背景:母体应激已被确定为与早产相关的最常见的临床表型之一。美国妇产科医师学会建议在围产期至少进行一次焦虑筛查。围产期焦虑的患病率受到缺乏正式筛查方案和高危人群报告不足的挑战。例如有不良妊娠结局史的患者。
目的:本研究在有或无自发性早产患者的队列中使用了一种有效的焦虑筛查工具,并比较了组间评分和阳性筛查率的差异。此外,这项研究评估了与阳性筛查相关的围产期结局,并描述了一项转诊方案,包括围产期心理健康咨询师的评估和临床诊断.假设先前有自发性早产史的患者会比对照组有更高的自我报告的焦虑症状,而那些在妊娠<35周时复发性早产的患者会有最高的焦虑筛查得分。
方法:这是一项前瞻性观察性队列研究,对我们机构2个产前护理诊所的患者进行广泛性焦虑症7项筛查。早产队列由有自发性早产病史的患者组成,胎膜早破,或宫颈机能不全与没有此病史的对照组相比。筛查是在进入产前护理或转诊到我们的高风险产科诊所时开始的。纳入标准包括说英语或西班牙语的患者和单胎妊娠,排除标准包括妊娠合并重大先天性异常,妊娠34周后登记,妊娠<20周时分娩,和不完整的交付数据。对于广泛性焦虑症7项屏幕得分≥10的患者,将其转诊给心理健康顾问。围产期结局比较广泛性焦虑症7项筛查阳性组与广泛性焦虑症7项筛查阴性组,包括学生t检验,卡方检验,和Wilcoxon秩和检验,P值<.05以确定显著性。
结果:在2020年9月至2021年12月之间,对1349名参与者进行了分析,在先前的早产队列中有143例患者(11%),在对照组中有1206例(89%)。在研究妊娠中,有早产和妊娠≤35周随后分娩史的患者,其广泛性焦虑症7项筛查评分明显高于妊娠35周后分娩的对照组(中位评分:4[四分位距,1-9]vs2[四分位数间距,0-6],分别为;P=.006)。总的来说,187名参与者(14%)筛查阳性,在先前的早产组中明显高于对照组(20%vs13%;P=0.036)。值得注意的是,117名患者(63%)接受了转诊,32例(17%)筛查阳性的患者被诊断为围产期情绪障碍。
结论:使用广泛性焦虑症7项筛查,复发性早产患者的自我报告焦虑高于对照组。在那些有正面屏幕的人中,17%的人被诊断患有围产期情绪障碍。
BACKGROUND: Maternal stress has been identified as one of the most common clinical phenotypes associated with preterm birth. The American College of Obstetricians and Gynecologists recommends anxiety screening at least once in the perinatal period. The prevalence of perinatal anxiety is challenged by the absence of formalized screening protocols and underreporting in high-risk populations, such as those with a history of adverse pregnancy outcomes.
OBJECTIVE: This
study administered a validated anxiety screening tool in a cohort of patients with and without a previous spontaneous preterm birth and compared differences in score and rate of a positive screen between groups. Moreover, this
study evaluated perinatal outcomes associated with a positive screen and described a referral protocol involving evaluation by a perinatal mental health counselor and clinical diagnoses. A hypothesis was made that patients with a previous history of spontaneous preterm birth would have higher self-reported anxiety symptoms than controls and that those with recurrent preterm delivery at <35 weeks of gestation would have the highest anxiety screening scores.
METHODS: This was a prospective observational cohort
study administering the Generalized Anxiety Disorder 7-item screen to patients enrolled in 2 prenatal care clinics at our institution. The preterm birth cohort consisted of patients with a history of spontaneous preterm labor, premature rupture of membranes, or cervical insufficiency compared with the control cohort without this history. Screening was initiated at entry to prenatal care or referral to our high-risk obstetrical clinic. The inclusion criteria included English- or Spanish-speaking patients and singleton pregnancy, and the exclusion criteria included pregnancies complicated by a major congenital anomaly, enrollment after 34 weeks of gestation, delivery at <20 weeks of gestation, and incomplete delivery data. Referral to a mental health counselor was offered to those with a Generalized Anxiety Disorder 7-item screen score of ≥10. Perinatal outcomes as a comparison between the Generalized Anxiety Disorder 7-item screen-positive group and Generalized Anxiety Disorder 7-item screen-negative group were performed with statistical methods, including the Student t test, chi-square test, and Wilcoxon rank-sum test, with a P value of <.05 to determine significance.
RESULTS: Between September 2020 and December 2021, 1349 participants were analyzed, with 143 patients (11%) in the previous preterm birth cohort and 1206 (89%) patients in the control cohort. Patients with a history of preterm birth and subsequent delivery at ≤35 weeks of gestation in the
study pregnancy had significantly higher Generalized Anxiety Disorder 7-item screen scores than controls with delivery after 35 weeks of gestation (median score: 4 [interquartile range, 1-9] vs 2 [interquartile range, 0-6], respectively; P=.006). Overall, 187 participants (14%) screened positive with significantly higher rates in the previous preterm birth group than in the control group (20% vs 13%; P=.036). Of note, 117 patients (63%) accepted a referral, and 32 patients (17%) with a positive screen were diagnosed with a perinatal mood disorder.
CONCLUSIONS: Patients with recurrent preterm birth have higher self-reported anxiety using the Generalized Anxiety Disorder 7-item screen than controls. Of those with a positive screen, 17% were diagnosed with a perinatal mood disorder.