孕期家庭暴力与孕妇心理、产后抑郁、新生儿神经生化及遗传—环境交互作用对婴儿认知行为的影响
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摘要
第一章孕期家庭暴力及产后抑郁社会心理因素的研究
目的
调查孕期家庭暴力及产后抑郁的发生率,了解孕期受虐女性的社会心理特征,探讨孕期家庭暴力与产后抑郁的关系,发现孕期家庭暴力及产后抑郁的风险因素,为心理干预和家庭暴力的预防提供科学依据。
方法
1.采用横断面调查方法,随机抽查长沙市妇幼保健院住院部身体健康产妇846名。通过虐待评估调查问卷(Abuse Assessment Screen,AAS)筛查,将孕妇分为家暴组和非家暴组。并采取半定式面谈方法,由产妇独立完成一般情况调查表,简易应对方式问卷,社会支持评定量表,自尊量表,艾森克个性问卷等内容。
2.产后1月至42天内随访,利用爱丁堡产后抑郁量表,自评抑郁量表评估产后抑郁的发生状况。
3.研究对象一般人口学资料中构成比、率间比较采用卡方(x2)检验,所有计数资料完成正态性检验,非正态分布资料采用秩和检验(Z),正态分布资料单因素方差分析采用t检验,多因素方差分析采用F检验。影响因素间的相互关联采用Spearman相关分析,危险因素预测采用Logistic回归分析法。显著性水平为a=0.05(双尾检验)。
结果
1.孕期家庭暴力总的发生率为11.3%,单纯精神暴力最高(7.0%),其次是精神暴力合并性暴力(3.9%),单纯性暴力为0.7%,三种合并发生率最低(0.5%);家暴组丈夫从事个体经商者为多,经济状况较好者比例高于对照组,较差和中等水平者低于对照组。
2.家暴组丈夫吸烟史、饮酒史、过去一年饮酒史、赌博史以及孕妇吸烟史、过去一年饮酒史比例明显高于对照组,未计划怀孕、流产史以及产前担心胎儿性别比例也高于对照组。
3.家暴组家暴认可态度、童年期家暴目睹史、被打骂经历、性伤害经历的比例明显高于对照组。
4.家暴组孕妇积极应对、总体社会支持、自尊水平、EPQ-E分明显低于对照组,而消极应对、EPQ-N分则明显高于对照组得分。
5.遭受不同程度精神暴力孕妇之间未发现社会心理特征差异,伴有性暴力者积极应对及客观支持分低于无性暴力者;受虐孕妇既往流产史低于3次者与多于3次者相比,消极应对低于后者,客观支持和社会支持总分高于后者。
6.相关分析和Logistic回归分析显示,家庭经济状况较好,未计划怀孕、流产史,家暴认可态度、家暴目睹史和缺乏主观支持进入孕期家暴发生的回归方程。
7.随访调查显示,产后抑郁发生率为31.2%。家暴组EPDS、SDS得分明显高于非家暴组,相关分析以及Logistic回归分析显示,丈夫职业,流产史,孕期夫妻饮酒史,家暴认可态度,孕期精神暴力,担心胎儿健康,消极应对和神经质人格特征进入产后抑郁的回归方程。
结论
1.孕期家庭暴力总的发生率为11.3%,单纯精神暴力最高(7.0%)。
2.孕妇及丈夫吸烟饮酒史,赌博行为,未计划怀孕,流产史,家暴认可态度,家暴目睹史和童年期受虐与孕期家暴的发生相关,其中,家庭经济状况较好,未计划怀孕,流产史,家暴认可态度、家暴目睹史和缺乏主观支持是孕期家暴发生的高危因素。
3.产后抑郁总的发生率为31.2%,其中受虐孕妇产后抑郁发生率25.1%。丈夫职业,流产史,孕期夫妻饮酒史,家暴认可态度,孕期精神暴力,担心胎儿健康,消极应对和神经质人格特征是产后抑郁的危险因素。
第二章孕期家庭暴力与新生儿神经生化及分子生物学关系的初步探讨
目的
观察孕期家庭暴力对新生儿Glu、GABA神经递质和血浆皮质醇水平的影响。了解家庭暴力与新生儿rs4680、rs4818、rs6313SNP多态性的相关性,探讨家庭暴力对新生儿可能的神经生化和分子生物学影响机制。
方法
1.新生儿相应分为家暴组和对照组。采用库仑阵列电化学高效液相色谱检测法(HPLC-ECD)测定两组对象血浆谷氨酸(Glu)和r-氨基丁酸(GABA)含量,血浆皮质醇(Cortisol)含量采用放免法测定。
2.利用连接酶检测反应(ligase detection reaction,LDR)和测序分型方法观察两组rs4680、rs4818、rs6313SNP多态性各基因型及等位基因、单体型的差异。
3.两组基因型和等位基因频率的差异采用卡方(x~2)检验,两组研究对象生化指标含量的差异采用t检验,各基因型与临床表型的关联分析采用单向方差分析(One-way ANOVA)。影响因素间的相互关联采用Spearman相关分析。显著性水平为α=0.05。
结果
