| 【Background】 Women of child-bearing age have many physiological and social psychological changes brought by pregnancy and delivery,and are more likely to have or relapse psychological distress.Depression and anxiety are the most common psychological distress during pregnancy,the incidence of anxiety and depression during pregnancy is reported 8-10% by WHO.What’s more,60% of pregnant women with depression during pregnancy are often accompanied by other psychological distress,of which anxiety accounts for 80%.A growing body of research suggests that mothers who are depressed or anxious during pregnancy are more likely to delivery by cesarean delivery and their offspring are more likely to have adverse birth outcomes,mainly including low birth weight and preterm birth.The mechanism by which psychological distress during pregnancy influence adverse perinatal outcomes may be based on the hypothalamic-pituitary-adrenal axis.High levels of epinephrine exposure would activate the sympathetic nervous system and affect uterine muscle contractions,while increased catecholamine release would lead to placental hypoperfusion,which in turn increases the risk of adverse birth outcomes.Although studies based on the natural pregnancy population have shown that psychological factors have a significant impact on the clinical decision of cesarean section and adverse birth outcomes in offspring,there has been no study to explore the relationship between perinatal outcomes and psychological factors during pregnancy in ART pregnant women.Infertility is reported to affect about 9-15% of couples of childbearing age worldwide.In China,up to 15-20% of women of childbearing age are infertile.As the number of infertile people is steadly increasing recently,assisted reproductive technology(ART)has been widely used and become the most important method to treat infertility.Up to date,more than 400,000 newborns in China have been born with ART.Compared to those who conceived naturally,some studies have found that women who conceived with ART tend to suffer higher distress level during pregnancy including more depressive or anxious symptoms.In addition,ART pregnant women would have higher rates of cesarean sections and risk of PTB or LBW of their offsprings.It’s warranted to investigate on the association between prenatal psychological distress of ART pregnant women and delivery mode,PTB and LBW in 1st,2nd,3rd trimester of pregnancy.Therefore,we conducted a prospective study to investigate the effect of psychological distress during pregnancy on cesarean section without clinical indications,PTB,and LBW among ART pregnant women.【Method】 We conducted a prospective study within the Jiangsu Birth Cohort Study,we included all 1825 women conceived up to 20 weeks’ gestation through the ART procedures between August 2016 and May 2019.We collected baseline and exposure information by on-site questionnaire follow-ups,hospital electronic medical record collection,and telephone follow-ups.The outcome variables related to delivery mode,preterm birth and low birth weight were collected by searching the clinical reproduction medicine management system and obtained by using hospital information system.CS without clinical indications was coded according to the International Classification of Diseases,10 th edition(ICD-10 codes).After sorting and summarizing the relevant literature,covariates are separately included for analysis.In the Jiangsu birth cohort,strict quality controls on the implementation of this study ensure the credibility of our findings.We compared the distribution of maternal characteristics for included study population according to delivery mode and birth outcomes.We then analyzed the effect of psychological distress during pregnancy on delivery mode and birth outcomes separately.The risk ratio(RR)and its 95% confidence intervals(CI)were calculated with the use of poisson regression model.【Results】 A total of 400 CS without clinical indications-and 458 vaginaldeliveries were included in final analysis.Compared with vaginal delivery,we found the age of women were significantly older,the proportion of pre-pregnancy overweight or obese,GDM,GH and frozen type were significantly higher in CS group.In the univariate analysis,we found depression in 3rd trimester of pregnancy would increase the risk of CS without clinical indications(crude RR: 1.52,95%CI:1.1–2.08),what’s more,depression with anxiety in 3rd trimester of pregnancy would increase the risk of CS without clinical indications(crude RR: 1.93,95%CI:1.14–3.26).In addition,longest duration of suffering from any symptom would affect delivery mode(crude RR: 1.93,95%CI: 1.14–3.26).In the multivariable poisson regression,after adjusting for female age,annual household income,BMI before pregnancy,education level,parity,GDM,GH,cycle type and fertilization method depression in 3rd trimester of pregnancy would increase the risk of CS without clinical indications(adjusted RR: 1.46,95%CI: 1.05–2.02).When considering psychological distress during overall periods of pregnancy,both unadjusted and adjusted mixed effect model showed that higher distress level would increase the likelihood of CS without clinical indications.The overall incidence of PTB in this study was 8.7%,LBW was 5.0%.With regard to PTB,A total of 114 PTB and 1196 non-PTB were included in final analysis.Compared with non-PTB group,we found the proportion of women who had alcohol use during pregnancy were significantly higher in PTB group.With regard to LBW,A total of 65 LBW and 1245 non-LBW were included in final analysis.Compared with non-LBW group,we found the proportion of women who were overweight or obese before pregnancy were significantly higher in LBW group.Except for covariates above,other baseline characteristics of the study population were similar in the two study groups.In the univariate analysis,we found depression in 3rd trimester of pregnancy would increase the risk of PTB(crude RR: 2.36,95%CI: 1.29–4.31)and LBW(crude RR: 3.32,95%CI: 1.57–7.04).In addition,duration of suffering from any symptom would not affect PTB or LBW.In the multivariable poisson regression,after adjusting for female age,annual household income,BMI before pregnancy,education level,parity,GDM,GH,cycle type and fertilization method,depression in3 rd trimester of pregnancy would increase the risk of PTB(adjusted RR: 2.21,95%CI:1.2-4.06)and LBW(adjusted RR: 3.16,95%CI: 1.47–6.79).When considering psychological distress during overall periods of pregnancy,no association was found between psychological distress and of PTB or LBW after adjusting for potential covariates.【Conclusion】 Our findings support effect of depressive symptom in 3rd trimester of pregnancy on CS without clinical indications,PTB and LBW among pregnant women undergoing Assisted Reproductive Technology.What’s more,our results suggest that higher distress level during overall periods of pregnancy have effect on CS without clinical indications,while on effect on PTB and LBW.Therefore,more concern should be put on maternal psychological distress,and policies aimed at detection and management of prenatal psychological distress may reduce CS without clinical indications and help improve birth outcomes. |
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