臺灣初產婦孕前身體質量指數及孕期體重增加量對孕期憂鬱之影響

Abstract

背景：母親體重和孕期憂鬱皆會影響婦女健康與子代發展，兩者已是全球性的婦女健康議題。過去研究顯示孕前身體質量指數或孕期增重量與孕期憂鬱相關。相較於西方國家，東亞婦女孕前體重過輕的比例較高，但此類研究明顯缺少東亞婦女的相關結果。 目的：了解臺灣初產婦孕前身體質量指數、孕期增重量和孕期憂鬱現況，並探討孕前身體質量指數和孕期增重量與孕期憂鬱之間的相關性。 研究方法：本研究採橫斷式研究設計。研究對象為初產婦，自台灣北部三家醫學中心收案（N=188）。自2022年1月至5月，運用結構式問卷和面訪方式於第二孕期進行資料收集。變項包含社會人口學特性、孕期相關變項、過去病史、健康行為（菸酒習慣、身體活動、飲食行為）、家庭關係和支持、身高、孕前和孕期體重、憂鬱等。孕期憂鬱採用愛丁堡產後憂鬱量表測量，總分13分以上定義為孕期憂鬱。孕前身體質量指數（BMI）使用孕婦自述懷孕前身高和體重進行計算，分成三組：過輕（<18.5kg/m2）、適中（18.5≤BMI<25kg/m2）、過重和肥胖（≥25kg/m2）。孕期體重取自孕婦健康手冊和病歷紀錄的產檢體重。孕期每週平均增重量以收案時體重減去孕前體重，再以實際對應的週數平均之。以國健署建議的孕期增重10-14公斤再除以40週作為孕期每週平均增重量分類標準，區分為每週增重量過少（<0.25 kg）、適當（0.25-0.35 kg）與過多（>0.35 kg）。以卡方檢定和二元羅吉斯迴歸檢測孕前身體質量指數和孕期增重量與孕期憂鬱之間的相關性。 結果：初產婦的第二孕期憂鬱率為12.3%。懷孕前體重過輕（BMI <18.5 kg/m2）和過重肥胖（BMI ≥25 kg/m2）的初產婦分別占11.2%和14.4%。雙變項分析中，孕前體重過輕者（28.6%）的孕期憂鬱率高於孕前體重正常者（10.7%）和過重與肥胖者（7.4%）；孕期每週平均增重量過多（31.3%）的孕期憂鬱率高於每週平均增重量適當（12.1%）和過少（10.1%）。二元羅吉斯迴歸指出當控制年齡、家庭收入、曾終止妊娠、胎兒性別期待、憂鬱症病史、婆媳關係、孕前運動習慣與含糖飲料飲用次數等變項後，孕前體重過輕（OR=6.37，p<0.01）和孕期每週增重量過多（OR=5.06，p=0.04）與較高的第二孕期憂鬱傾向有關。當把孕前身體質量指數和孕期增重量一起考慮時，則孕前體重過輕且孕期每週增重量過少者具有較高的第二孕期憂鬱風險（OR=7.19，p<0.01）。 結論：臺灣初產婦第二孕期憂鬱率高。孕前體重過輕和孕期平均每週增重量>0.35公斤為孕期憂鬱之重要危險因子。孕前過輕且孕期平均每週增重量少於0.25kg的孕婦有較高的孕期憂鬱風險。建議產檢時，除了提供合適體重衛教之外，也應依據孕前BMI和孕期增重量，及早提供孕期憂鬱評估和轉介，以促進孕婦健康。建議未來研究驗證母親體重和孕期憂鬱的因果關係，以及針對孕前體重過輕婦女探討孕期憂鬱的相關危險因子。

