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Observational Study
. 2019 Dec;51(10):626-636.
doi: 10.1016/j.aprim.2018.06.009. Epub 2018 Nov 16.

Association between affective disorders presenting before and during pregnancy and pre-term birth, considering socio-demographic factors, obstetric factors, health conditions, and use of medication

Arantxa Aliaga  1 , Oriol Cunillera  2 , María Del Carmen Amador  3 , Mercedes Aliaga  4 , Martí Arquerons  5 , Jesús Almeda  6
Affiliations
Observational Study

Association between affective disorders presenting before and during pregnancy and pre-term birth, considering socio-demographic factors, obstetric factors, health conditions, and use of medication

Arantxa Aliaga et al. Aten Primaria. 2019 Dec.

Abstract
in English, Spanish

Objective: To study the relationship between maternal affective disorders (AD) before and during pregnancy, and pre-term birth.

Design: Retrospective observational study.

Location: Sexual and reproductive health units at the Institut Català de la Salut (ICS) in Catalonia, Spain.

Participants: Pregnant women with a result of live-born child from 1/1/2012 to 30/10/2015.

Interventions: Data were obtained from the ICS Primary Care electronic medical record.

Main measurements: Diagnosis of AD before and during pregnancy, months of pregnancy, and possible confusion factors were collected. Descriptive statistical analysis (median, interquartile range, and absolute and relative frequency), bivariate analysis (Wilcoxon test and Chi-square test), and multivariate analysis (logistic regression) were performed.

Results: 102,086 women presented valid information for the study. Prevalence of AD during pregnancy was 3.5% (4.29% in pre-term and 3.46% in term births; p<0.004). Pregnant women with pre-term births presented a higher age, smoking habit, lower inter-pregnancy interval, and a lower socio-economic status. Pre-term birth was significantly associated to previous history of stress and dissociative disorder (SDD), anxiety, obsessive-compulsive disorder (OCD) and eating disorders (ED), and use of antidepressants. It was also associated to abuse of alcohol, smoking, and use of psychoactive substances, as well as SDD, ED, use of antipsychotics, and divorce during pregnancy. Multivariate analysis confirmed the relationship between pre-term birth and history of AD, SDD, ED, and smoking, but not with AD during pregnancy.

Conclusions: Examining the previous history of SDD and ED in pregnant women, and SDD, and ED during pregnancy is highly relevant to avoid pre-term birth.

Objetivo: Estudiar la relación entre diagnósticos de trastornos afectivos (TA) antes y durante el embarazo, y factores de confusión con prematuridad del neonato.

Diseño: Estudio observacional retrospectivo.

Emplazamiento: Servicios de atención sexual y reproductiva del Institut Català de la Salut (ICS) en Cataluña, España.

Participantes: Embarazadas atendidas con resultado de hijo vivo del 1/1/2012 al 30/10/2015.

Intervenciones: Datos recogidos en la base de datos de la historia clínica informatizada.

Mediciones: Se recogió los diagnósticos de TA antes y durante el embarazo, meses de gestación y posibles factores de confusión. Se realizó análisis estadístico descriptivo (mediana y rango intercuartílico y frecuencias absoluta y relativa), bivariante (test de Wilcoxon y Chi-cuadrado) y multivariante (regresión logística).

Resultados: Ciento dos mil ochenta y seis mujeres presentaban información válida para el estudio. La prevalencia de TA durante el embarazo fue del 3,5% (4,29% en prematuros y 3,46% en a término; p < 0,004). Las embarazadas con partos prematuros presentan mayor edad, más tabaquismo, menor tiempo entre embarazos y menor nivel socioeconómico. La prematuridad se asoció a antecedentes previos de trastorno por estrés y disociativo (TED), de ansiedad y obsesivo-compulsivo, de conducta alimentaria (TCA) y uso de antidepresivos. También a abuso de alcohol, tabaco y sustancias psicoactivas; TED, TCA, uso de antipsicóticos y divorcio durante el embarazo. El análisis multivariante confirmó la relación de prematuridad con antecedentes de TA, TED, TCA y tabaquismo, pero no con TA durante el embarazo.

Conclusiones: Es importante explorar antecedentes de TED y TA en la embarazada y los TED durante el embarazo, para disminuir la prematuridad.

Keywords: Affective disorders; Antidepresivos; Antidepressive agents; Embarazo; Factores de riesgo; Infant; Pregnancy; Premature; Recién nacido Prematuro; Risk factors; Trastornos psicóticos afectivos.

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Study schema. Retrospective observational study with the aim to investigate the relationship between maternal affective disorders (AD) before and during pregnancy, and pre-term birth.
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