分娩方式与产后精神疾病的关联
这是一项美国全国性观察性队列研究，纳入2008-2022年单胎活产且产前无精神疾病诊断的934524例分娩。与自然阴道分娩相比，计划剖宫产、未尝试手术阴道分娩的不计划剖宫产及手术阴道分娩失败后的不计划剖宫产，产后6个月内新发精神疾病风险均升高；成功手术阴道分娩与自然阴道分娩风险相似。
要点
- 剖宫产（计划或不计划）与产后精神疾病风险升高相关。
- 成功手术阴道分娩与自然阴道分娩的产后精神疾病风险相似。
- 剖宫产后应加强产后精神疾病的监测。
核心结论
- 剖宫产（计划或不计划）后产后精神疾病风险升高，而成功手术阴道分娩后未见升高。
- 结果提示剖宫产可能与精神疾病风险增加相关，值得产后更密切监测。
研究设计与样本
- 观察性队列研究，使用美国Merative™ MarketScan® Commercial Database，纳入2008-2022年单胎活产个体。
- 排除产前已有精神疾病诊断者及37周前早产者，最终纳入934524例分娩。
主要发现
- 与自然阴道分娩相比，计划剖宫产后产后精神疾病发生率11.4% vs 9.2%，调整RR 1.19（95%CI 1.17-1.21）。
- 未尝试手术阴道分娩的不计划剖宫产10.8% vs 9.2%，调整RR 1.16（95%CI 1.14-1.18）。
- 手术阴道分娩失败后的不计划剖宫产10.9% vs 9.2%，调整RR 1.26（95%CI 1.18-1.35）。
- 成功手术阴道分娩与自然阴道分娩风险相似（9.2% vs 9.2%，调整RR 1.00，95%CI 0.97-1.03）。
关键数值与推荐
- 主要结局为产后6个月内新诊断抑郁、焦虑、创伤后应激或其他严重精神疾病，或新开抗抑郁药处方。
- 暴露分为自然阴道分娩、成功手术阴道分娩、计划剖宫产、未尝试手术阴道分娩的不计划剖宫产、手术阴道分娩失败后的不计划剖宫产。
临床怎么用
- 对剖宫产分娩者，尤其是手术阴道分娩失败后转剖宫产者，产后应加强精神疾病筛查与随访。
- 成功手术阴道分娩者的产后精神疾病风险与自然阴道分娩相似，监测策略可参照自然阴道分娩。
以上解读依据论文摘要（全文未开放获取或许可不允许翻译转载）。
原文
OBJECTIVE: To evaluate the association between mode of delivery and incidence of new postpartum maternal psychiatric conditions in a national obstetric cohort. METHODS: This was an observational cohort study of individuals with singleton live births in the United States (2008-2022) identified from the Merative™ MarketScan® Commercial Database using International Classification of Diseases, Ninth or Tenth Revision, Clinical Modification codes. Individuals with a psychiatric diagnosis preceding delivery and those with preterm births before 37 weeks of gestation were excluded. The exposure was mode of delivery, categorized as 1) spontaneous vaginal, 2) successful operative vaginal delivery (OVD), 3) planned cesarean, 4) unplanned cesarean without OVD attempt, 5) and unplanned cesarean after failed OVD attempt. The primary outcome was a new diagnosis of depression, anxiety, posttraumatic stress, or other serious psychiatric condition or a new antidepressant prescription within 6 months postpartum. Multivariable Poisson regression models with robust SEs estimated associations between mode of delivery and postpartum psychiatric conditions, first for any psychiatric condition and then separately by each condition. RESULTS: Of 934,524 included births, 66% were spontaneous vaginal, 4% were successful OVD, 14% were planned cesareans, 15% were unplanned cesareans without OVD attempt, and 1% were unplanned cesareans after failed OVD attempt. Compared with spontaneous vaginal births, postpartum psychiatric conditions were higher after planned cesarean births (11.4% vs 9.2%, adjusted risk ratio [RR] 1.19, 95% CI, 1.17-1.21), unplanned cesarean births without OVD (10.8% vs 9.2%, adjusted RR 1.16, 95% CI, 1.14-1.18), and unplanned cesarean births with failed OVD (10.9% vs 9.2%, adjusted RR 1.26, 95% CI, 1.18-1.35). Postpartum psychiatric condition risks were similar between individuals with spontaneous vaginal births and those with successful OVDs (9.2% vs 9.2%, adjusted RR 1.00, 95% CI, 0.97-1.03). CONCLUSION: Postpartum psychiatric conditions were increased after cesarean deliveries, planned or unplanned, but not after successful OVDs. Results suggest that cesarean delivery may be associated with an increased risk of psychiatric conditions and warrants closer surveillance postpartum.
引用
- Kruger SL, Perlman N, Sherwin EB, et al. Association Between Delivery Mode and Postpartum Psychiatric Conditions. Obstet Gynecol. 2026. PMID: 42166775. doi:10.1097/AOG.0000000000006321
供执业医师工作参考，不替代临床判断；数值与分级以指南原文为准。