Correlation And Interaction Between Adverse Symptoms During Pregnancy And Perinatal Depressive Symptoms Based On Classification Tree Model

Objective:1.To learn the current incidence of perinatal depressive symptoms in pregnant women and to analyze the risk factors of depressive symptoms.2.To explore the relationship between gestational hypertension,gestational diabetes mellitus and perinatal depressive symptoms.3.To explore the interaction between those factors affecting perinatal depressive symptoms,in order to provide theoretical for promoting physical and mental health of pregnant women.Methods:The subjects of the survey were from a prospective cohort study,which recruited pregnant women when pregnancy is less than 16 weeks.The study conducted basic demographic data collection from pregnant women who were enrolled in the cohort in January 2017 and had completed delivery for one month in June 2018.Questionnaires were conducted during the second trimester and follow-up to one month after delivery.The main contents include:social demographic data of pregnant women,registered blood pressure values during pregnancy check-up,glucose tolerance test results,pregnancy discomfort symptoms,nutritional supplements during pregnancy,pregnancy outcomes during childbirth;perinatal depression questionnaires include prenatal depressive symptoms and a one-month postpartum depression symptom after birthing.The data were analyzed by SPSS22.0 statistical analysis software.The influence factors of perinatal depressive symptoms were analyzed by chi-square test,unconditional logistic regression model and classification tree models.The classification tree models were used to explore the interaction with the influencing factors.Results:1.A total of 943 cases of pregnant women were collected in the study.After the arrangement,excluded 2 subjects who withdrawal cohort during pregnancy,18 birthed in other hospitals and 26 ineffective questionnaires,in the end 897 cases of pregnant women included in the study,the effective rate of questionnaires was 95.12%.The average age of the subjects was(29.87±3.93)years old,the average body weight before pregnancy(54.57±8.34)kg,and the average gestational age of delivery was(39.24±1.13)weeks.2.The questionnaires survey used the simplified version of the Center for Epidemiologic Studies Depression Scale 10 showed that the average score of prenatal depression was(6.68±3.85),the prenatal depression detection rate was 20.8%;postpartum depression is investigated using the Edinburgh Postnatal Depression Scale showed that the average score of postpartum depression was(9.08±3.95),the postpartum depression detection rate was 17.5%.3.Analysis of the influencing factors of perinatal depressive symptoms.The protective factors for prenatal depressive symptoms were:family annual total income? 30,000 yuan(OR=0.482,95%CI:0.249?0.931),calcium supplementation when pregnancy is greater than 3 months(OR=0.626,95%CI:0.437?0.897);risk factors were:protein powder supplemented when pregnancy is greater than 3 months(OR=3.061,95%CI:1.271?7.372),gestational diabetes mellitus(OR=2.178,95%CI:1.373?3.456).The protective factors for postpartum depression were:age(?35 years old)(OR=0.553,95%Cl:0.307-0.995),working during pregnancy(OR=0.630,95%CI:0.383?1.035);risk factors included:prenatal depressive symptoms(OR=1.827,95%CI:1.223?2.729),with gestational diabetes mellitus(OR=2.940,95%CI:1.827?4.731),vaginal bleeding symptoms during pregnancy(OR=1.533,95%CI:1.025?2.291).4.The prenatal depression classification tree model had 2 layers,5 nodes,and 3 terminal nodes.Among them,gestational diabetes mellitus was the primary risk factor for prenatal depression,and secondly,calcium supplementation for when pregnancy is greater than 3 months is also a major factor affecting the occurrence of prenatal depressive symptoms;In the classification tree model of factors affecting postpartum depression,the results showed that there were 3 layers,9 nodes,and 5 terminal nodes.Prenatal depressive symptoms was a risk factor affecting postpartum depression on the second layer of the classification tree model.According to the hierarchical relationship between the influencing factors,the results of interaction analysis showed that there is positive additive interaction between prenatal depressive symptoms and age grouping,RERI=1.715,(95%CI:0.401?3.029),AP=0.519,(95%CI:0.208?-0.831),S=3.914,(95%CI:1.671?22.846).Conclusions:1.Family annual total income,supplementation of calcium when pregnancy is greater than 3 months,supplementation of protein powder when pregnancy is greater than 3 months,and gestational diabetes mellitus are factors affecting prenatal depressive symptoms.Among them,gestational glucose mellitus is the main risk factor of prenatal depressive symptoms in this study.2.Age(?35 years old),work during pregnancy,multivitamin supplementation when pregnancy less than 3 months,multivitamin supplementation when pregnancy is greater than 3 months,prenatal depressive symptoms,gestational diabetes mellitus,vaginal bleeding during pregnancy symptom are factors affecting postpartum depressive symptoms.Among them,gestational diabetes mellitus and prenatal depressive symptoms are the main risk factors of postpartum depressive symptoms.3.The effect of prenatal depression and age grouping(?35 years)on postpartum depression symptoms has an additive interaction.Therefore,when the younger pregnant women have abnormal blood glucose during pregnancy,they should pay more attention to the changes of the psychological state of pregnant women,and avoid the influence of physiological symptoms and psychological symptoms interact effect on the postpartum psychological state of pregnant women.4.Health care workers and pregnant women should pay more attention to whether they have symptoms of vaginal bleeding during pregnancy.So as to avoid the burden on pregnant women,leading to adverse psychological symptoms.