目的 探讨多次体外受精-胚胎移植（IVF-ET）失败女性创伤后应激障碍（PTSD）轨迹的潜在类别，分析不同人口学特征及心理因素对其PTSD轨迹潜在类别的影响。 方法 采用前瞻性观察研究，便利抽样法选取2021年5月至2022年10月上海市第一人民医院生殖科IVF-ET失败≥2次的女性为研究对象，分别于最近1次移植失败后3 d（T1）、10 d（T2）、20 d（T3）及下一移植周期前3 d（T4）采用创伤后应激障碍平民版量表进行4次随访，电话随访和线上随访相结合，获得4个时间点的PTSD水平，使用潜类别增长模型识别4个时间点PTSD得分轨迹的潜在类别，并采用无序多分类Logistic进行影响因素分析。 结果 最终纳入196例IVF-ET失败女性，年龄（29.42 ± 4.13）岁。本研究拟合出3条PTSD轨迹，分别为无PTSD组82例占42%、轻度PTSD组61例占31%及PTSD升高组53例占27%；Logistic回归分析显示，年龄、文化程度、生育压力、婚姻调适水平是多次IVF-ET失败女性PTSD轨迹的预测因素；以无PTSD组为参照，年龄≥35岁、初中及以下文化程度及婚姻调适水平越低的女性越易进入PTSD升高组（OR=4.570、8.540、0.949，均P<0.05），年龄≥35岁及生育压力越大的女性越易进入轻度PTSD组（OR=3.871、1.063，P<0.05）。 结论 多次IVF-ET失败女性在下一移植周期内PTSD的轨迹存在群体异质性，年龄大、文化程度低、生育压力大及婚姻调适差可预测PTSD的变化轨迹。生育压力及婚姻调适为可改变的变量，医护人员可通过进行健康教育、正念干预以缓解女性生育压力，促进良好的婚姻调适状态，尽可能降低PTSD对下一周期受孕的不良影响。 Objective To explore the potential categories of post-traumatic stress disorder (PTSD) trajectories in women with multiple in vitro fertilization-embryo transfer (IVF-ET) failures, and to analyze the effects of different demographic characteristics and psychological factors on the potential categories of PTSD trajectories. Methods This was a prospective empirical research, from May 2021 to October 2022, women with IVF-ET failure ≥ 2 times in the reproductive department of Shanghai First People′s Hospital from May 2021 to October 2022 were selected as the research objects. Post-traumatic stress disorder civilian version scale was used for 4 follow-ups at 3 d (T1), 10 d (T2), 20 d (T3) after the last transplantation failure and 3 d before the next transplantation cycle (T4). Telephone follow-up and online follow-up were combined to obtain the PTSD level at 4 time points. Potential categories of PTSD score trajectories at four time points were identified using a latent category growth model, and analyze influencing factors using unordered multi classification logistic analysis. Results Totally 196 IVF-ET women were admitted, aged (29.42 ± 4.13) years. Three PTSD trajectories were fitted in this study, including 82 cases (42%) in non-PTSD group, 61 cases (31%) in mild PTSD group and 53 cases (27%) in elevated PTSD group. Logistic regression analysis showed that age, education level, fertility pressure and marital adjustment level were the predictors of PTSD trajectory in women with multiple IVF-ET failures. Compared with the non-PTSD group, women aged ≥35 years, with lower education level and marital adjustment level were more likely to enter the elevated PTSD group (OR=4.570, 8.540, 0.949, all P<0.05). Women aged 35 years and with greater reproductive pressure were more likely to enter the mild PTSD group (OR=3.871, 1.063, both P<0.05). Conclusions There is group heterogeneity in the trajectories of PTSD in women with multiple IVF-ET failures in the next transplantation cycle. Old age, low education level, high fertility pressure and poor marital adjustment can predict the trajectories of PTSD. Fertility stress and marriage adjustment are changeable variables. Medical staff can relieve women′s fertility pressure through health education and mindfulness intervention, promote a good state of marriage adjustment, and minimize the adverse effects of PTSD on the next cycle of conception.
Trajectories and influencing factors of post-traumatic stress disorder in women with multiple in vitro fertilization embryo transfer failures
Objective To explore the potential categories of post-traumatic stress disorder (PTSD) trajectories in women with multiple in vitro fertilization-embryo transfer (IVF-ET) failures, and to analyze the effects of different demographic characteristics and psychological factors on the potential categories of PTSD trajectories. Methods This was a prospective empirical research, from May 2021 to October 2022, women with IVF-ET failure ≥ 2 times in the reproductive department of Shanghai First People′s Hospital from May 2021 to October 2022 were selected as the research objects. Post-traumatic stress disorder civilian version scale was used for 4 follow-ups at 3 d (T1), 10 d (T2), 20 d (T3) after the last transplantation failure and 3 d before the next transplantation cycle (T4). Telephone follow-up and online follow-up were combined to obtain the PTSD level at 4 time points. Potential categories of PTSD score trajectories at four time points were identified using a latent category growth model, and analyze influencing factors using unordered multi classification logistic analysis. Results Totally 196 IVF-ET women were admitted, aged (29.42 ± 4.13) years. Three PTSD trajectories were fitted in this study, including 82 cases (42%) in non-PTSD group, 61 cases (31%) in mild PTSD group and 53 cases (27%) in elevated PTSD group. Logistic regression analysis showed that age, education level, fertility pressure and marital adjustment level were the predictors of PTSD trajectory in women with multiple IVF-ET failures. Compared with the non-PTSD group, women aged ≥35 years, with lower education level and marital adjustment level were more likely to enter the elevated PTSD group (OR=4.570, 8.540, 0.949, all P<0.05). Women aged 35 years and with greater reproductive pressure were more likely to enter the mild PTSD group (OR=3.871, 1.063, both P<0.05). Conclusions There is group heterogeneity in the trajectories of PTSD in women with multiple IVF-ET failures in the next transplantation cycle. Old age, low education level, high fertility pressure and poor marital adjustment can predict the trajectories of PTSD. Fertility stress and marriage adjustment are changeable variables. Medical staff can relieve women′s fertility pressure through health education and mindfulness intervention, promote a good state of marriage adjustment, and minimize the adverse effects of PTSD on the next cycle of conception.
In vitro fertilization-embryo transferPregnancy failurePost-traumatic stress disorderTrajectoryPotential categories
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