1.家暴组和非家暴组新生儿相比较,其Glu、GABA神经递质以及血浆皮质醇水平明显高于对照组;孕妇精神暴力多于5次者与低于5次者相比,子代血浆皮质醇水平明显高于后者,精神暴力合并有性暴力者与无性暴力者相比,子代血浆皮质醇水平明显高于后者;相关分析显示,新生儿Glu、GABA、Cortisol水平与孕期精神暴力、性暴力严重程度呈显著正相关,但未发现与躯体暴力存在相关关系,同时发现,Glu、GABA水平与孕妇的精神质存在正相关,Cortisol与产后SDS得分呈负相关,Glu、GABA还与孕妇童年期被打骂、遭受性侵犯呈正相关关系。
2.家暴组和非家暴组新生儿相比较,rs4818SNP多态性基因型和等位基因频率在两组间存在显著性差异,家暴组CC基因型和C等位基因频率显著高于对照组,GG基因型和G等位基因频率显著低于对照组,rs4680SNP、rs6313SNP则未发现两组间各基因型和等位基因频率存在显著性差异;家暴组rs4680-rs4818单体型A-G频率明显高于对照组,差异具有统计学意义(P＜0.01),联合风险度OR为2.756,相对危险度95%可信区间在1.286～5.903间;关联分析显示,GABA水平在rs4818SNP基因型间存在显著性差异,GG基因型携带者GABA水平低于CC和C/G基因型携带者,rs4680SNP、rs6313SNP则未发现与临床表型之间存在关联。
结论
1.孕期家庭暴力可能导致子代氨基酸神经递质及血浆皮质醇的变化。
2.COMT基因rs4818SNP可能和暴力行为存在关联,rs4680-rs4818单体型A-G联合增加了子代暴力行为发生的风险,rs4818SNP多态性可能和GABA神经递质变化有关。
第三章孕期家庭暴力的遗传-环境交互作用对婴儿生长发育影响的前瞻性研究及生物数学模型的建立
目的
通过建立基于神经网络感知器的多元线性回归模型,阐述孕期家庭暴力的遗传-环境交互作用对婴儿认知行为发育的近期影响。
方法
1.采用前瞻性研究方法,完成婴儿出生近一年的随访,评估婴儿各气质维度和智能及运动发展功能。
2.利用MATLAB神经网络感知器,建立多元线性回归模型,观察遗传-环境交互作用对婴儿认知行为发育的近期影响。
3.两组婴儿气质及发展指数的差异采用t检验,各基因型与临床表型的关联分析采用单向方差分析(One-way ANOVA)。影响因素间的相互关联采用Spearman相关分析。数学模型的建立及分析运用Matlab5.1神经网络工具箱操作。显著性水平为α=0.05。
结果
1.家暴组婴儿和非家暴组婴儿相比,节律性、情绪本质、注意分散度因子分明显高于对照组,贝利发展量表MDI、PDI得分明显低于对照组,差异有统计学意义(p＜0.01,p＜0.05)。其余指标未显示显著性差异(p＞0.05)。
2.相关分析显示,节律性与PDI呈正相关,趋避性与GABA呈负相关,情绪性与计划怀孕以及MDI、PDI呈负相关,与母孕期精神暴力严重程度呈正相关,注意分散度与PDI呈负相关,PDI与孕期主观支持程度呈正相关(p＜0.01,p＜0.05)。
3.基因型与临床表型的关联分析显示:rs4680SNP基因型在婴儿趋避性方面存在差异,AA基因型携带者趋避性明显高于A/G和GG基因型携带者;rs4818SNP基因型在婴儿MDI方面存在差异,CC基因型携带者MDI分明显低于C/G和GG基因型携带者;rs6313SNP基因型在节律性和注意分散度方面存在差异,C/T和TT基因型携带者节律性和注意分散度分明显高于CC基因型携带者。
4.基于神经网络感知器的多元线性回归模型显示,遗传-环境交互作用与婴儿的情绪性、PDI存在线性相关关系,与MDI存在线性相关趋势。
结论
1.孕妇受虐其婴儿表现明显的节律性弱、情绪消极、注意易分散以及智利和运动发育相对缓慢等认知行为特征。
2.COMT基因和5-HT基因多态性(rs4818SNP、rs4680SNP、rs6313SNP)可能与婴儿的节律性、趋避性、注意分散以及智能和运动发育等存在关联。
3.孕期家庭暴力的遗传-环境交互作用可能对婴儿的认知行为发育存在近期影响。
Objective
To investigate the prevalence of domestic violence in pregnancy and postpartum depression and related psychosocial characteristics in order to find the risk factors of abused pregnant women and postpartum depression and provide with systematic prevention.
