妊娠合并严重精神障碍精神疾病孕妇妊娠结局的临床分析

doi:10.3877/cma.j.issn.1673-5250.2022.06.016

中华妇幼临床医学杂志(电子版) ›› 2022, Vol. 18 ›› Issue (06) : 739 -744. doi: 10.3877/cma.j.issn.1673-5250.2022.06.016

论著

妊娠合并严重精神障碍精神疾病孕妇妊娠结局的临床分析

鲍引娣¹, 范翠芳¹, 张珺¹, 孙艳梅¹, 杨菁²^,^†(

)

¹武汉大学人民医院妇产科，武汉　430060
²武汉大学人民医院生殖医学中心/湖北省辅助生殖与胚胎发育医学临床研究中心，武汉　430060

收稿日期:2022-05-04 修回日期:2022-10-19 出版日期:2022-12-01
通信作者: 杨菁

Clinical analysis of pregnancy outcomes of psychotic pregnant women with severe mental disorders

Yindi Bao¹, Cuifang Fan¹, Jun Zhang¹, Yanmei Sun¹, Jing Yang²^,^†()

¹Department of Obstetrics and Gynecology, Renmin Hospital of Wuhan University, Wuhan 430060, Hubei Province, China
²Reproductive Medicine Center, Renmin Hospital, Wuhan University / Hubei Clinic Research Center for Assisted Reproductive Technology and Embryonic Development, Wuhan 430060, Hubei Province, China

Received:2022-05-04 Revised:2022-10-19 Published:2022-12-01
Corresponding author: Jing Yang
Supported by:
National Natural Science Foundation of China(81971356)

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引用本文：

鲍引娣, 范翠芳, 张珺, 孙艳梅, 杨菁. 妊娠合并严重精神障碍精神疾病孕妇妊娠结局的临床分析[J/OL]. 中华妇幼临床医学杂志(电子版), 2022, 18(06): 739-744.

Yindi Bao, Cuifang Fan, Jun Zhang, Yanmei Sun, Jing Yang. Clinical analysis of pregnancy outcomes of psychotic pregnant women with severe mental disorders[J/OL]. Chinese Journal of Obstetrics & Gynecology and Pediatrics(Electronic Edition), 2022, 18(06): 739-744.

目的

探讨对合并严重精神障碍(SMI)孕妇采取抗精神疾病药物(APD)治疗对妊娠结局、孕期SMI变化及围生儿结局的影响。

方法

选择2017年1月至2021年12月在武汉大学人民医院住院分娩的154例SMI孕妇为研究对象。采取回顾性分析方法，将154例SMI孕妇分为研究组(n＝70，孕期使用APD治疗)和对照组(n＝84，孕期未采取APD治疗)。对2组孕妇一般临床资料、妊娠结局和并发症发生率，以及2组围生儿结局进行统计学分析。本研究遵循的程序符合2013年修订的《世界医学协会赫尔辛基宣言》要求。

结果

①2组孕妇文化水平、SMI病程、孕期病情加重/APD治疗达到稳定状态后再次复发率和孕前采取APD治疗率比较，差异均有统计学意义(P<0.05)。②研究组孕妇妊娠期糖尿病(GDM)发病率为28.6%(20/70)，显著高于对照组的6.0%(5/84)，并且差异有统计学意义(χ²＝14.36，P<0.001)。③研究组孕妇分娩的生儿出生体重及身长分别为(3 247.1±497.5) g、(49.3±1.6) cm，均显著高于对照组的(2 991.9±456.9) g、(48.7±1.8) cm，并且差异均有统计学意义(t＝3.22、2.04，P＝0.002、0.043)。

结论

对合并SMI孕妇采取APD治疗，可降低已经达到病情稳定SMI孕妇的SMI复发率，有利于维持SMI孕妇的病情稳定，且对SMI孕妇及其围生儿均无明显影响。产科医师应重视对SMI孕妇合并GDM的早期筛查和管理，并对其制定个体化管理方案。

关键词: 严重精神障碍, 抗精神病药, 妊娠期糖尿病, 妊娠结局, 新生儿结局, 孕妇

Objective

To investigate the effects of antipsychotic medication during pregnancy in pregnant women complicated with severe mental illness (SMI) on maternal outcomes, pregnancy condition changes, and perinatal outcomes.

Methods

The clinical data of 154 pregnant women combined with SMI who delivered in the Renmin Hospital of Wuhan University from January 2017 to December 2021 were selected as research subjects. They were divided into experimental group (n=70, regular antipsychotics during pregnancy) and control group (n=84, without psychotropic medication) according to whether they used antipsychotics during pregnancy. The general clinical data, pregnancy outcomes, complications and perinatal outcomes of the two groups were retrospectively analyzed. The study was conducted in accordance with World Medical Association Declaration of Helsinki revised in 2013. All subjects informed consent and signed the informed consent forms for the clinical study.

