Child Health Hospital from July 2020 to March 2022 by using Social Support Rating Scale (SSRS), Self-Rating Depression Scale (SDS), Self-Rating Anxiety Scale (SAS) and other tools, and to follow up the pregnancy outcomes.
ResultsThe social support scores of 211 GDM patients were (38.39±6.17), which were in the middle level. There were 102 cases of adverse pregnancy outcomes. Linear regression analysis showed that the working situation of pregnant women significantly affected the total score of social support (P < 0.05), family residence and family economic support during pregnancy affected the objective support score (P < 0.05), and the parity affected the subjective support score (P < 0.05). Workingstatus, husband's education background and family economic support during pregnancy affected the utilization of support (P < 0.05). The results of correlation analysis showed that objective support, utilization of support and total social support were negatively correlated with postpartum hemorrhage (r=-0.194, -0.240, -0.203, P < 0.05). Binary Logistic regression analysis showed that the utilization of support was a protective factor for postpartum hemorrhage (OR=0.440; 95%CI, 0.264 to 0.734; P=0.002), and depression (OR=2.118; 95%CI, 1.088 to 4.125; P=0.027) and pre-pregnancy body mass index (OR=1.223; 95%CI, 1.096 to 1.364; P < 0.001) were risk factors for macrosomia in GDM patients, and husband's education background was a protective factor for macrosomia in GDM patients (OR=0.268; 95%CI, 0.120 to 0.595, P=0.001).
ConclusionThe level of social support is closely related to depression and anxiety. Therefore, improving the level of social support in the second and third trimesters of pregnancy is a potential intervention strategy to improve the pregnancy outcome of GDM patients.
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表 1 社会支持影响因素的线性回归分析
因变量 自变量 回归系数B 标准误 t P 社会支持总分 工作情况 2.76 1.07 2.58 0.010 客观支持评分 家庭居住地 0.91 0.40 2.30 0.022 孕期家庭经济支持 1.25 0.44 2.82 0.005 主观支持评分 产次 1.41 0.63 2.23 0.027 对支持的利用度评分 工作情况 0.91 0.33 2.81 0.005 丈夫学历 0.59 0.29 2.00 0.040 孕期家庭经济支持 -1.09 0.34 -3.23 0.001 
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表 2 巨大儿影响因素的二元Logistic回归分析
变量 回归系数 标准误 Wald χ2 P OR(95%CI) 抑郁 0.751 0.340 4.873 0.027 2.118(1.088~4.125) 孕前体质量指数 0.201 0.056 13.003 < 0.001 1.223(1.096~1.364) 丈夫学历 -1.318 0.408 10.453 0.001 0.268(0.120~0.595)
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[1] 中华医学会妇产科学分会产科学组, 中华医学会围产医学分会, 中国妇幼保健协会妊娠合并糖尿病专业委员会, 等. 妊娠期高血糖诊治指南(2022)[第一部分][J]. 中华妇产科杂志, 2022, 57(1): 3-12. [2] MENSAH G P, VAN ROOYEN D R M, TEN HAM-BALOYI W. Nursing management of gestational diabetes mellitus in Ghana: perspectives of nurse-midwives and women[J]. Midwifery, 2019, 71: 19-26. doi: 10.1016/j.midw.2019.01.002
[3] GAO C H, SUN X, LU L, et al. Prevalence of gestational diabetes mellitus in mainland China: a systematic review and meta-analysis[J]. J Diabetes Investig, 2019, 10(1): 154-162. doi: 10.1111/jdi.12854
[4] 刘艺, 牛蓓. 妊娠期糖尿病患者心理健康状况的调查[J]. 国际护理学杂志, 2018, 37(2): 167-172. doi: 10.3760/cma.j.issn.1673-4351.2018.02.007 [5] 陈玲, 陈文玮, 陈黎, 等. 妊娠期糖尿病经产妇口服葡萄糖耐量试验时间-血糖曲线的曲线下面积与妊娠结局的相关性[J]. 实用临床医药杂志, 2021, 25(19): 98-100, 106. doi: 10.7619/jcmp.20212937 [6] HARRISON A L, TAYLOR N F, SHIELDS N, et al. Attitudes, barriers and enablers to physical activity in pregnant women: a systematic review[J]. J Physiother, 2018, 64(1): 24-32. doi: 10.1016/j.jphys.2017.11.012
[7] IZADIRAD H, NIKNAMI S, ZAREBAN I, et al. Effects of social support and self-efficacy on maternal prenatal cares among the first-time pregnant women, iranshahr, Iran[J]. J Family Reprod Health, 2017, 11(2): 67-73.