Methods
1. By using cross-sectional survey and semi-structured interview, 846 pregnant women were screened by Abuse Assessment Screen(AAS), and a sample of abused and control pregnant women was randomly selected for study and administered Self-designed demographic Questionnaire, Simpled Coping Style Questionnaire(TCSQ), Social Supporting Rating Scale(SSRS), Self-esteem Scale(SES), and Eysenck's Personality Questionnaire(EPQ), respectively.
2. Study subjects were received follow-up visit after childbirth 30 to 42 days and administered in Edingburg Postnatal Depression Scale(EPDS), Self-rating Depression Scale(SDS).
3. The chi-square test was used to examine the differences between two groups on demographic variables. An analysis of multiple dependent variables was employed for multiple comparisons between groups on continuous variables by performing multiple F/t/z tests. Spearman correlation and Logistic regression analysis was performed to determine risk factors. All analyses were performed using the Statistical Program for Social Sciences (SPSS), Version 13.0 for Windows. All statistical significance was set at p< .05.
Results
1. The overall prevalence of domestic violence in pregnancy was 11.3% , the most common form of DV was both psychological abuse(7.0%) and psychological combined sexual abuse(3.9%), and the less was combined three forms abuse(0.5%). there was significant difference in husband employment and family income level between two groups.
2. There were more frequent smoking, alcohol drinking(including past 1 year), gambing from husbands and smoking and alcohol drinking past 1 year from pregnant women in DV group than in control group, and more obvious unexpected pregnancy, abortion experience and worrying about fetus gender.
3. The attitude of DV acceptance, witness to DV and abuse in childhood were much more in DV group than in control one.
4. Compared to control group, there were lower levels of general social support, self-esteem and EPQ-E, but higher levels of negative coping style and EPQ-N in DV group.
5. There were lower levels of positive coping style, objective social support in psychological combined sexual abuse group than in only psychological abuse group, there were higher levels of objective social support and general social support, but lower levels of negative coping style in less 3 abortion than above 3 abortion experience.
6. The correlation and binary Logistic regression analysis showed that better family status, unexpeted pregnancy, abortion, attitude of DV acceptance, witness to DV and poor subjective social support may predict DV in pregnancy.
7. Follow-up interview showed the overall prevalence of postpartum depression was 31.2%, there were higher levels of EPDS and SDS in DV group than in no-DV group; Binary Logistic Regression analysis showed that husband employment, abortion, alcohol drinking of the couple, attitude of DV acceptance, psychological abuse in pregnancy, worrying about fetus health, negative coping style and EPQ-N may be predictive factors of postpartum depression.
Conclusions
1. The overall prevalence of DV in pregnancy was 11.3%, psychological abuse was most common.
2. Better family status, unexpected pregnancy, abortion, attitude of DV acceptance, witness to DV and poor subjective social support may be the risk factors of DV in pregnancy.
3. The overall prevalence of postpartum depression was 31.2%, husband employment, abortion, alcohol drinking of the couple, attitude of DV acceptance, psychological abuse in pregnancy, worrying about fetus health, negative coping style and EPQ-N may be the risk factors of postpartum depression.
Objective
To explore impact of domestic violence in pregnancy on Glutamate、r-aminobutyric acid and plasma Cortisol levels in neonates, and to find the correlation between rs4680, rs4818, rs6313SNP in neonates and domestic violence in pregnancy in order to formulate possible neurobiochemical and genetic mechanisms.
Methods
1. By cross-sectional survey, The neonates were divided from DV and no-DV group in accord with their mothers. Accumulations of Glu、GABA in plasma were assayed by high performance liquid chromatography with electrochemical detection(HPLC-ECD)on samples, levels of plasma Cortisol were detecteded by immunoradiometric assay.
