| ObjectiveTo explore the relationship between psychosocial stress of peri-conception gravida and congenital heart disease of the infant, carry out psychological counseling and health education during peri-conception, to provided the scientific basis for preventing the offspring of CHD.MethodWe conducted a 1:2 matched case-control study on 188 gravida with infants congenital heart disease as case group and 376 gravida with healthy infants as control group. All women were made antenatal examination and fetal echocardiography in Fujian Provincial Maternity and Child Care Center during January 2010 to December2014. We chose the questionnaire for interaction between environmental and genetic factors in Pre-pregnancy and pregnancy to gather data from 564 gravida, such as the basic information, the exposure of negative life events during peri-conception. We use Symptom Check List 90 to evaluate the maternal mental health status of early pregnancy. We used Epidata 3.1 to enter data and performed data analysis by SPSS19.0: T test, Chi-squared test, rank test, univariate and multivariate Logistic regression analysis.Result1.The rate of negative life events during peri-conception in the case group was31.9%, which was significantly higher than that in the control group(10.6%). The score of SCL-90 in the case group was 205.72±40.20, which was significantly higher than that in the control group(152.30±38.16). The positive rates of mental disorders was also significantly higher in the case group than that in the control group(88.3%VS 36.7%). The positive rates of somatization, obsessive-compulsive symptoms,depression, anxious, paranoid, hostility, terror and other symptoms were significantlyhigher in the case group than that in the control group. And the severity were also significantly higher than that of the control group(P<0.05).2.For women whose expose to negative life events during peri-conception(OR=3.937,95%CI:2.513-6.168)or mental disorders in early pregnancy(OR=13.013,95%CI:7.959-21.277),the offsprings were more likely to have CHD,especially for merged extracardiac anomalies CHD,the exposure of negative life events during peri-conception(OR=6.000,95%CI:3.263-11.032),mental disorders during early pregnancy(OR=13.058,95%CI:5.776-29.519).3.Pregnant women during peri-conception experience marital discord(OR=3.522,95%CI:1.800-6.890), parents don't(OR=3.701,95%CI:1.524-8.987),pressure of work and life(OR=3.832,95%CI:1.395-10.530), seriously illness or injured of a family member(OR=10.246,95%CI:1.188-88.338) and the death of family members(OR=3.597,95%CI:1.040-12.444), the offsprings will have an increased risk of CHD. Pregnant women during early pregnancy with mild depression,anxious,paranoid the offsprings were more likely to CHD(ORs:2.392, 1.518, 1.823respectively). And with the increase of the severity, the risk of CHD increased correspondingly. Mild somatization, interpersonal sensitivity, obsessive-compulsive symptoms, terror, hostility and other symptoms don't increase the risk of CHD, when the degree were increase to moderate-severe, the offsprings will have an significantly increased risk of CHD(ORs:2.367, 4.172, 1.579, 3.662, 1.570, 1.748 respectively).4.The multiple factors logistic models showed:compared to experience one negative life events during peri-conception, the pregnant women who expose to two or more negative life events, the offsprings were more likely to have CHD(OR=4.715,95%CI:1.499-14.838)vs(OR=2.683,95%CI:1.461-4.927).With the increasing of the severity of mental disorders in the pregnant women in the early pregnancy, the risk of CHD increased correspondingly, mild mental disorders(OR=8.315,95%CI:4.689-14.745), moderate mental disorders(OR=16.336,95%CI:8.511-31.356), severe mental disorders(OR =30.512,95%CI:12.951-71.889). Unintended pregnancy could raise the risk of CHD(OR=1.738,95%CI:1.116-2.708). The higher the degree of maternal educational level, the smaller risk for the offspring CHD, high school level(OR=0.180,95%CI:0.034-0.970),college level and above(OR=0.132,95%CI:0.023-0.753).Conclusion1.The women whose expose to psychosocial stress during peri-conception, the offsprings were more likely to have CHD, especially for merged extracardiac anomalies CHD.A dose-effect relationship existed between psychosocial stress of pregnant women during peri-conception and congenital heart disease of the infant.Comparing to the pregnant women who experience one negative life events during peri-conception, the women who expose to two or more negative life events, the offsprings were more likely to have CHD.With the increasing of the severity of mental disorders in the pregnant women in the early pregnancy, the risk of CHD increased correspondingly.2.The high degree of maternal educational level is protective factor of CHD.Unintended pregnancy is risk factor of CHD.3.Strengthening the mental health care during peri-conception, to improve the level of mental health in the pregnant women, especially the women who have the poor education or unintended pregnancy. Timely psychological intervention and psychological counseling on the pregnant women who exposure to negative life events during peri-conception, would reduce the psychosocial stress, have important significance to reduce the incidence of offspring CHD. |
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