Association between breastfeeding and postpartum depression in women with gestational diabetes mellitus
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摘要:
目的 探讨母乳喂养对妊娠期糖尿病（GDM）产妇产后抑郁（PPD）风险的影响，并比较GDM与非GDM产妇母乳喂养及产后抑郁状况的差异。 方法 前瞻性纳入2022年5月—2024年6月于安徽医科大学第二附属医院分娩的180例GDM产妇和198例非GDM产妇。随访至产后6~8周，收集母乳喂养资料，采用爱丁堡产后抑郁量表（EPDS）评估PPD风险。采用多因素logistic回归分析探讨母乳喂养对PPD风险的独立影响，并进行交互作用及简单效应分析。 结果 GDM和非GDM组间产后6~8周母乳喂养率及PPD筛查阳性率差异均无统计学意义（P＞0.05）。多因素logistic回归分析显示，母乳喂养是GDM组PPD风险的独立保护性因素（OR=0.251，95% CI：0.090~0.702，P=0.009）；而非GDM组内二者无显著关联（P＞0.05）；GDM状态与母乳喂养的交互项在未校正模型中显著（P=0.027），但在校正混杂因素后无统计学意义。简单效应分析进一步证实母乳喂养对PPD的保护作用仅在GDM组中有统计学意义（OR=0.234，95% CI：0.086~0.634，P=0.004）。 结论 GDM产妇的PPD风险未显著高于非GDM产妇，母乳喂养对GDM产妇具有特异性的心理保护作用。建议将鼓励和支持母乳喂养作为GDM产妇产后抑郁预防的核心干预措施。 Abstract:Objective To investigate the impact of breastfeeding on postpartum depression (PPD)risk in women with gestational diabetes mellitus (GDM) and to compare breastfeeding practices and PPD risk between GDM and non-GDM women. Methods This prospective cohort study included 180 GDM and 198 non-GDM women, followed up for 6-8 weeks postpartum. Data on breastfeeding practices were collected via questionnaires. PPD risk was assessed using the Edinburgh postnatal depression scale (EPDS). Multivariable logistic regression and interaction analyses were conducted to evaluate the independent association between breastfeeding and PPD risk. Results No statistically significant differences were found between the GDM and non-GDM groups in breastfeeding rate or positive screening rate for PPD at 6-8 weeks postpartum (P>0.05). Multivariate logistic regression analysis showed that breastfeeding was an independent protective factor against PPD risk in the GDM group (OR=0.251, 95% CI: 0.090-0.702, P=0.009), whereas no significant association was observed in the non-GDM group (P>0.05). The interaction term between GDM status and breastfeeding was significant in the unadjusted model (P=0.027), but became non-significant after adjusting for confounding factors. Simple effects analysis further confirmed that the protective effect of breastfeeding against PPD was statistically significant only in the GDM group (OR=0.234, 95% CI: 0.086-0.634, P=0.004). Conclusion While the overall PPD risk was comparable between groups, breastfeeding confers a specific psychological protective effect in women with GDM. Therefore, breastfeeding support should be prioritized as a core intervention strategy for PPD prevention in this population. -
表 1 2组产妇基线资料比较
Table 1. Comparison of baseline characteristics between the two groups of postpartum women
项目 GDM组(n=180) 非GDM组(n=198) 统计量 P值 社会人口学特征 年龄[M(P25, P75), 岁] 31(28, 33) 31(28, 34) -0.040a 0.968 孕前体重[M(P25, P75), kg] 57.0(52.0, 64.0) 55.0(50.0, 60.0) -2.293a 0.022 孕前BMI[M(P25, P75)] 21.91(20.13, 23.82) 20.98(19.57, 22.87) -3.020a 0.003 孕期增重[M(P25, P75), kg] 12.0(9.0, 14.4) 13.0(10.5, 15.1) -3.210a 0.001 产后6~8周体重[M(P25, P75), kg] 61.0(55.3, 67.0) 60.0(55.0, 67.0) -0.422a 0.673 孕次[M(P25, P75), 次] 2(1, 3) 2(1, 2) -1.582a 0.114 产次[M(P25, P75), 次] 1(1, 2) 1(1, 2) -1.515a 0.130 教育程度[M(P25, P75)] 2(1, 2) 2(1, 2) -1.893a 0.058 就业状态[例(%)] 0.679b 0.410 在职 149(82.8) 170(85.9) 非在职 31(17.2) 28(14.1) 分娩相关资料 分娩孕周[M(P25, P75), 周] 39(38, 40) 39(38, 40) -1.563a 0.118 分娩方式[例(%)] 1.325b 0.250 剖宫产 74(41.1) 70(35.4) 顺产 106(58.9) 128(64.6) 胎儿性别[例(%)] 1.145b 0.285 女 72(40.0) 90(45.5) 男 108(60.0) 108(54.5) 新生儿体重(x±s, g) 3 348.2±412.1 3 293.5±407.4 0.006c 0.940 新生儿身长[M(P25, P75), cm] 50(49, 51) 50(49, 51) -0.048a 0.962 注: a为Z值，b为χ2值，c为t值。