近日,，發(fā)表于2月刊《普通精神病學(xué)文獻(xiàn)》（Archives of General Psychiatry）上的一篇報告稱，有精神病住院史的婦女在孕早期接受人工流產(chǎn)并不會增加再入院的風(fēng)險,。主要作者,、丹麥奧胡斯大學(xué)國立注冊研究中心的Trine Munk-Olsen博士稱，孕早期人工流產(chǎn)似乎不影響任何精神疾病的病程,。
既往關(guān)于人工流產(chǎn)對精神健康不良影響的研究得出了矛盾的結(jié)果,，但這些研究普遍存在回應(yīng)率低、失訪率高,、回憶偏倚等局限性,，而且對流產(chǎn)方式和精神疾病的界定也不統(tǒng)一。為此,，Munk-Olsen博士及其同事分析了丹麥注冊數(shù)據(jù)庫中1962~1992年期間出生的婦女在1994~2007年期間接受的人工流產(chǎn),，以及該人群所有精神疾病住院的詳細(xì)數(shù)據(jù)。作為對照,，他們評估了同期有任何類型精神疾病住院史且活產(chǎn)嬰兒的同齡婦女,。
研究人員發(fā)現(xiàn)，在首次孕早期人工流產(chǎn)的婦女中2,838人有精神疾病記錄,，這些婦女在人工流產(chǎn)之前9個月至之后12個月期間共發(fā)生321例精神病入院,。與此相對，同期有5,293名有精神疾病記錄的婦女生育了第一個孩子,，這些婦女在人工流產(chǎn)之前9個月至之后12個月期間共發(fā)生273例精神病入院,。
從人工流產(chǎn)之前到之后，精神病入院的粗發(fā)生率下降,。而與此相反的是,，從分娩活產(chǎn)嬰兒之前到之后,，精神病入院的粗發(fā)生率上升。此外,，分娩后1個月的精神病入院風(fēng)險高于人工流產(chǎn)后1個月,。在人工流產(chǎn)前后的任意時間點，任何類型精神病入院風(fēng)險均無顯著升高,。相比之下,，分娩后第1個月內(nèi)的精神病入院風(fēng)險顯著升高，尤其是雙相情感障礙和精神分裂癥樣疾病,。
研究人員認(rèn)為兩個預(yù)后因素是所有受試者再入院的最強預(yù)測因素：與最近1次精神病入院的間隔時間較短,，以及既往入院次數(shù)較多。
雖然注冊數(shù)據(jù)庫采集的資料遠(yuǎn)比自我報告獲得的數(shù)據(jù)更準(zhǔn)確,，但研究人員承認(rèn)這項研究仍存在局限性,，即不清楚妊娠是計劃內(nèi)還是意外，以及人工流產(chǎn)的原因,。
這項研究由Susan Thompson Buffett基金會和丹麥醫(yī)學(xué)研究委員會發(fā)起,。Munk-Olsen博士的同事承認(rèn)與拜耳先靈制藥和斯坦利醫(yī)學(xué)研究所有關(guān)聯(lián)。（生物谷Bioon.com）
doi:10.1001/archgenpsychiatry.2011.153
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First-time first-trimester induced abortion and risk of readmission to a psychiatric hospital in women with a history of treated mental disorder.
Mortensen PB,Pedersen CB,Lidegaard O,et al.
CONTEXT:Mental health problems are associated with women's reproductive decisions and predict poor mental health outcomes after abortion and childbirth.
OBJECTIVES:To study whether having a first-trimester induced abortion influenced the risk of psychiatric readmission and compare findings with read... CONTEXT:Mental health problems are associated with women's reproductive decisions and predict poor mental health outcomes after abortion and childbirth.
OBJECTIVES:To study whether having a first-trimester induced abortion influenced the risk of psychiatric readmission and compare findings with readmission risk in women with mental disorders giving birth.
DESIGN:Survival analyses were performed in a population-based cohort study merging data from the Danish Civil Registration System, the Danish Psychiatric Central Register, and the Danish National Hospital Register from January 1,1994, to December 31, 2007.
SETTING:Denmark.
PARTICIPANTS:All women born in Denmark between 1962 and 1992 with a record of 1 or more psychiatric admissions at least 9 months before a first-time first-trimester induced abortion or childbirth. Main Outcome Measure Readmission at a psychiatric hospital with any type of mental disorder from 9 months before to 12 months after a first-time first-trimester induced abortion or childbirth.
RESULTS:Relative risk (RR) for readmission risk 9 to 0 months before a first-trimester induced abortion was 0.95 (95% CI, 0.73-1.23) compared with the first year after the abortion. This contrasts with a reduced risk of readmission before childbirth (RR, 0.56; 95% CI, 0.42-0.75) compared with the first year post partum. Proximity to previous psychiatric admission in particular predicted rehospitalization risks in both the abortion and the childbirth group.
CONCLUSIONS:Risk of readmission is similar before and after first-time first-trimester abortion, contrasting with a marked increased in risk of readmission post partum. We speculate that recent psychiatric episodes may influence women's decisions to have an induced abortion; however, this decision does not appear to influence the illness course in women with a history of treated mental disorders.
