根據在線發表於12月17日的《普通精神病學文獻》上的一篇報告，伴有情緒障礙的妊娠婦女70%以上發生至少1次與分娩相關的情緒障礙發作，與妊娠相關的情緒障礙發作相對較少。

　　威爾士Cardiff大學精神藥物和臨床神經科學研究所的Ian Jones醫生及其同事利用來自兩項關於情緒障礙的臨床和遺傳學研究的數據，評估了與分娩相關的多種精神障礙的發生情況。一個研究隊列中納入573例於1998~2004年間有複發性重度抑鬱症的女性患者，另一個隊列中納入980例於1991~2010年間發生雙相Ⅰ障礙女性患者和232例雙相Ⅱ障礙的女性患者。共獲得其中1,410例女性的3,017次妊娠的數據。

　　結果顯示，妊娠期間或分娩後1年內，躁狂、輕躁狂、抑鬱症伴精神病或非精神病重度抑鬱症發作的患病率在各種情緒障礙譜中相似：雙相Ⅰ障礙為70.8%，雙相Ⅱ障礙為70.9%，複發性重度抑鬱症為73.7%。在這個樣本中，94%的躁狂或精神病性抑鬱症發作是發生於產後4周內。對於雙相Ⅰ障礙女性，大約20%的分娩與產後躁狂或精神病性抑鬱症發作相關，另外25%與非精神病重度抑鬱症發作相關。總之，在雙相Ⅰ障礙女性中，接近半數的分娩與“某些重度情緒障礙發作”相關，Jones博士及其合作者報告。盡管此類發作的發生率低於雙相Ⅱ障礙和複發性重度抑鬱症，“也不可以低估”此類發作對於這一患者群體的重要意義。在雙相Ⅱ障礙或重度複發性抑鬱症女性患者中，大約40%的分娩與此類障礙發作相關。在這一樣本中，僅有很小比例的精神病或抑鬱發作發生於妊娠期間，而非產後。但雙相Ⅱ障礙女性患者的發生率(18.4%)約為雙相Ⅰ障礙(8.6%)和複發性重度抑鬱症患者(11%)的2倍。相對較少的孕期精神病或抑鬱症發作均衡分布於早、中、晚三個孕期。相似的，所有精神病或抑鬱症發作中僅有不足4%發生於產後6個月之後，並且在3種類型情緒障礙組中的發生率相似，Jones博士及其合作者說。

　　研究者總結認為，情緒障礙發作與妊娠和分娩之間存在關聯，因此“不可低估妊娠和分娩對於情緒障礙女性患者的重要性”。(Arch. Gen. Psychiatry 2012 Dec. 17 [doi:10.1001/jamapsychiatry.2013.279])。

　　這項研究由Wellcome Trust、Stanley醫學研究所和威爾士議會政府衛生獎學金資助。作者未披露任何利益衝突。

　　By: MARY ANN MOON, Ob.Gyn. News Digital Network

　　More than 70% of women with mood disorders who become pregnant experience at least one episode of their disorder in association with the birth or, less often, the pregnancy, according to a report published online Dec. 17 in Archives of General Psychiatry.

　　Given that approximately 40% of all pregnancies are unplanned, the risk of perinatal episodes of mania, hypomania, psychotic depression, and nonpsychotic major depression should be discussed with all women of childbearing age who have mood disorders, even those who are not planning a pregnancy, said Dr. Ian Jones of the Institute of Psychological Medicine and Clinical Neurosciences at Cardiff (Wales) University and his associates.

　　In addition, "it is important that all professionals providing health care for pregnant women, including midwives, family physicians, and obstetricians, are aware of this increased risk," they wrote.

　　Dr. Jones and his colleagues assessed the occurrence of a range of psychological disorders associated with childbirth using data from two clinical and genetic studies of mood disorders. One study cohort included 573 women with recurrent major depression occurring in 1998-2004, and the other included 980 women with bipolar I disorder and 232 with bipolar II disorder occurring in 1991-2010.

　　Data were available regarding 3,017 pregnancies in 1,410 of these women. The prevalence of episodes of mania, hypomania, depression with psychosis, or nonpsychotic major depression either during pregnancy or within 1 year of childbirth was similar across the spectrum of mood disorders: 70.8% for bipolar I disorder, 70.9% for bipolar II disorder, and 73.7% for recurrent major depression.

　　"The importance of pregnancy and childbirth for women with mood disorders should therefore not be underestimated," the investigators said (Arch. Gen. Psychiatry 2012 Dec. 17 [doi:10.1001/jamapsychiatry.2013.279]).

　　In this sample, 94% of the episodes of mania or psychotic depression occurred within 4 weeks postpartum.

　　For women with bipolar I disorder, approximately 20% of deliveries were associated with a postpartum episode of mania or psychotic depression and an additional 25% were associated with an episode of nonpsychotic major depression. Altogether, nearly half of the deliveries in women with bipolar I disorder were associated with "an episode of a major mood disorder of some description," Dr. Jones and his associates reported.

　　Although the rate of such episodes was lower for both bipolar II disorder and recurrent major depression, "it would be wrong to underestimate the importance" of such episodes in these patient populations, they said. Approximately 40% of deliveries among women with bipolar II disorder or major recurrent depression were associated with episodes of these disorders.

　　Only a small proportion of psychotic or depressive episodes occurred during pregnancy rather than postpartum in this sample. The rate, however, was roughly twice as high in women with bipolar II disorder (18.4%) than in those with bipolar I disorder (8.6%) or recurrent major depression (11%).

　　The relatively few episodes of psychosis or depression that developed during pregnancy were equally distributed across the three trimesters.

　　Similarly, less than 4% of all episodes of psychosis or depression occurred after 6 months postpartum, and the rates were similar across the three types of mood disorder, Dr. Jones and his associates said.

　　This study was supported by the Wellcome Trust, the Stanley Medical Research Institute, and the Welsh Assembly Government Health Studentship. No financial conflicts were reported.