Results

① There were statistically significant differences between two groups in the terms of educational level, the course of SMI, the percentage of exacerbation/relapse during pregnancy and the percentage of pre-pregnancy psychotropic medication (P<0.05). ② The prevalence of gestational diabetes mellitus (GDM) in pregnant women of experimental group was 28.6% (20/70), which was significantly higher than that in control group (6.0%, 5/84), and the difference was statistically significant (χ²=14.36, P<0.001). ③The birth weight and body length of newborns of experimental group were (3 247.1± 497.5) g and (49.3±1.6)cm, respectively, which were significantly higher or longer than those in control group (2 991.9±456.9) g and (48.7±1.8)cm, and both the differences were statistically significant (t=3.22, 2.04; P=0.002、0.043).

Conclusions

Regular antipsychotics medication in pregnancy complicated with SMI can reduce the incidence of aggravation or recurrence during pregnancy and is beneficial to maintain the stability of the condition. It has no obvious effects on maternal and perinatal outcomes, but the incidence of gestational diabetes increased, we should pay more attention to early screening of GDM and develop individualized management for the population.

Key words: Serious Mental illness, Antipsychotic agents, Gestational diabetes mellitus, Pregnancy outcome, Maternal outcomes, Pregnant women

表1 2组SMI孕妇一般临床资料比较

组别	例数	年龄(岁，±s)	文化水平[例数(%)]		居住地[例数(%)]		孕次[次，M(Q₁，Q₃)]	产次(次，±s)
组别	例数	年龄(岁，±s)	初中及以下	高中及以上	乡镇	城市	孕次[次，M(Q₁，Q₃)]	产次(次，±s)
研究组	70	30.9±3.9	23(32.9)	47(67.1)	31(44.3)	39(55.7)	1(1，2)	1.2±0.4
对照组	84	29.9±4.4	42(50.0)	42(50.0)	39(46.4)	45(53.6)	1(1，2)	1.3±0.5
统计量		t＝1.37	χ²＝4.60		χ²＝0.07		Z＝－0.05	t＝－1.96
P值		0.172	0.032		0.791		0.959	0.052
组别	例数	流产次数[次，M(Q₁，Q₃)]	剖宫产术分娩史[例数(%)]	SMI病程[年，M(Q₁，Q₃)]	SMI类型[例数(%)]			SMI加重/复发[例数(%)]	孕前采取APD治疗[例数(%)]
组别	例数	流产次数[次，M(Q₁，Q₃)]	剖宫产术分娩史[例数(%)]	SMI病程[年，M(Q₁，Q₃)]	精神分裂症	双相情感障碍	其他精神障碍	SMI加重/复发[例数(%)]	孕前采取APD治疗[例数(%)]
研究组	70	0(0，1)	5(7.1)	8.5(4.0，10.0)	47(67.1)	4(5.7)	19(27.1)	13(18.6)	65(92.9)
对照组	84	0(0，1)	15(17.9)	5.0(2.0，10.0)	49(58.3)	7(8.3)	28(33.3)	54(64.3)	36(42.9)
统计量		Z＝－1.22	χ²＝4.96	Z＝－3.00	χ²＝1.32			χ²＝32.95	χ²＝42.29
P值		0.220	0.084	0.003	0.516			<0.001	<0.001

表1 2组SMI孕妇一般临床资料比较

组别	例数	年龄(岁，±s)	文化水平[例数(%)]		居住地[例数(%)]		孕次[次，M(Q₁，Q₃)]	产次(次，±s)
组别	例数	年龄(岁，±s)	初中及以下	高中及以上	乡镇	城市	孕次[次，M(Q₁，Q₃)]	产次(次，±s)
研究组	70	30.9±3.9	23(32.9)	47(67.1)	31(44.3)	39(55.7)	1(1，2)	1.2±0.4
对照组	84	29.9±4.4	42(50.0)	42(50.0)	39(46.4)	45(53.6)	1(1，2)	1.3±0.5
统计量		t＝1.37	χ²＝4.60		χ²＝0.07		Z＝－0.05	t＝－1.96
P值		0.172	0.032		0.791		0.959	0.052
组别	例数	流产次数[次，M(Q₁，Q₃)]	剖宫产术分娩史[例数(%)]	SMI病程[年，M(Q₁，Q₃)]	SMI类型[例数(%)]			SMI加重/复发[例数(%)]	孕前采取APD治疗[例数(%)]
组别	例数	流产次数[次，M(Q₁，Q₃)]	剖宫产术分娩史[例数(%)]	SMI病程[年，M(Q₁，Q₃)]	精神分裂症	双相情感障碍	其他精神障碍	SMI加重/复发[例数(%)]	孕前采取APD治疗[例数(%)]
研究组	70	0(0，1)	5(7.1)	8.5(4.0，10.0)	47(67.1)	4(5.7)	19(27.1)	13(18.6)	65(92.9)
对照组	84	0(0，1)	15(17.9)	5.0(2.0，10.0)	49(58.3)	7(8.3)	28(33.3)	54(64.3)	36(42.9)
统计量		Z＝－1.22	χ²＝4.96	Z＝－3.00	χ²＝1.32			χ²＝32.95	χ²＝42.29
P值		0.220	0.084	0.003	0.516			<0.001	<0.001

