Abstract

To investigate the associations between maternal mental health disorders before and during pregnancy and perinatal outcomes and child healthcare utilization between 6 and 18 months of age. Among the 6814 mother-child pairs from the Italian Internet-based NINFEA birth cohort, maternal depression, anxiety, and sleep disorders diagnosed by a physician before and during pregnancy were assessed through self-reported questionnaires completed during pregnancy and 6 months after delivery. Perinatal outcomes (preterm birth, birth weight, small for gestational age, congenital anomalies, and neonatal intensive care unit (NICU)) and children’s healthcare utilization (emergency department (ED) visits, hospitalizations, and outpatient visits) were reported by mothers at 6 and 18 months postpartum. We used regression models adjusted for maternal age, education, parity, country of birth, region of delivery, and household income. Maternal mental health disorders were not associated with perinatal outcomes, except for depression, which increased the risk of offspring admission to NICU, and anxiety disorders during pregnancy, which were associated with preterm birth and lower birth weight. Children born to mothers with depression/anxiety disorders before pregnancy, compared to children of mothers without these disorders, had an increased odds of a visit to ED for any reason (odds ratio (OR_adj) = 1.26, 95% confidence interval (CI): 1.02–1.54), of an ED visit resulting in hospitalization (OR_adj = 1.75, 95%CI: 1.27–2.42), and of planned hospital admissions (OR_adj = 1.55, 95%CI: 1.01–2.40). These associations with healthcare utilization were similar for mental disorders also during pregnancy. The association pattern of maternal sleep disorders with perinatal outcomes and child healthcare utilization resembled that of maternal depression and/or anxiety disorders with these outcomes.

Conclusion: Antenatal maternal mental health is a potential risk factor for child-health outcomes and healthcare use. Early maternal mental health interventions may help to promote child health and reduce healthcare costs.

What is Known: • Poor maternal mental health affects pregnancy outcomes and child health, and children of mothers with mental health conditions tend to have increased healtcare utilization. • Parents with poor mental health often face challenges in caring for their children and have less parenting self-efficacy, which could potentially lead to frequent medical consultations for minor health issues.

What is New: • Maternal pre-pregnancy mental disorders were not associated with preterm birth, low birth weight, SGA, and congenital anomalies, except for depression, which increased the risk of offspring admission to NICU. Anxiety disorders during pregnancy were associated with lower birth weight and an increased odds of preterm birth. • Maternal depression and/or anxiety and sleep disorders, both before and during pregnancy, were associated with an increase in children’s healthcare utilization between 6 and 18 months of life.

中文翻译：

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NINFEA 出生队列研究中母亲产前心理健康及其与围产期结局和儿童医疗保健服务使用的关系

摘要

旨在调查孕前和孕期孕产妇心理健康障碍与围产期结局和 6 至 18 个月龄儿童医疗保健利用之间的关联。在来自意大利互联网 NINFEA 出生队列的 6814 对母子中，通过在怀孕期间和产后 6 个月完成的自我报告问卷，对医生在怀孕前和怀孕期间诊断出的母亲抑郁、焦虑和睡眠障碍进行了评估。母亲在 6 岁时报告围产期结局（早产、出生体重、小于胎龄、先天性异常和新生儿重症监护病房 (NICU)）和儿童医疗保健利用（急诊科 (ED) 就诊、住院和门诊就诊）以及产后18个月。我们使用了针对母亲年龄、教育程度、胎次、出生国、分娩地区和家庭收入进行调整的回归模型。母亲心理健康障碍与围产期结局无关，但抑郁症除外，抑郁症会增加后代入住新生儿重症监护病房的风险，而怀孕期间的焦虑症则与早产和低出生体重有关。与没有这些疾病的母亲所生的孩子相比，怀孕前患有抑郁/焦虑症的母亲所生的孩子因任何原因去急诊室就诊的几率更高（比值比 (OR _adj ) = 1.26，95% 置信区间 (CI) ：1.02–1.54），急诊就诊导致住院（OR _adj  = 1.75，95%CI：1.27–2.42），以及计划入院（OR _adj  = 1.55，95%CI：1.01–2.40）。这些与医疗保健利用的关联与怀孕期间的精神障碍相似。母亲睡眠障碍与围产期结局和儿童保健利用的关联模式类似于母亲抑郁症和/或焦虑症与这些结局的关联模式。

结论：产前母亲心理健康是儿童健康结果和医疗保健使用的潜在危险因素。早期孕产妇心理健康干预可能有助于促进儿童健康并降低医疗费用。

已知信息： • 孕产妇心理健康状况不佳会影响妊娠结局和儿童健康，而患有心理健康问题的母亲所生的孩子往往会增加医疗保健的利用率。 • 心理健康状况不佳的父母在照顾孩子方面常常面临挑战，养育自我效能感较低，这可能会导致他们因轻微的健康问题而频繁就医。

新内容： • 母亲孕前精神障碍与早产、低出生体重、SGA 和先天性异常无关，但抑郁症除外，抑郁症会增加后代入住 NICU 的风险。怀孕期间的焦虑症与出生体重较低和早产几率增加有关。 • 怀孕前和怀孕期间的母亲抑郁和/或焦虑和睡眠障碍与儿童在出生后6 至18 个月期间医疗保健利用率的增加有关。