2. Genetypes and Allels of rs4680SNP, rs4818SNP and rs6313SNP were assayed by ligase detection reaction(LDR) and DNA sequencing, we observed frequency difference of genetype and allel between two groups.
3. The Chi-square test was used to examine the frequency difference of genetype and allel between two groups. Phenotype difference in DV group were tested by performing multiple F tests. spearman's correlations was performed to determine related factors. All analyses were performed using the Statistical Program for Social Sciences (SPSS), Version 13.0 for Windows. All statistical significance was set at p < .05.
Results
1. By comparision, our study reported that higher levels of Glu、GABA and plasma Cortisol in DV neonates than no-DV controls; there were higher levels of Cortisol in neonates whose mothers abused psychologically above 5 than less 5, and higher levels of Cortisol in neonates whose mother abused psychologically with sexually than only psychologically; Spearman correlation analysis showed significantly positive correlation between severity of psychological abuse and sexual abuse and levels of Glu、GABA and Cortisol, meanwhile, our study showed that positive correlation between EPQ-P of pregnant women and levels of Glu, GABA, and negative correlation between SDS of mother and levels of Cortisol, our study also showed that positive correlation between abuse experience in childhood of pregnant women and levels of Glu, GABA.
2. We found significant difference of rs4818SNP genetype and allel between DV neonates and no-DV neonates, there were higher ratio of CC genetype and C allel, but lower ratio of GG genetype and G allel in DV neonates than in no-DV neonates, ratio of haplotype A-G of rs4680-rs4818SNP was higher in DV neonates than in no-DV neonates (P<0.01) ,odd ratio was 2.756, 95%confidence interval was between 1.286 to 5.903. we did not find difference of rs4680SNP and rs6313SNP genetype and allel between two groups; association analysis showed that levels of GABA with GG carrier were lower than that of GABA with CC and C/G carrier of rs4818SNP genetype, but showed no correlation between rs4680SNP, rs6313SNP and phenotypes.
Conclusions
1. Domestic violence in pregnancy may influence plasma amino acid and cortisol in neonates.
2. Domestic violence in pregnancy may associate with rs4818SNP, haplotype A-G of rs4680-rs4818 possibly increased risk of violence behavior in offsprings, and rs4818SNP may lead to vary GABA level.
Objective
By constructing multiple linear regression model under perceptron neural network, to explore the impact of gene-environment interaction on infants' cognitive-behavioral development.
Methods
1. By using prospective study, we finished a follow-up to infants within near 1 year. We evaluated temperament and mental and motor development of infants.
2. We constructed multiple linear regression model under perceptron neural network in order to explore the impact of gene-environment interaction on infants' cognitive-behavioral development.
3. An analysis of all temperament dimensions and MDI, PDI variables was employed for comparison between groups by performing t tests, an association analysis of all phenotypes and genetypes in DV group was tested by performing multiple F tests. Spearman's correlations was performed to determine related factors. we constructed biomathematic model by using Matlab5.1 neural network toolbox. All statistical significance was set at p < .05.
Results
1. There were higher levels of rhythmicity, emotion, attention, but lower levels of MDI and PDI in DV infants tnan in no-DV infants (p <0.01, p<0.05) .
2. Correlation analysis showed significantly positive correlation between rhythmicity and PDI, negative correlation between phobotaxi and levels of GABA, and negative correlation between emotion and MDI, PDI, unexpected pregnancy, but positive correlation with severity of psychological abuse in pregnancy, there was negative correlation between PDI and attention, but positive correlation with subjective perceived support in pregnancy (p <0.01, p <0.05) .
3. Association analysis showed that levels of phobotaxi with AA carrier were higher than that of phobotaxi with A/G and GG carrier of rs4680SNP genetype, levels of MDI with CC carrier were lower than that of MDI with C/G and GG carrier of rs4818SNP genetype, levels of attention with C/T and TT carrier were higher than that of attention with CC carrier of rs6313SNP genetype.
4. Multiple linear regression model under neural network perceptron showed that gene-environment interaction may influence emotion, PDI and MDI.
Conclusions
1. Infants whose mothers abused in pregnancy showed poor rhythmicity, negative emotion, no persistent attention, and delayed mental and motor development.
2. COMT and 5-HT gene polymorphism may be associated with some phenotype ,such as rhythmicity, phobotaxi, attention as well as mental, motor development.
