近日，发表于2月刊《普通精神病学文献》（Archives of General Psychiatry）上的一篇报告称，有精神病住院史的妇女在孕早期接受人工流产并不会增加再入院的风险。主要作者、丹麦奥胡斯大学国立注册研究中心的Trine Munk-Olsen博士称，孕早期人工流产似乎不影响任何精神疾病的病程。
既往关于人工流产对精神健康不良影响的研究得出了矛盾的结果，但这些研究普遍存在回应率低、失访率高、回忆偏倚等局限性，而且对流产方式和精神疾病的界定也不统一。为此，Munk-Olsen博士及其同事分析了丹麦注册数据库中1962~1992年期间出生的妇女在1994~2007年期间接受的人工流产，以及该人群所有精神疾病住院的详细数据。作为对照，他们评估了同期有任何类型精神疾病住院史且活产婴儿的同龄妇女。
研究人员发现，在首次孕早期人工流产的妇女中2,838人有精神疾病记录，这些妇女在人工流产之前9个月至之后12个月期间共发生321例精神病入院。与此相对，同期有5,293名有精神疾病记录的妇女生育了第一个孩子，这些妇女在人工流产之前9个月至之后12个月期间共发生273例精神病入院。
从人工流产之前到之后，精神病入院的粗发生率下降。而与此相反的是，从分娩活产婴儿之前到之后，精神病入院的粗发生率上升。此外，分娩后1个月的精神病入院风险高于人工流产后1个月。在人工流产前后的任意时间点，任何类型精神病入院风险均无显著升高。相比之下，分娩后第1个月内的精神病入院风险显著升高，尤其是双相情感障碍和精神分裂症样疾病。
研究人员认为两个预后因素是所有受试者再入院的最强预测因素：与最近1次精神病入院的间隔时间较短，以及既往入院次数较多。
虽然注册数据库采集的资料远比自我报告获得的数据更准确，但研究人员承认这项研究仍存在局限性，即不清楚妊娠是计划内还是意外，以及人工流产的原因。
这项研究由Susan Thompson Buffett基金会和丹麦医学研究委员会发起。Munk-Olsen博士的同事承认与拜耳先灵制药和斯坦利医学研究所有关联。（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.
