JAMA 子刊:社区发起的袋鼠母亲护理对低出生体重儿母亲产后抑郁症状和压力的影响 随机临床试验

2021
05/10

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ciKMC的实践可以大大降低中度至重度母亲产后抑郁症状的风险。该证据支持KMC作为一项干预措施,可纳入低收入和中等收入环境的基本新生儿护理计划中。


JAMA子刊

社区发起的袋鼠母亲护理对低出生体重儿母亲产后抑郁症状和压力的影响 随机临床试验

 

 



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摘要

重要性  在低收入和中等收入国家中,大约有五分之一的妇女患有产后抑郁症,低出生体重(LBW)婴儿的母亲患此病的风险更高。袋鼠妈妈护理(KMC)可有效改善低出生体重婴儿的存活率,但对妈妈使用KMC的益处尚无很好的描述。

目的  评估社区发起的KMC(ciKMC)对产妇中度至重度产后抑郁症状的风险以及唾液皮质醇浓度(应激的生物标志物)的影响。

设计,场所和参加者  这是一个不设盲,平行,随机分组的临床试验。参与者包括2017年4月至2018年3月在印度北部农村和半城市低收入人群中出生的1950名稳定的LBW婴儿(体重1500-2250 g)的母亲。数据分析时间为2020年1月至2020年7月。

干预  通过分组随机将符合条件的参与者随机分配至干预组或对照组。支持干预组的母亲练习ciKMC,直到出生后28天或直到婴儿从KMC位置扭动(即不再停留在KMC位置)为止。干预措施包括促进和支持皮肤接触,并通过家访提供纯母乳喂养。

主要结果和措施  使用《患者健康问卷》 测量新生儿期末的产后抑郁症状,将10分或更高的分数用于识别中度至重度抑郁症状。在出生后第28天母乳喂养前后的550位母亲的子样本中测量了唾液皮质醇的浓度。

结果  在1950名参与者中(平均[SD]年龄,23 [3.5]岁),干预组的1047名参与者中的974名(93%)完成了结果评估,对照组的903名参与者中的852名(94%)完成了结果评估。百分之六十四的参与者(1826名参与者中的1175名)属于最低的三分之二的收入者。干预组中度至重度产后抑郁症状的母亲所占比例为10.8%(95%CI,8.9%-12.9%;974名母亲中的105名),对照组中有852位母亲中有116位13.6%(95%CI,11.4%-16.1%; 95%CI))。调整后的中度至重度母亲产后抑郁症状的相对风险为0.75(95%CI,0.59-0.96),有效率为25%。在母乳喂养之前或之后,ciKMC和对照组母亲在第28天的唾液皮质醇浓度没有差异。

结论与相关性  这些发现表明,ciKMC的实践可以大大降低中度至重度母亲产后抑郁症状的风险。该证据支持KMC作为一项干预措施,可纳入低收入和中等收入环境的基本新生儿护理计划中。

Abstract

Importance  Approximately 1 in 5 women in low- and middle-income countries experience postpartum depression, and the risk is higher among mothers of low-birth-weight (LBW) infants. Kangaroo mother care (KMC) is effective in improving survival among LBW infants, but the benefits of KMC for mothers are not well described.

Objective  To estimate the effects of community-initiated KMC (ciKMC) on maternal risk of moderate-to-severe postpartum depressive symptoms and on salivary cortisol concentration, a biomarker of stress.

Design, Setting, and Participants  This was an unmasked, parallel-group, individually randomized clinical trial. Participants included 1950 mothers of stable LBW infants (weighing 1500-2250 g) in rural and semiurban low-income populations in North India enrolled between April 2017 and March 2018. Data analysis was performed from January to July 2020.

Interventions  Eligible participants were randomly assigned to the intervention or control group by block randomization. The mothers in the intervention group were supported to practice ciKMC until 28 days after birth or until the infant wriggled out of the KMC position (ie, was no longer staying in the KMC position). The intervention included promotion and support of skin-to-skin contact and exclusive breastfeeding through home visits.

Main Outcomes and Measures  Postpartum depressive symptoms at the end of the neonatal period were measured using the Patient Health Questionnaire–9, with a score of 10 or higher used to identify moderate-to-severe depressive symptoms. Salivary cortisol concentration was measured in a subsample of 550 mothers before and after breastfeeding on day 28 after birth.

Results  Of the 1950 participants (mean [SD] age, 23 [3.5] years), outcome assessment was completed for 974 of 1047 participants (93%) in the intervention group and 852 of 903 participants (94%) in the control group. Sixty-four percent of participants (1175 of 1826 participants) belonged to the lowest 3 wealth quintiles. The proportion of mothers with moderate-to-severe postpartum depressive symptoms was 10.8% (95% CI, 8.9%-12.9%; 105 of 974 mothers) in the intervention group vs 13.6% (95% CI, 11.4%-16.1%; 116 of 852 mothers) in the control group. The adjusted relative risk of moderate-to-severe maternal postpartum depressive symptoms was 0.75 (95% CI, 0.59-0.96), or an efficacy of 25%. There was no difference in day-28 salivary cortisol concentration between the ciKMC and control group mothers before or after breastfeeding. The analysis estimated that supporting 36 mothers to perform KMC at home would prevent 1 mother from experiencing moderate-to-severe postpartum depressive symptoms.

Conclusions and Relevance  These findings suggest that ciKMC practice may substantially reduce the risk of moderate-to-severe maternal postpartum depressive symptoms. This evidence supports KMC as an intervention to be incorporated in essential newborn care programs in low- and middle-income settings.




原文链接:

https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2779045


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关键词:
症状,压力,抑郁,护理

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