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作者：Laurie Barclay, MD  
出處：WebMD醫學新聞

　　November 9, 2009 — 根據11月兒科與週產期流行病學期刊(Paediatric and Perinatal Epidemiology)的一篇縱向世代研究結果，孕婦在第2和第3懷孕期時的特質性焦慮(Trait anxiety)，與產下體型較小的嬰兒有關。
　　
　　賓州大學的Shahla M. Hosseini等人寫道，報告指出，婦女在懷孕期間經歷壓力和焦慮，發生不佳生產結果的比率會比較高，包括5分鐘時阿普伽新生兒評分法(Apgar Score)分數較低與更多的產科併發症。不過，這些研究與其他聚焦在懷孕時期焦慮之影響的研究，只有探討焦慮和生育結果之關聯的一些可能因素。
　　
　　藉由「Maternal Health Practices and Child Development Project」這項研究計畫的縱向世代資料，研究者檢視懷孕期間的特質性焦慮和子代之生育結果之間的關聯。根據Spielberger氏「情境－特質焦慮量表(State-Trait Anxiety Inventory[STAI])」的「情境－特質個人指標(State-Trait Personality Index[STPI])」，在懷孕4個月和7個月時(分別代表第1和第2懷孕期)，測量自我報告的特質性焦慮，產後不久再測試一次，代表第3懷孕期。
　　
　　產前評估人口統計學、社會、心理及醫療特徵和物質使用情況。對763名順利生產的單胞胎，在生產時評估生產結果。
　　
　　使用回歸模式校正共變項之後，第2和3懷孕期時報告有特質性焦慮，可以預測未來會有較低的出生體重和身高。校正共變項之後，第3懷孕期時的焦慮與妊娠年齡縮短有關。
　　
　　出生體重及身高與母親特質性焦慮的關聯，第1和2懷孕期時，只有和嚴重焦慮有顯著關聯。相較於各懷孕期都沒有嚴重焦慮或只有1期有嚴重焦慮者，至少2期以上有嚴重焦慮者，更容易產下出生體重和身高較低的嬰兒。
　　
　　相較於各懷孕期都沒有嚴重焦慮之婦女的子代，3個懷孕期都有嚴重焦慮者的子代，其平均妊娠年齡較少。
　　
　　研究作者寫道，報告有慢性、嚴重特質性焦慮的婦女，妊娠期較短與產下體型較小嬰兒的風險最高。預防孩童和成人健康問題的方法之一是，注意產前時期的照護。這是後續研究應注意的關鍵，尋求可以改善婦女特質性焦慮對於胎兒發展之影響的介入方式。
　　
　　研究限制包括，心理檢測的固有限制、第3懷孕期之特質性焦慮是在母親生產後第2天進行分析、使用STPI測量特質性焦慮和生氣程度，而非使用完整版的STAI量表。
　　
　　研究作者結論表示，第1或第2懷孕期時，低到中度的焦慮並不會顯著影響生育結果，但是懷孕期間大部份時間都嚴重焦慮的婦女，應考慮給予減輕焦慮的介入方式。對於有關焦慮對生育結果之影響的發現，我們仍需加以評估，以及探討有關孕婦心理健康的產前照護，是否可改善生育結果。而婦女的焦慮不問，不論是發生在懷孕前或懷孕時，都應及早確認，以便減輕焦慮。
　　
　　MH15169和DA03874資助本研究。

Trait Anxiety in Pregnant Women Linked to Smaller Infant Size

By Laurie Barclay, MD
Medscape Medical News

November 9, 2009 — Trait anxiety in pregnant women at the second and third trimesters is linked to smaller infant size, according to the results of a longitudinal cohort study reported in the November issue of Paediatric and Perinatal Epidemiology.

"Women who experience stress and anxiety during pregnancy are reported to have higher rates of adverse birth outcomes, including lower 5-minute Apgar scores and more obstetric complications," write Shahla M. Hosseini, from the Pennsylvania State University in Monaca, Pennsylvania, and colleagues. "However, these studies and others which focused on the effects of anxiety during pregnancy controlled only for some of the potential confounders of the relationships between anxiety and birth outcomes."

Using a longitudinal cohort from the Maternal Health Practices and Child Development Project, the investigators examined the associations between trait anxiety symptoms of women during pregnancy and birth outcomes of their offspring. Self-reported trait anxiety was measured with the State-Trait Personality Index (STPI), based on Spielberger's State-Trait Anxiety Inventory (STAI), at 4 and at 7 months' gestation, representing the first and second trimesters, respectively, and again shortly after delivery, representing the third trimester.

Demographic, social, psychological, and medical characteristics and substance use were evaluated prenatally. For the 763 live, singleton births, outcomes were assessed at delivery.

Trait anxiety reported at the second and third trimesters predicted lower birth weight and shorter birth length, after adjustment for confounders using regression models. Anxiety at the third trimester was associated with shortened gestational age, after adjustment for confounders.

The association of birth weight and birth length with maternal trait anxiety at the first and second trimesters was significant only for severe anxiety. Compared with women who reported severe anxiety at none or at only one of the trimesters, those who reported severe anxiety for at least 2 trimesters were significantly more likely to give birth to infants with lower birth weight and shorter birth length.

Mean gestational age was also younger in offspring of women who had severe anxiety during all 3 trimesters vs offspring of women who did not report severe anxiety at any trimester.

"Women who report chronic, severe trait anxiety are at the highest risk of having shorter gestations and delivering smaller babies," the study authors write. "One way to prevent health problems in children and adults is to focus care on the prenatal period. It is key to pursue further research which addresses interventions to ameliorate the effects that a woman's trait anxiety has on the development of fetuses."

Limitations of this study include those inherent in the psychological measures, third trimester trait anxiety determined by maternal report in the first 2 days after delivery, and use of the STPI to measure trait anxiety and anger instead of the full-length STAI instruments.

"Low to moderate levels of anxiety in women during either the first or second trimester did not significantly affect the birth outcomes, but women who are severely anxious during much of their pregnancy should be considered for anxiety-reducing interventions," the study authors conclude. "Our finding that anxiety affected birth outcome points to the need to assess whether prenatal care that addresses the psychological well-being of pregnant women would result in improved birth outcomes. Anxious women should be identified early in or even prior to pregnancy and targeted for anxiety reduction."

This study was supported by MH15169 and DA03874.

Paediatr Perinatal Epidemiol. 2009;23:557-566.