表2 2组SMI孕妇妊娠结局及孕期并发症发生率比较

组别	例数	分娩孕龄(周，±s)	分娩方式[例数(%)]		死胎[例数(%)]	妊娠期高血压疾病[例数(%)]	GDM[例数(%)]	胎膜早破[例数(%)]
组别	例数	分娩孕龄(周，±s)	阴道分娩	剖宫产术分娩	死胎[例数(%)]	妊娠期高血压疾病[例数(%)]	GDM[例数(%)]	胎膜早破[例数(%)]
研究组	70	38.3±1.7	16(22.9)	54(77.1)	2(2.9)	11(15.7)	20(28.6)	9(12.9)
对照组	84	38.2±1.8	29(34.5)	55(65.5)	7(8.3)	7(8.3)	5(6.0)	15(17.9)
统计量		t＝0.45	χ²＝2.51		χ²＝1.20^a	χ²＝2.02	χ²＝14.36	χ²＝0.73
P值		0.654	0.113		0.272	0.156	<0.001	0.394

表2 2组SMI孕妇妊娠结局及孕期并发症发生率比较

组别	例数	分娩孕龄(周，±s)	分娩方式[例数(%)]		死胎[例数(%)]	妊娠期高血压疾病[例数(%)]	GDM[例数(%)]	胎膜早破[例数(%)]
组别	例数	分娩孕龄(周，±s)	阴道分娩	剖宫产术分娩	死胎[例数(%)]	妊娠期高血压疾病[例数(%)]	GDM[例数(%)]	胎膜早破[例数(%)]
研究组	70	38.3±1.7	16(22.9)	54(77.1)	2(2.9)	11(15.7)	20(28.6)	9(12.9)
对照组	84	38.2±1.8	29(34.5)	55(65.5)	7(8.3)	7(8.3)	5(6.0)	15(17.9)
统计量		t＝0.45	χ²＝2.51		χ²＝1.20^a	χ²＝2.02	χ²＝14.36	χ²＝0.73
P值		0.654	0.113		0.272	0.156	<0.001	0.394

表3 2组SMI孕妇所分娩新生儿结局比较

组别	例数	出生体重(g，±s)	出生身长(cm，±s)	生后1 min Apgar评分[例数(%)]	生后5 min Apgar评分[例数(%)]	早产[例数(%)]
研究组	68	3 247.1±497.5	49.3±1.6	0(0)	0(0)	9(13.2)
对照组	77	2 991.9±456.9	48.7±1.8	3(3.9)	1(1.3)	11(14.3)
统计量		t＝3.22	t＝2.04	χ²＝3.85	χ²＝2.70	χ²＝0.03
P值		0.002	0.043	0.248	0.259	0.855
组别	例数	新生儿畸形[例数(%)]	转入NICU[例数(%)]	足月低出生体重儿[%(n/n′)]^a	足月巨大儿[%(n/n′)]^b	性别[例数(%)]
组别	例数	新生儿畸形[例数(%)]	转入NICU[例数(%)]	足月低出生体重儿[%(n/n′)]^a	足月巨大儿[%(n/n′)]^b	男	女
研究组	68	1(1.5)	4(5.9)	3.4(2/59)	10.2(6/59)	34(50.0)	34(50.0)
对照组	77	0(0)	9(11.7)	6.1(4/66)	3.0(2/66)	41(53.2)	36(46.8)
统计量		χ²＝1.52	χ²＝1.49	χ²＝0.49	χ²＝2.65	χ²＝0.15
P值		0.217	0.222	0.486	0.104	0.696

表3 2组SMI孕妇所分娩新生儿结局比较

组别	例数	出生体重(g，±s)	出生身长(cm，±s)	生后1 min Apgar评分[例数(%)]	生后5 min Apgar评分[例数(%)]	早产[例数(%)]
研究组	68	3 247.1±497.5	49.3±1.6	0(0)	0(0)	9(13.2)
对照组	77	2 991.9±456.9	48.7±1.8	3(3.9)	1(1.3)	11(14.3)
统计量		t＝3.22	t＝2.04	χ²＝3.85	χ²＝2.70	χ²＝0.03
P值		0.002	0.043	0.248	0.259	0.855
组别	例数	新生儿畸形[例数(%)]	转入NICU[例数(%)]	足月低出生体重儿[%(n/n′)]^a	足月巨大儿[%(n/n′)]^b	性别[例数(%)]
组别	例数	新生儿畸形[例数(%)]	转入NICU[例数(%)]	足月低出生体重儿[%(n/n′)]^a	足月巨大儿[%(n/n′)]^b	男	女
研究组	68	1(1.5)	4(5.9)	3.4(2/59)	10.2(6/59)	34(50.0)	34(50.0)
对照组	77	0(0)	9(11.7)	6.1(4/66)	3.0(2/66)	41(53.2)	36(46.8)
统计量		χ²＝1.52	χ²＝1.49	χ²＝0.49	χ²＝2.65	χ²＝0.15
P值		0.217	0.222	0.486	0.104	0.696

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Clinical analysis of pregnancy outcomes of psychotic pregnant women with severe mental disorders

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Clinical analysis of pregnancy outcomes of psychotic pregnant women with severe mental disorders