经前期紊乱与围产期抑郁之间的双向关联:瑞典的一项全国性登记研究。

IF 15.8 1区 医学 Q1 Medicine PLoS Medicine Pub Date : 2024-03-28 eCollection Date: 2024-03-01 DOI:10.1371/journal.pmed.1004363
Qian Yang, Emma Bränn, Elizabeth R Bertone-Johnson, Arvid Sjölander, Fang Fang, Anna Sara Oberg, Unnur A Valdimarsdóttir, Donghao Lu
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引用次数: 0

摘要

背景:经前期紊乱(PMDs)和围产期抑郁症(PND)具有共同的症状,而且这两种疾病的症状出现时间与自然的荷尔蒙波动相吻合,这可能表明它们具有共同的病因。然而,关于这两种疾病之间潜在的双向联系的前瞻性数据却明显缺乏,而这种联系对于指导临床治疗至关重要。我们利用瑞典全国范围内的前瞻性登记数据,旨在研究 PMD 与 PND 之间的双向关联:2001年至2018年期间,瑞典出生医学登记册记录了1,041,419名妇女的1,803,309次单胎妊娠,我们开展了一项巢式病例对照研究,以考察PMD后发生PND的风险,这相当于一项队列研究,并将该设计过渡为一项具有后续随访的匹配队列研究,以模拟前瞻性研究设计,考察PND后发生PMD的风险(在同一研究人群中)。通过临床诊断或处方药来确定是否发生 PND 和 PMD。我们随机抽取了 10 名未患有 PND 的孕妇,通过发病密度抽样(N:84,949:849,482)与每个 PND 病例的孕产妇年龄和日历年单独匹配。我们(1)在巢式病例对照研究中使用条件逻辑回归法计算了PMD的几率比(OR)和95%置信区间(CI)。对人口统计学因素(出生国、教育程度、居住地区和同居状况)进行了调整。我们(2)在配对队列研究中使用分层考克斯回归法计算了PND后PMD的危险比(HR)和95% CIs。除人口统计学因素外,我们还进一步控制了吸烟、体重指数、胎次和精神病史。为进行同胞比较,确定了 PND 病例全姐妹的怀孕情况,从而对比了每组 PND 不一致的全姐妹的风险。在巢式病例对照研究中,我们在PND女性患者中发现了2488例(2.9%)孕前PMD,在对照组中发现了5199例(0.6%)。PMD与随后发生PND的较高风险相关(OR 4.76,95% CI [4.52,5.01];P < 0.001)。在平均随访7.40年的匹配队列中,我们在患有PND的妇女中发现了4227例新诊断的PMD(发病率(IR)为7.6/1,000人年),在对照组中发现了21326例新诊断的PMD(IR为3.8)。与匹配的对照组相比,罹患PND的妇女随后罹患PMD的风险更高(HR 1.81,95% CI [1.74,1.88];P < 0.001)。产前和产后抑郁均存在双向关联,在无精神病史的妇女中,这种关联性更强(交互作用 p < 0.001)。同胞比较显示的双向关联有所减弱,但在统计学上有显著意义。本研究的主要局限性在于,我们的研究结果是基于登记册中记录的临床诊断,可能无法很好地推广到患有轻度 PMD 或 PND 的妇女:在这项研究中,我们观察到 PMD 与 PND 之间存在双向关联。这些研究结果表明,PMD病史可为PND易感性提供信息,反之亦然,并为这两种疾病之间的共同病因提供了支持。
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The bidirectional association between premenstrual disorders and perinatal depression: A nationwide register-based study from Sweden.

Background: Premenstrual disorders (PMDs) and perinatal depression (PND) share symptomology and the timing of symptoms of both conditions coincide with natural hormonal fluctuations, which may indicate a shared etiology. Yet, there is a notable absence of prospective data on the potential bidirectional association between these conditions, which is crucial for guiding clinical management. Using the Swedish nationwide registers with prospectively collected data, we aimed to investigate the bidirectional association between PMDs and PND.

Methods and findings: With 1,803,309 singleton pregnancies of 1,041,419 women recorded in the Swedish Medical Birth Register during 2001 to 2018, we conducted a nested case-control study to examine the risk of PND following PMDs, which is equivalent to a cohort study, and transitioned that design into a matched cohort study with onward follow-up to simulate a prospective study design and examine the risk of PMDs after PND (within the same study population). Incident PND and PMDs were identified through clinical diagnoses or prescribed medications. We randomly selected 10 pregnant women without PND, individually matched to each PND case on maternal age and calendar year using incidence density sampling (N: 84,949: 849,482). We (1) calculated odds ratio (OR) and 95% confidence intervals (CIs) of PMDs using conditional logistic regression in the nested case-control study. Demographic factors (country of birth, educational level, region of residency, and cohabitation status) were adjusted for. We (2) calculated the hazard ratio (HR) and 95% CIs of PMDs subsequent to PND using stratified Cox regression in the matched cohort study. Smoking, BMI, parity, and history of psychiatric disorders were further controlled for, in addition to demographic factors. Pregnancies from full sisters of PND cases were identified for sibling comparison, which contrasts the risk within each set of full sisters discordant on PND. In the nested case-control study, we identified 2,488 PMDs (2.9%) before pregnancy among women with PND and 5,199 (0.6%) among controls. PMDs were associated with a higher risk of subsequent PND (OR 4.76, 95% CI [4.52,5.01]; p < 0.001). In the matched cohort with a mean follow-up of 7.40 years, we identified 4,227 newly diagnosed PMDs among women with PND (incidence rate (IR) 7.6/1,000 person-years) and 21,326 among controls (IR 3.8). Compared to their matched controls, women with PND were at higher risk of subsequent PMDs (HR 1.81, 95% CI [1.74,1.88]; p < 0.001). The bidirectional association was noted for both prenatal and postnatal depression and was stronger among women without history of psychiatric disorders (p for interaction < 0.001). Sibling comparison showed somewhat attenuated, yet statistically significant, bidirectional associations. The main limitation of this study was that our findings, based on clinical diagnoses recorded in registers, may not generalize well to women with mild PMDs or PND.

Conclusions: In this study, we observed a bidirectional association between PMDs and PND. These findings suggest that a history of PMDs can inform PND susceptibility and vice versa and lend support to the shared etiology between both disorders.

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来源期刊
PLoS Medicine
PLoS Medicine MEDICINE, GENERAL & INTERNAL-
CiteScore
17.60
自引率
0.60%
发文量
227
审稿时长
4-8 weeks
期刊介绍: PLOS Medicine is a prominent platform for discussing and researching global health challenges. The journal covers a wide range of topics, including biomedical, environmental, social, and political factors affecting health. It prioritizes articles that contribute to clinical practice, health policy, or a better understanding of pathophysiology, ultimately aiming to improve health outcomes across different settings. The journal is unwavering in its commitment to uphold the highest ethical standards in medical publishing. This includes actively managing and disclosing any conflicts of interest related to reporting, reviewing, and publishing. PLOS Medicine promotes transparency in the entire review and publication process. The journal also encourages data sharing and encourages the reuse of published work. Additionally, authors retain copyright for their work, and the publication is made accessible through Open Access with no restrictions on availability and dissemination. PLOS Medicine takes measures to avoid conflicts of interest associated with advertising drugs and medical devices or engaging in the exclusive sale of reprints.
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