[8] 李伟波, 谢晶晶. 妊娠期女性妊娠压力与心理健康现状和社会支持状况相关性分析[J]. 中国妇幼保健, 2021, 36(14): 3317-3320. doi: 10.19829/j.zgfybj.issn.1001-4411.2021.14.049 [9] JUAN J, YANG H X. Prevalence, prevention, and lifestyle intervention of gestational diabetes mellitus in China[J]. Int J Environ Res Public Health, 2020, 17(24): 9517. doi: 10.3390/ijerph17249517
[10] WEI D M, AU YEUNG S L, HE J R, et al. The role of social support in family socio-economic disparities in depressive symptoms during early pregnancy: evidence from a Chinese birth cohort[J]. J Affect Disord, 2018, 238: 24-32. doi: 10.1016/j.jad.2018.05.029
[11] JONSDOTTIR S S, THOME M, STEINGRIMSDOTTIR T, et al. Partner relationship, social support and perinatal distress among pregnant Icelandic women[J]. Women Birth, 2017, 30(1): e46-e55. doi: 10.1016/j.wombi.2016.08.005
[12] 唐昭, 邓梦瑶, 周伽, 等. 妊娠期糖尿病患者的社会支持现状及影响因素分析[J]. 安徽医科大学学报, 2021, 56(3): 462-466. https://www.cnki.com.cn/Article/CJFDTOTAL-YIKE202103025.htm [13] 沈亚平. 妊娠期糖尿病患者孕期自我管理现状及影响因素分析[D]. 北京: 北京协和医学院, 2018. [14] 余洪. 产前心理护理干预对初产妇分娩方式、产后出血及产后心理的影响[J]. 实用医院临床杂志, 2020, 17(3): 185-188. https://www.cnki.com.cn/Article/CJFDTOTAL-YYLC202003054.htm [15] CALLAGHAN W M, KUKLINA E V, BERG C J. Trends in postpartum hemorrhage: United States, 1994-2006[J]. Am J Obstet Gynecol, 2010, 202(4): 353. e1-353. e6.
[16] GILBERT L, GROSS J, LANZI S, et al. How diet, physical activity and psychosocial well-being interact in women with gestational diabetes mellitus: an integrative review[J]. BMC Pregnancy Childbirth, 2019, 19(1): 60.
[17] HONG O Y, BO C, ABDULRAHMAN A M, et al. Associations between gestational diabetes and anxiety or depression: a systematic review[J]. J Diabetes Res, 2021, 2021: 9959779.
[18] 陈娟, 张晓燕, 张媚梅, 等. 妊娠期糖尿病产妇分娩镇痛过程血糖水平的健康干预[J]. 实用临床医药杂志, 2021, 25(6): 110-112. doi: 10.7619/jcmp.20201122 [19] 陈雪香, 魏碧蓉, 陈良英, 等. 妊娠糖尿病患者抑郁状况及其影响因素研究[J]. 中国护理管理, 2015, 15(9): 1071-1073, 1074. https://www.cnki.com.cn/Article/CJFDTOTAL-GLHL201509018.htm [20] 佘露, 张培, 王世伟, 等. 妊娠期糖尿病孕妇和糖耐量正常孕妇妊娠压力与社会支持的相关性研究[J]. 现代预防医学, 2022, 49(7): 1222-1225, 1240. https://www.cnki.com.cn/Article/CJFDTOTAL-XDYF202207014.htm [21] 陶旻枫, 丁辉, 游川, 等. 北京市围产营养门诊妊娠期糖尿病孕妇的焦虑、抑郁状况及相关影响因素[J]. 神经疾病与精神卫生, 2017, 17(4): 257-260. [22] EGAN A M, DUNNE F P, LYDON K, et al. Diabetes in pregnancy: worse medical outcomes in type 1 diabetes but worse psychological outcomes in gestational diabetes[J]. QJM, 2017, 110(11): 721-727.
[23] KC K, SHAKYA S, ZHANG H. Gestational diabetes mellitus and macrosomia: a literature review[J]. Ann Nutr Metab, 2015, 66(Suppl 2): 14-20.
[24] SIMMONS D, JELSMA J G M, GALJAARD S, et al. Results from a European multicenter randomized trial of physical activity and/or healthy eating to reduce the risk of gestational diabetes mellitus: the DALI lifestyle pilot[J]. Diabetes Care, 2015, 38(9): 1650-1656.
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