【摘要】 [背景]焦虑和抑郁是孕期女性最常见的心理健康问题。两者通常共病发生，并可能导致严重的不良母婴结局。[目的]评估上海地区女性孕期生活方式与焦虑合并抑郁（CAD）状况的关联。[方法]本研究基于中国国家出生队列（CNBC）辅助生殖技术子代胚胎源性疾病子队列，采用《焦虑自评量表》（SAS）和《抑郁流调量表》（CES–D）分别在孕早、中、晚期评估孕妇的CAD患病率。使用自制问卷、《匹兹堡睡眠质量指数》（PSQI）和《食物摄入频率问卷》（FFQ）收集孕妇的一般人口学资料及各孕期睡眠状况、营养摄入和运动状况等生活方式信息。分别采用二元逻辑回归模型和广义线性混合模型（GLMM）分析孕早、中、晚期生活方式（睡眠状况、营养摄入、运动状况）与孕妇CAD状况（是/否）的横向和纵向关联。[结果]本研究共纳入2 876例孕妇，在孕早、中、晚期的CAD患病率分别为10.6%（305例）、3.6%（103例）、5.5%（159例）。逻辑回归分析结果显示，以睡眠状况良好为参照，孕早、中、晚期睡眠状况不佳均与CAD患病率增加存在统计学关联，OR（95%CI）分别为2.817（1.845～4.301）、2.840（1.855～4.347）、9.316（5.835～14.876）。以摄入频率=7次·周^-1为参照，孕早期蛋类摄入频率≤3次·周^-1（OR=2.025,95%CI:1.197～3.425）及孕晚期摄入频率4～6次·周^-1（OR=1.896,95%CI:1.117～3.216）、≤3次·周^-1（OR=1.906,95%CI:1.082～3.357）均会增加CAD的患病风险（P <0.05）；以运动频率> 3次·周^-1为参照，孕中期从不或几乎不运动（OR=2.218,95%CI:1.220～4.035）均会增加CAD的患病风险（P <0.05）。GLMM分析结果显示，睡眠状况不佳及较低的运动频率和蔬菜、蛋类、奶类摄入频率均与CAD患病率风险增加存在统计学关联（P <0.05）。[结论]上海地区女性孕早、中、晚期CAD患病率呈U形分布，孕早期最高，孕中期最低。孕期较差的睡眠状况，蔬菜、蛋类、奶类摄入频率和运动频率不足等不良生活方式均可能增加CAD的患病风险。及时对孕期生活方式进行干预和调整，将有助于降低孕期女性发生心理健康问题的风险，进一步提升母婴健康水平。更多还原

【Abstract】 [Background] Anxiety and depression are common perinatal mental health issues that often occur together and can have serious negative effects on both maternal and infant health.[Objective] To examine the relationships between lifestyle factors and comorbid anxiety and depression(CAD) among pregnant women in Shanghai.[Methods] The study estimated the prevalence of CAD during the first, second, and third trimesters of pregnancy using the Self-rating Anxiety Scale(SAS) and Center for Epidemiological Studies-Depression(CES-D) based on data from the China National Birth Cohort(CNBC) embryonic-derived diseases with assisted reproductive technology(ART) sub-cohort. Information on demographics, sleep status, nutritional intake, and exercise during each trimester was collected through self-made questionnaires, the Pittsburgh Sleep Quality Index(PSQI), and the Food Frequency Questionnaire(FFQ). Lifestyle factors(such as sleep status, nutritional intake, and exercise during each trimester) were analyzed using logistic regression and generalized linear mixed models(GLMM)to determine their impacts on the prevalence of CAD(yes or no) among pregnant women.[Results] A total of 2 876 pregnant women were included in this study. The prevalence of CAD was 10.6%(305), 3.6%(103), and 5.5%(159) in the first, second, and third trimesters of pregnancy, respectively. The logistic regression analysis revealed that poor sleep quality throughout the entire pregnancy were statistically associated with an increased prevalence of CAD, and the odds ratios(OR) with 95%confidence intervals(CI) were 2.817(1.845, 4.301), 2.840(1.855, 4.347), and 9.316(5.835, 14.876) for the first, second, and third trimesters, respectively, when compared to good sleep quality. Additionally, compared to an intake frequency of 7 times per week, the frequency of egg intake ≤3 times per week in the first trimester(OR=2.025, 95%CI: 1.197, 3.425) and the frequency of egg intake of 4–6times per week(OR=1.896, 95%CI: 1.117, 3.216) or ≤3 times per week(OR=1.906, 95%CI: 1.082, 3.357) in the third trimester were associated with an increased risk of CAD(P < 0.05). Moreover, when compared to a frequency of exercise > 3 times per week, never or almost never exercising in the second trimester(OR=2.218, 95%CI: 1.220, 4.035) was associated with an increased risk of CAD(P < 0.05). The GLMM analysis also demonstrated a significant association between poor sleep quality, lower exercise frequency, or lower intake frequency of vegetables, eggs, or milk and an increased risk of CAD(P < 0.05).[Conclusion] The prevalence of CAD among pregnant women in Shanghai follows a U-shaped distribution, with the highest rate occurring in early pregnancy and the lowest rate in mid-pregnancy. Factors such as poor sleep quality, inadequate intake of vegetables, eggs, or milk, and lack of exercise during pregnancy may increase the risk of CAD. Implementing lifestyle interventions during pregnancy could potentially reduce the risk of mental health problems and improve the overall health of both mothers and babies.更多还原