3. Gene-environment interaction may play an important role in infants' cognitive-behavioral development.
目的
调查孕期家庭暴力及产后抑郁的发生率,了解孕期受虐女性的社会心理特征,探讨孕期家庭暴力与产后抑郁的关系,发现孕期家庭暴力及产后抑郁的风险因素,为心理干预和家庭暴力的预防提供科学依据。
方法
1.采用横断面调查方法,随机抽查长沙市妇幼保健院住院部身体健康产妇846名。通过虐待评估调查问卷(Abuse Assessment Screen,AAS)筛查,将孕妇分为家暴组和非家暴组。并采取半定式面谈方法,由产妇独立完成一般情况调查表,简易应对方式问卷,社会支持评定量表,自尊量表,艾森克个性问卷等内容。
2.产后1月至42天内随访,利用爱丁堡产后抑郁量表,自评抑郁量表评估产后抑郁的发生状况。
3.研究对象一般人口学资料中构成比、率间比较采用卡方(x2)检验,所有计数资料完成正态性检验,非正态分布资料采用秩和检验(Z),正态分布资料单因素方差分析采用t检验,多因素方差分析采用F检验。影响因素间的相互关联采用Spearman相关分析,危险因素预测采用Logistic回归分析法。显著性水平为a=0.05(双尾检验)。
结果
1.孕期家庭暴力总的发生率为11.3%,单纯精神暴力最高(7.0%),其次是精神暴力合并性暴力(3.9%),单纯性暴力为0.7%,三种合并发生率最低(0.5%);家暴组丈夫从事个体经商者为多,经济状况较好者比例高于对照组,较差和中等水平者低于对照组。
2.家暴组丈夫吸烟史、饮酒史、过去一年饮酒史、赌博史以及孕妇吸烟史、过去一年饮酒史比例明显高于对照组,未计划怀孕、流产史以及产前担心胎儿性别比例也高于对照组。
3.家暴组家暴认可态度、童年期家暴目睹史、被打骂经历、性伤害经历的比例明显高于对照组。
4.家暴组孕妇积极应对、总体社会支持、自尊水平、EPQ-E分明显低于对照组,而消极应对、EPQ-N分则明显高于对照组得分。
5.遭受不同程度精神暴力孕妇之间未发现社会心理特征差异,伴有性暴力者积极应对及客观支持分低于无性暴力者;受虐孕妇既往流产史低于3次者与多于3次者相比,消极应对低于后者,客观支持和社会支持总分高于后者。
6.相关分析和Logistic回归分析显示,家庭经济状况较好,未计划怀孕、流产史,家暴认可态度、家暴目睹史和缺乏主观支持进入孕期家暴发生的回归方程。
7.随访调查显示,产后抑郁发生率为31.2%。家暴组EPDS、SDS得分明显高于非家暴组,相关分析以及Logistic回归分析显示,丈夫职业,流产史,孕期夫妻饮酒史,家暴认可态度,孕期精神暴力,担心胎儿健康,消极应对和神经质人格特征进入产后抑郁的回归方程。
结论
1.孕期家庭暴力总的发生率为11.3%,单纯精神暴力最高(7.0%)。
2.孕妇及丈夫吸烟饮酒史,赌博行为,未计划怀孕,流产史,家暴认可态度,家暴目睹史和童年期受虐与孕期家暴的发生相关,其中,家庭经济状况较好,未计划怀孕,流产史,家暴认可态度、家暴目睹史和缺乏主观支持是孕期家暴发生的高危因素。
3.产后抑郁总的发生率为31.2%,其中受虐孕妇产后抑郁发生率25.1%。丈夫职业,流产史,孕期夫妻饮酒史,家暴认可态度,孕期精神暴力,担心胎儿健康,消极应对和神经质人格特征是产后抑郁的危险因素。
第二章孕期家庭暴力与新生儿神经生化及分子生物学关系的初步探讨
目的
观察孕期家庭暴力对新生儿Glu、GABA神经递质和血浆皮质醇水平的影响。了解家庭暴力与新生儿rs4680、rs4818、rs6313SNP多态性的相关性,探讨家庭暴力对新生儿可能的神经生化和分子生物学影响机制。
方法
1.新生儿相应分为家暴组和对照组。采用库仑阵列电化学高效液相色谱检测法(HPLC-ECD)测定两组对象血浆谷氨酸(Glu)和r-氨基丁酸(GABA)含量,血浆皮质醇(Cortisol)含量采用放免法测定。
2.利用连接酶检测反应(ligase detection reaction,LDR)和测序分型方法观察两组rs4680、rs4818、rs6313SNP多态性各基因型及等位基因、单体型的差异。
3.两组基因型和等位基因频率的差异采用卡方(x~2)检验,两组研究对象生化指标含量的差异采用t检验,各基因型与临床表型的关联分析采用单向方差分析(One-way ANOVA)。影响因素间的相互关联采用Spearman相关分析。显著性水平为α=0.05。
结果