Background: Maternal weight and depression during pregnancy could affect women's health and offspring development, which have been viewed as global health issues for women. Previous studies indicated that pre-pregnancy body mass index (BMI) or gestational weight gain was associated with depression during pregnancy. When compared to women in Western countries, those in East Asia had a higher rate of underweight. However, previous studies were less likely to focus on women with lower BMI, including those residing in East Asia. Objectives: This study aimed to describe pre-pregnancy BMI, gestational weight gain, and depression during pregnancy and explore the association of pre-pregnancy BMI and gestational weight gain with depression during pregnancy among primipara women in Taiwan. Method: This study employed an observational, cross-sectional study design. Primipara women who were singleton were recruited from three medical centers in northern Taiwan (N=188). The data were collected by face-to-face using a structured questionnaire in the second trimester (12 to 24 weeks of gestation) from January to May 2022. The variables in the structured questionnaire included sociodemographic variables, pregnancy-related variables, medical history, healthy behavior (tobacco and alcohol use, physical activities, and diet behavior), family relationship and support, body height, pre-pregnancy and gestational weight, and depression. Depressive symptomatology in the second trimester was measured by Edinburgh Postnatal Depression Scale with a cut-off value of 13. Pre-pregnancy BMI was calculated by self-reported height and weight. Based on the BMI standard of the World Health Organization, pre-pregnancy BMI could be divided into three groups: underweight (<18.5kg/m2), normal weight (18.5≤BMI<25kg/m2), and overweight and obese (≥25kg/m2). Gestational weights were obtained from the weight records of pregnancy checkups in the maternal health booklet or medical records. The average weekly weight gain during pregnancy is calculated by that weight at the time of recruitment minus the pre-pregnancy weight and then divided by the actual corresponding weeks of gestation. According to the gestational weight gain standards (total weight gained in the 40-week pregnancy is 10-14 kg) of the Health Promotion Administration in Taiwan, we distinguished the average weekly weight gain during pregnancy as inadequate (<0.25 kg per week), normal (0.25-0.35 kg per week), and excessive weight gain (>0.35 kg per week). Chi-squared test and multiple binary logistic regression were used to examine the relationship between pre-pregnancy BMI, gestational weight gain, and depression during pregnancy. Results: The prevalence of depression in the second trimester among primipara women in Taiwan was 12.3%. The rates of underweight (BMI <18.5 kg/m2) and overweight and obesity (BMI ≥25 kg/m2) were 11.2% and 14.4%, respectively. In bivariate analysis, primipara women with pre-pregnancy underweight (28.6%) had a higher rate of depressive symptomatology in the second trimester than those with normal weight (10.7%) and overweight and obese (7.4%) before pregnancy. Primipara women with excessive weight gain per week during pregnancy (31.3%) had a higher rate of depressive symptomatology in the second trimester than those with normal weight gain (12.1%) and inadequate weight gain (10.1%) per week during pregnancy. Multiple binary logistic regression indicated that maternal pre-pregnancy underweight (OR=6.37;p<0.01) and excessive weight gain per week during pregnancy (OR=5.06;p=0.04) were associated with increased depressive symptomatology in the second trimester when accounting for age, family income, miscarriage, son preference, depression history, relationship with mother-in-law, pre-pregnancy exercising habits, and the number of sugar-sweetened beverages during pregnancy. When considering pre-pregnancy BMI and gestational weight gain together, primipara women who had “pre-pregnancy underweight with inadequate gestational weight gain” were more likely to have a higher risk for depressive symptomatology in the second trimester (OR=7.19;p<0.01). Conclusion: A higher rate of depression in the second trimester was observed among primipara women in Taiwan. Pre-pregnancy underweight and weight gain of more than 0.35 kg/week during pregnancy were important risk factors for depression in the second trimester. In pregnant primiparas who were underweight before pregnancy and gained less than 0.25 kg per week on average during pregnancy, these women had an increased risk of depression in the second trimester. Appropriate education on gestational weight gain should be provided in pregnancy checkups. Health practitioners should also provide corresponding depression assessments and referrals based on maternal pre-pregnancy BMI and gestational weight gain as early as possible to promote maternal health. Future studies should clarify the causal relationship between maternal weight and depression and explore the related factors of maternal depression for primiparas with pre-pregnancy underweight.