Retrospective Study
Copyright ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Psychiatry. Oct 19, 2023; 13(10): 763-771
Published online Oct 19, 2023. doi: 10.5498/wjp.v13.i10.763
Construction and validation of a personalized prediction model for postpartum anxiety in pregnant women with preeclampsia
Le-Jing Lin, Hai-Xian Zhou, Zhi-Yun Ye, Qi Zhang, Shu Chen
Le-Jing Lin, Hai-Xian Zhou, Zhi-Yun Ye, Qi Zhang, Department of Obstetrics and Gynecology, Wenzhou Hospital of Integrated Traditional Chinese and Western Medicine, Wenzhou 325000, Zhejiang Province, China
Shu Chen, Department of Gynecology, Wenzhou Traditional Chinese Medicine Hospital, Wenzhou 325000, Zhejiang Province, China
Author contributions: Lin LJ and Chen S designed the study and wrote the paper; Zhou HX participated in the analysis; Ye ZY and Zhang Q provided clinical advice.
Institutional review board statement: The study was reviewed and approved by the Wenzhou Hospital of Integrated Traditional Chinese and Western Medicine, No. 202304240852000335465.
Informed consent statement: All patients have signed informed consent forms.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Data sharing statement: The dataset used for this study can be obtained from the corresponding author.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Shu Chen, MM, Attending Doctor, Department of Gynecology, Wenzhou Traditional Chinese Medicine Hospital, No. 9 Jiaowei Road, Lucheng District, Wenzhou 325000, Zhejiang Province, China. wzszyychenshu@126.com
Received: August 8, 2023
Peer-review started: August 8, 2023
First decision: August 24, 2023
Revised: September 1, 2023
Accepted: September 20, 2023
Article in press: September 20, 2023
Published online: October 19, 2023
Processing time: 65 Days and 2.2 Hours
Abstract
BACKGROUND

Preeclampsia is a pregnancy-specific multi-system disease with multi-factor and multi-mechanism characteristics. The cure for preeclampsia is to terminate the pregnancy and deliver the placenta. However, it will reduce the perinatal survival rate, prolong the pregnancy cycle, and increase the incidence of maternal complications. With relaxation of the birth policy, the number of elderly pregnant women has increased significantly, and the prevalence rate of preeclampsia has increased. Inappropriate treatment can seriously affect the normal postpartum life of pregnant women. Studies have shown that postpartum anxiety in women with preeclampsia can affect physical and mental health, as well as infant growth and development.

AIM

To analyze the factors influencing preeclampsia in pregnant women complicated with postpartum anxiety, and to construct a personalized predictive model.

METHODS

We retrospectively studied 528 pregnant women with preeclampsia who delivered in Wenzhou Hospital of Integrated Traditional Chinese and Western Medicine between January 2018 and December 2021. Their basic data were collected, and various physiological and biochemical indicators were obtained by laboratory examination. The self-rating anxiety scale was used to determine whether the women had postpartum anxiety 42 d after delivery. The independent factors influencing postpartum anxiety in early pregnant women with eclampsia were analyzed with multifactor logistic regression and a predictive model was constructed. The Hosmer-Lemeshow test and receiver operating characteristic (ROC) curve were used to evaluate the calibration and discrimination of the predictive model. Eighty pregnant women with preeclampsia admitted to our hospital from January 2022 to May 2022 were retrospectively selected to verify the prediction model.

RESULTS

We excluded 46 of the 528 pregnant women with preeclampsia because of loss to follow-up and adverse outcomes. A total of 482 cases completed the assessment of postpartum anxiety 42 d after delivery, and 126 (26.14%) had postpartum anxiety. Bad marital relationship, gender discrimination in family members, hematocrit (Hct), estradiol (E2) hormone and interleukin (IL)-6 were independent risk factors for postpartum anxiety in pregnant women with preeclampsia (P < 0.05). Prediction model: Logit (P) = 0.880 × marital relationship + 0.870 × gender discrimination of family members + 0.130 × Hct - 0.044 × E2 + 0.286 × IL-6 - 21.420. The area under the ROC curve of the model was 0.943 (95% confidence interval: 0.919-0.966). The threshold of the model was -1.507 according to the maximum Youden index (0.757), the corresponding sensitivity was 84.90%, and the specificity was 90.70%. Hosmer-Lemeshow χ2 = 5.900, P = 0.658. The sensitivity, specificity and accuracy of the model were 81.82%, 84.48% and 83.75%, respectively.

CONCLUSION

Poor marital relationship, family gender discrimination, Hct, IL-6 and E2 are the influencing factors of postpartum anxiety in preeclampsia women. The constructed prediction model has high sensitivity and specificity.

Keywords: Preeclampsia; Postpartum anxiety; Risk factors; Predictive model

Core Tip: Preeclampsia is a progressive multisystem disease during pregnancy, characterized by new hypertension and proteinuria after 20 wk of pregnancy, and the condition develops continuously, which has a serious effect on the health of the mother and child. We analyzed the biochemical indicators of 528 pregnant women with preeclampsia and the independent factors influencing postpartum anxiety, and constructed a predictive model, with high clinical value.