1.家暴组和非家暴组新生儿相比较,其Glu、GABA神经递质以及血浆皮质醇水平明显高于对照组;孕妇精神暴力多于5次者与低于5次者相比,子代血浆皮质醇水平明显高于后者,精神暴力合并有性暴力者与无性暴力者相比,子代血浆皮质醇水平明显高于后者;相关分析显示,新生儿Glu、GABA、Cortisol水平与孕期精神暴力、性暴力严重程度呈显著正相关,但未发现与躯体暴力存在相关关系,同时发现,Glu、GABA水平与孕妇的精神质存在正相关,Cortisol与产后SDS得分呈负相关,Glu、GABA还与孕妇童年期被打骂、遭受性侵犯呈正相关关系。
2.家暴组和非家暴组新生儿相比较,rs4818SNP多态性基因型和等位基因频率在两组间存在显著性差异,家暴组CC基因型和C等位基因频率显著高于对照组,GG基因型和G等位基因频率显著低于对照组,rs4680SNP、rs6313SNP则未发现两组间各基因型和等位基因频率存在显著性差异;家暴组rs4680-rs4818单体型A-G频率明显高于对照组,差异具有统计学意义(P＜0.01),联合风险度OR为2.756,相对危险度95%可信区间在1.286～5.903间;关联分析显示,GABA水平在rs4818SNP基因型间存在显著性差异,GG基因型携带者GABA水平低于CC和C/G基因型携带者,rs4680SNP、rs6313SNP则未发现与临床表型之间存在关联。
结论
1.孕期家庭暴力可能导致子代氨基酸神经递质及血浆皮质醇的变化。
2.COMT基因rs4818SNP可能和暴力行为存在关联,rs4680-rs4818单体型A-G联合增加了子代暴力行为发生的风险,rs4818SNP多态性可能和GABA神经递质变化有关。
第三章孕期家庭暴力的遗传-环境交互作用对婴儿生长发育影响的前瞻性研究及生物数学模型的建立
目的
通过建立基于神经网络感知器的多元线性回归模型,阐述孕期家庭暴力的遗传-环境交互作用对婴儿认知行为发育的近期影响。
方法
1.采用前瞻性研究方法,完成婴儿出生近一年的随访,评估婴儿各气质维度和智能及运动发展功能。
2.利用MATLAB神经网络感知器,建立多元线性回归模型,观察遗传-环境交互作用对婴儿认知行为发育的近期影响。
3.两组婴儿气质及发展指数的差异采用t检验,各基因型与临床表型的关联分析采用单向方差分析(One-way ANOVA)。影响因素间的相互关联采用Spearman相关分析。数学模型的建立及分析运用Matlab5.1神经网络工具箱操作。显著性水平为α=0.05。
结果
1.家暴组婴儿和非家暴组婴儿相比,节律性、情绪本质、注意分散度因子分明显高于对照组,贝利发展量表MDI、PDI得分明显低于对照组,差异有统计学意义(p＜0.01,p＜0.05)。其余指标未显示显著性差异(p＞0.05)。
2.相关分析显示,节律性与PDI呈正相关,趋避性与GABA呈负相关,情绪性与计划怀孕以及MDI、PDI呈负相关,与母孕期精神暴力严重程度呈正相关,注意分散度与PDI呈负相关,PDI与孕期主观支持程度呈正相关(p＜0.01,p＜0.05)。
3.基因型与临床表型的关联分析显示:rs4680SNP基因型在婴儿趋避性方面存在差异,AA基因型携带者趋避性明显高于A/G和GG基因型携带者;rs4818SNP基因型在婴儿MDI方面存在差异,CC基因型携带者MDI分明显低于C/G和GG基因型携带者;rs6313SNP基因型在节律性和注意分散度方面存在差异,C/T和TT基因型携带者节律性和注意分散度分明显高于CC基因型携带者。
4.基于神经网络感知器的多元线性回归模型显示,遗传-环境交互作用与婴儿的情绪性、PDI存在线性相关关系,与MDI存在线性相关趋势。
结论
1.孕妇受虐其婴儿表现明显的节律性弱、情绪消极、注意易分散以及智利和运动发育相对缓慢等认知行为特征。
2.COMT基因和5-HT基因多态性(rs4818SNP、rs4680SNP、rs6313SNP)可能与婴儿的节律性、趋避性、注意分散以及智能和运动发育等存在关联。
3.孕期家庭暴力的遗传-环境交互作用可能对婴儿的认知行为发育存在近期影响。
Objective
To investigate the prevalence of domestic violence in pregnancy and postpartum depression and related psychosocial characteristics in order to find the risk factors of abused pregnant women and postpartum depression and provide with systematic prevention.
