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期刊来源：Nat Med

原文链接：https://doi.org/10.1038/s41591-024-02809-x

摘要内容如下：

妇女在怀孕期间经历的焦虑非常普遍，尤其是在资源匮乏的环境中，并且强烈预测产后常见精神障碍（CMD）、焦虑和抑郁。我们评估了以焦虑为中心的早期产前干预对预防产后CMD的有效性。该研究是一项在巴基斯坦进行的3期、两组、单盲、随机对照试验，研究对象为妊娠≤22周且至少有轻度焦虑但无临床抑郁的妇女。参与者被随机分配到快乐母亲-健康婴儿计划，该计划基于认知行为疗法，由非专业提供者提供的61次孕期干预课程组成，或单独接受强化护理。主要转归为分娩后6周时的重度抑郁、广泛性焦虑障碍或两者兼有。总体而言，755名妇女完成了产后评估（干预组380人（50.3%）；375例（49.7%）为强化护理组。达到了主要结果。通过联合检查，我们发现随机接受干预的女性发生重度抑郁发作（MDE）或中度至重度焦虑的几率降低了81%（调整后的比值比（AOR）=0.19，95%CI 0.14-0.28）。总体而言，干预组中有12%的妇女在产后6周发生了MDE，而对照组为41%。我们发现，产后MDE（AOR=0.19，95%CI 0.13-0.28）和中度至重度焦虑（AOR=0.26，95%CI 0.17-0.40）的几率分别降低了81%和74%。快乐母亲-健康婴儿计划：早期产前干预，关注焦虑症状，减少产后CMDS。ClinicalTrials.gov标识符NCT03880032。

英文原文如下：

Abstracts

Anxiety experienced by women during pregnancy is highly prevalent, especially in resource-poor settings and strongly predicts postnatal common mental disorders (CMDs), anxiety and depression. We evaluated the effectiveness of an anxiety-focused early prenatal intervention on preventing postnatal CMDs. This study was a phase 3, two-arm, single-blind, randomized controlled trial conducted in Pakistan with women who were ≤22 weeks pregnant and had at least mild anxiety without clinical depression. Participants were randomized to the Happy Mother-Healthy Baby program, based on cognitive behavioral therapy, consisting of six one-on-one intervention sessions in pregnancy delivered by non-specialist providers, or to enhanced care alone. The primary outcome was major depression, generalized anxiety disorder or both at 6 weeks after delivery. Overall, 755 women completed postnatal assessments (380 (50.3%), intervention arm; 375 (49.7%) enhanced-care arm). The primary outcomes were met. Examined jointly, we found 81% reduced odds of having either a major depressive episode (MDE) or moderate-to-severe anxiety for women randomized to the intervention (adjusted odds ratio (aOR) = 0.19, 95% CI 0.14-0.28). Overall, 12% of women in the intervention group developed MDE at 6 weeks postpartum, versus 41% in the control group. We found reductions of 81% and 74% in the odds of postnatal MDE (aOR = 0.19, 95% CI 0.13-0.28) and of moderate-to-severe anxiety (aOR = 0.26, 95% CI 0.17-0.40), respectively. The Happy Mother-Healthy Baby program early prenatal intervention focusing on anxiety symptoms reduced postpartum CMDs. ClinicalTrials.gov identifier NCT03880032 .

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