試管嬰兒治療婦女產後六個月之產後憂鬱及其相關因子

背景：人工生殖技術使不孕夫妻增加懷孕的機會，不孕婦女有特殊治療與懷孕經驗，其產後憂鬱情形值得關注。過去文獻顯示產後憂鬱時間較多在產後一個月，且可能持續至產後一年。婦女於產後六個月時已較勝任母職角色，接受試管嬰兒治療婦女產後憂鬱及其相關因子是否與自然受孕婦女不同值得探討。目的：本研究目的在探討試管嬰兒治療產後六個月婦女之產後憂鬱情形，瞭解自尊、社會支持及親職壓力對產後憂鬱的影響，並與自然受孕婦女做比較。研究設計：採橫斷式研究法，於婦女產後六個月時以郵寄問卷方式收集資料。接受試管嬰兒治療婦女為研究組，收案83人；自然受孕婦女為對照組，收案99人。資料以SPSS/PC Window 19.0進行統計分析，統計方法包含個數、百分比、平均值±標準差、卡方檢定、t檢定及迴歸分析。比較研究組與對照組婦女之自尊、社會支持及親職壓力是否影響其產後六個月之產後憂鬱情形。以邏輯式迴歸分析婦女產後六個月之產後憂鬱預測因子。結果：研究組及對照組年齡平均分別為34.77±3.7及31.15±3.6，呈顯著差異(p<0.001)。大專以上教育程度在研究組及對照組，分別為72.0%及91.8%呈顯著差異(p<0.001)。陰道生產方式在研究組及對照組，分別為35.8%及74.5%呈顯著差異(p<0.001)。研究組雙胎數占32.1%，對照組占3.2%，二組呈顯著差異(p<0.001)。哺乳母乳研究組與對照組分別為45.1% vs. 65.3%，二組呈顯著差異(p<0.001)。EPDS輕度以上研究組占36.2%，對照組占46.5%，二組無顯著差異。自尊量表及社會支持量表之平均總分，研究組及對照組均無顯著差異(p>0.05)。親職壓力量表研究組及對照組總分平均為78.96±17.0及84.67±18.1呈顯著差異(p=0.03)；其次量表父母困擾平均總分二組分別為30.00±8.9及33.19±9.1，呈顯著差異(p=0.01)。研究組婦女產後六個月產後憂鬱之預測因子為胎數、自尊及社會支持。對照組婦女產後六個月產後憂鬱之預測因子為自尊及父母困擾之親職壓力。結論： 本研究發現試管嬰兒治療婦女產後六個月產後憂鬱之盛行率與平均分數與自然受孕組婦女雖無顯著差異，然應強化對雙胞胎、低社會支持及低自尊試管嬰兒治療婦女之照護，以持續提升婦女產後心理健康。

Background: The use of assisted reproductive technology has made pregnancy possible for many infertile couples. The unusual pregnancy and medical treatments experienced by infertile women makes their postpartum depression (PPD) worthy of attention. Previous studies have shown that PPD usually occurs in the first month after giving birth, and can last for more than one year. It’s worthwhile to investigate whether there is difference in the prevalence of PPD and its related factors in women who receive in vitro fertilization (IVF) treatment versus those conceive naturally six month after childbirth, by then women are more competent in motherhood.Objective: The specific aim of this study is to investigate the PPD in women who receive IVF treatment, and the impact of self-esteem, social support and parenting stress on PPD, as well as the comparison with those in who conceive naturally.Design of the study: A cross-sectional study was carried out. Data were collected by mailing questionnaires at six month after childbirth. A total of 83 women who received IVF treatment were recruited in the study group; and a total of 99 women who conceived naturally are enrolled in the control group. Data were analyzed with SPSS/PC Window 19.0, including number, percentage, mean ± standard deviation, chi-square test, t-test and regression analysis. Whether self-esteem, social support and parenting stress will affect PPD at six months after childbirth was compared between two groups. Logistic regression was carried out for the analysis of prediction factors of PPD in women at six months after childbirth.RESULTS: Significant differences between the study and control groups were revealed in the average age (34.77±3.7 and 31.15±3.6 years, respectively, p<0.001), education level at college or above (72.0% and 91.8%, p<0.001), percentage in vaginal delivery (35.8% v.s. 74.5%, p<0.001), twin-birth rate (32.1% v.s. 3.2%, p<0.001), and breastfeeding percentage (45.1% vs. 65.3%, p<0.001).There was no significant difference between the study and control groups in the EPDS score with mild depression or more (36.2% v.s. 46.5%, respectively), self-esteem and social support (p>0.05). Significant difference was found in the average scores in parenting stress (78.96±17.0 and 84.67±18.1 in study and control, respectively, p=0.03), as well as in the score of parental distress (30.00±8.9 and 33.19±9.1, respectively, p=0.01).The prediction factors of PPD in the study group at six months after delivery are number of birth, self-esteem and social support; and those in the control group are self-esteem and parental distress.Conclusion: Here we revealed that albeit no significant difference was found in the prevalence of PPD and the average scores in women who received IVF treatment versus those conceived naturally, among women receiving IVF treatment, there should be more medical care for those with low social support, low self-esteem and gave birth to twins to improve their postpartum mental health.