Methods
1. By using cross-sectional survey and semi-structured interview, 846 pregnant women were screened by Abuse Assessment Screen(AAS), and a sample of abused and control pregnant women was randomly selected for study and administered Self-designed demographic Questionnaire, Simpled Coping Style Questionnaire(TCSQ), Social Supporting Rating Scale(SSRS), Self-esteem Scale(SES), and Eysenck's Personality Questionnaire(EPQ), respectively.
2. Study subjects were received follow-up visit after childbirth 30 to 42 days and administered in Edingburg Postnatal Depression Scale(EPDS), Self-rating Depression Scale(SDS).
3. The chi-square test was used to examine the differences between two groups on demographic variables. An analysis of multiple dependent variables was employed for multiple comparisons between groups on continuous variables by performing multiple F/t/z tests. Spearman correlation and Logistic regression analysis was performed to determine risk factors. All analyses were performed using the Statistical Program for Social Sciences (SPSS), Version 13.0 for Windows. All statistical significance was set at p< .05.
Results
1. The overall prevalence of domestic violence in pregnancy was 11.3% , the most common form of DV was both psychological abuse(7.0%) and psychological combined sexual abuse(3.9%), and the less was combined three forms abuse(0.5%). there was significant difference in husband employment and family income level between two groups.
2. There were more frequent smoking, alcohol drinking(including past 1 year), gambing from husbands and smoking and alcohol drinking past 1 year from pregnant women in DV group than in control group, and more obvious unexpected pregnancy, abortion experience and worrying about fetus gender.
3. The attitude of DV acceptance, witness to DV and abuse in childhood were much more in DV group than in control one.
4. Compared to control group, there were lower levels of general social support, self-esteem and EPQ-E, but higher levels of negative coping style and EPQ-N in DV group.
5. There were lower levels of positive coping style, objective social support in psychological combined sexual abuse group than in only psychological abuse group, there were higher levels of objective social support and general social support, but lower levels of negative coping style in less 3 abortion than above 3 abortion experience.
6. The correlation and binary Logistic regression analysis showed that better family status, unexpeted pregnancy, abortion, attitude of DV acceptance, witness to DV and poor subjective social support may predict DV in pregnancy.
7. Follow-up interview showed the overall prevalence of postpartum depression was 31.2%, there were higher levels of EPDS and SDS in DV group than in no-DV group; Binary Logistic Regression analysis showed that husband employment, abortion, alcohol drinking of the couple, attitude of DV acceptance, psychological abuse in pregnancy, worrying about fetus health, negative coping style and EPQ-N may be predictive factors of postpartum depression.
Conclusions
1. The overall prevalence of DV in pregnancy was 11.3%, psychological abuse was most common.
2. Better family status, unexpected pregnancy, abortion, attitude of DV acceptance, witness to DV and poor subjective social support may be the risk factors of DV in pregnancy.
3. The overall prevalence of postpartum depression was 31.2%, husband employment, abortion, alcohol drinking of the couple, attitude of DV acceptance, psychological abuse in pregnancy, worrying about fetus health, negative coping style and EPQ-N may be the risk factors of postpartum depression.
Objective
To explore impact of domestic violence in pregnancy on Glutamate、r-aminobutyric acid and plasma Cortisol levels in neonates, and to find the correlation between rs4680, rs4818, rs6313SNP in neonates and domestic violence in pregnancy in order to formulate possible neurobiochemical and genetic mechanisms.
Methods
1. By cross-sectional survey, The neonates were divided from DV and no-DV group in accord with their mothers. Accumulations of Glu、GABA in plasma were assayed by high performance liquid chromatography with electrochemical detection(HPLC-ECD)on samples, levels of plasma Cortisol were detecteded by immunoradiometric assay.