教育程度为分类变量，赋值为高中及以下=1，本科=2，硕士及以上=3。 
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表 2 2组产妇母乳喂养状况、产后抑郁情况比较
Table 2. Comparison of breastfeeding practices and postpartum depression status between the two groups of postpartum women
项目 GDM组(n=180) 非GDM组(n=198) 统计量 P值 喂养方式[例(%)] 0.244a 0.621 母乳喂养 158(87.8) 177(89.4) 非母乳喂养 22(12.2) 21(10.6) 日均母乳喂养频次[M(P25, P75), 次] 6(1, 7) 6(3, 7) -0.135b 0.892 日均配方奶喂养频次[M(P25, P75), 次] 2(0, 5) 2(0, 5) -0.102b 0.919 单次配方奶喂养量[M(P25, P75), mL] 60(0, 100) 60(0, 100) -0.195b 0.845 单次喂奶耗时[M(P25, P75)] 2(1, 2) 2(1, 2) -1.779b 0.075 日均喂奶频次[M(P25, P75)] 2(2, 3) 3(2, 3) -0.829b 0.407 产后抑郁风险[例(%)] 0.305a 0.581 存在 28(15.6) 35(17.7) 不存在 152(84.4) 163(82.3) EPDS评分[M(P25, P75), 分] 5(2, 9) 6(3, 8) -0.843b 0.399 注: a为χ2值，b为Z值；母乳喂养含纯母乳及混合喂养(WHO标准)。
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表 3 不同喂养方式下2组产妇产后抑郁情况比较[例(%)]
Table 3. Comparison of the incidence of postpartum depression among women in the two groups according to feeding pattern[cases(%)]
组别 例数 喂养方式 存在产后抑郁风险 不存在产后抑郁风险 P值a GDM组 180 母乳喂养 20(71.4) 138(90.8) 0.008 非母乳喂养 8(28.6) 14(9.2) 非GDM组 198 母乳喂养 29(82.9) 148(90.8) 0.221 非母乳喂养 6(17.1) 15(9.2) 注: a为采用Fisher精确检验。
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表 4 母乳喂养对产后抑郁风险影响的多因素logistic回归分析
Table 4. Multivariable logistic regression analysis of the association between breastfeeding and the risk of postpartum depression
组别 回归模型 B SE Waldχ2 P值 OR值 95% CI GDM组 Model 1 -1.372 0.502 7.470 0.006 0.254 0.095~0.681 Model 2 -1.547 0.524 8.716 0.009 0.251 0.090~0.702 非GDM组 Model 1 -0.714 0.533 1.794 0.173 0.490 0.182~1.468 Model 2 -0.449 0.530 0.718 0.431 0.657 0.244~1.950 注：变量赋值方法如下，因变量(产后抑郁风险)：不存在=0，存在=1；自变量(喂养方式)：非母乳喂养=0，母乳喂养=1；协变量：孕前BMI、孕产次、孕期增重按连续变量值录入；教育程度：高中及以下=1，本科=2，硕士及以上=3；就业状态：非在职=0，1在职=；分娩方式：顺产=0，剖宫产=1。
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表 5 GDM状态与母乳喂养对产后抑郁影响的交互作用分析
Table 5. Analysis of the interaction between GDM status and breastfeeding on the risk of postpartum depression
回归模型 自变量 P值 OR值 95% CI Model 1 GDM状态(vs.非GDM) 0.041 2.825 1.045~7.635 母乳喂养(vs.非母乳) 0.921 0.963 0.452~2.048 交互项: GDM×母乳喂养 0.027 0.243 0.070~0.849 Model 2 GDM状态(vs.非GDM) 0.506 1.570 0.414~6.128 母乳喂养(vs.非母乳) 0.182 0.473 0.166~1.449 交互项: GDM×母乳喂养 0.259 0.448 0.112~1.810
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表 6 母乳喂养对产后抑郁影响的简单效应分析
Table 6. Simple effect analysis of breastfeeding on postpartum depression
GDM状态 喂养方式 B SE Waldχ2 P值 OR值 95% CI 非GDM组 母乳喂养(vs.非母乳) -0.038 0.385 0.010 0.921 0.963 0.452~2.048 GDM组 母乳喂养(vs.非母乳) -1.453 0.510 8.117 0.004 0.234 0.086~0.634
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