2. Genetypes and Allels of rs4680SNP, rs4818SNP and rs6313SNP were assayed by ligase detection reaction(LDR) and DNA sequencing, we observed frequency difference of genetype and allel between two groups.
3. The Chi-square test was used to examine the frequency difference of genetype and allel between two groups. Phenotype difference in DV group were tested by performing multiple F tests. spearman's correlations was performed to determine related factors. All analyses were performed using the Statistical Program for Social Sciences (SPSS), Version 13.0 for Windows. All statistical significance was set at p < .05.
Results
1. By comparision, our study reported that higher levels of Glu、GABA and plasma Cortisol in DV neonates than no-DV controls; there were higher levels of Cortisol in neonates whose mothers abused psychologically above 5 than less 5, and higher levels of Cortisol in neonates whose mother abused psychologically with sexually than only psychologically; Spearman correlation analysis showed significantly positive correlation between severity of psychological abuse and sexual abuse and levels of Glu、GABA and Cortisol, meanwhile, our study showed that positive correlation between EPQ-P of pregnant women and levels of Glu, GABA, and negative correlation between SDS of mother and levels of Cortisol, our study also showed that positive correlation between abuse experience in childhood of pregnant women and levels of Glu, GABA.
2. We found significant difference of rs4818SNP genetype and allel between DV neonates and no-DV neonates, there were higher ratio of CC genetype and C allel, but lower ratio of GG genetype and G allel in DV neonates than in no-DV neonates, ratio of haplotype A-G of rs4680-rs4818SNP was higher in DV neonates than in no-DV neonates (P<0.01) ,odd ratio was 2.756, 95%confidence interval was between 1.286 to 5.903. we did not find difference of rs4680SNP and rs6313SNP genetype and allel between two groups; association analysis showed that levels of GABA with GG carrier were lower than that of GABA with CC and C/G carrier of rs4818SNP genetype, but showed no correlation between rs4680SNP, rs6313SNP and phenotypes.
Conclusions
1. Domestic violence in pregnancy may influence plasma amino acid and cortisol in neonates.
2. Domestic violence in pregnancy may associate with rs4818SNP, haplotype A-G of rs4680-rs4818 possibly increased risk of violence behavior in offsprings, and rs4818SNP may lead to vary GABA level.
Objective
By constructing multiple linear regression model under perceptron neural network, to explore the impact of gene-environment interaction on infants' cognitive-behavioral development.
Methods
1. By using prospective study, we finished a follow-up to infants within near 1 year. We evaluated temperament and mental and motor development of infants.
2. We constructed multiple linear regression model under perceptron neural network in order to explore the impact of gene-environment interaction on infants' cognitive-behavioral development.
3. An analysis of all temperament dimensions and MDI, PDI variables was employed for comparison between groups by performing t tests, an association analysis of all phenotypes and genetypes in DV group was tested by performing multiple F tests. Spearman's correlations was performed to determine related factors. we constructed biomathematic model by using Matlab5.1 neural network toolbox. All statistical significance was set at p < .05.
Results
1. There were higher levels of rhythmicity, emotion, attention, but lower levels of MDI and PDI in DV infants tnan in no-DV infants (p <0.01, p<0.05) .
2. Correlation analysis showed significantly positive correlation between rhythmicity and PDI, negative correlation between phobotaxi and levels of GABA, and negative correlation between emotion and MDI, PDI, unexpected pregnancy, but positive correlation with severity of psychological abuse in pregnancy, there was negative correlation between PDI and attention, but positive correlation with subjective perceived support in pregnancy (p <0.01, p <0.05) .
3. Association analysis showed that levels of phobotaxi with AA carrier were higher than that of phobotaxi with A/G and GG carrier of rs4680SNP genetype, levels of MDI with CC carrier were lower than that of MDI with C/G and GG carrier of rs4818SNP genetype, levels of attention with C/T and TT carrier were higher than that of attention with CC carrier of rs6313SNP genetype.
4. Multiple linear regression model under neural network perceptron showed that gene-environment interaction may influence emotion, PDI and MDI.
Conclusions
1. Infants whose mothers abused in pregnancy showed poor rhythmicity, negative emotion, no persistent attention, and delayed mental and motor development.
2. COMT and 5-HT gene polymorphism may be associated with some phenotype ,such as rhythmicity, phobotaxi, attention as well as mental, motor development.
3. Gene-environment interaction may play an important role in infants' cognitive-behavioral development.
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