Lancet Public Health:妈妈孕前心理社会危险因素影响孩子

2021-04-03 MedSci原创 MedSci原创

怀孕前20周的社会心理危险因素与低出生体重、早产及产后出院12个月期间受伤和死亡的风险大大增加有关。

孕妇的心理社会因素如得不到解决,可能对母亲及其婴儿的妊娠结局产生不利影响。国家健康和护理卓越研究所的指南建议,应在怀孕期间确定有“复杂社会风险因素”的妇女,以便提供额外的支持。这些指南认识到,易受伤害的妇女往往同时经历一系列社会风险因素,并强调年轻母亲(20岁以下)、滥用药物的妇女和遭受家庭暴力的妇女的具体需求。

现有的评估母体危险因素与婴儿结局(如出生体重、受伤入院和死亡率)之间关系的研究大多集中在单一危险因素上。Katie Harron等进行了相关研究,该研究的目的是确定常规记录的孕妇的心理社会特征,这些孕妇最有可能出现不良的婴儿结局,在怀孕前、怀孕期间和怀孕后就健康和社会支持的早期目标向临床和政治决策提供信息。研究成果发表在Lancet Public Health杂志。

该研究使用医院统计数据(Hospital Episode Statistics)为英国15-44岁、2010年4月1日或之后分娩、2015年3月31日之前或之后出院的所有母亲的分娩创建了一个队列。使用广义线性模型来评估怀孕20周前2年医院记录中记录的心理社会危险因素(例如,少女为人母、被剥夺、孕前因精神健康或行为状况入院,以及孕前因药物或酒精滥用、暴力和自残等逆境入院)与婴儿结局(即出生体重、意外入院受伤或出生后12个月内因任何原因死亡)之间的关系(例如,出生体重、意外入院受伤或因任何原因死亡,从出生后出院起12个月内),使用了广义线性模型来评估这些因素与婴儿结局(即出生体重、意外入院受伤或因任何原因死亡,出院后12个月内)之间的关系。

母亲年龄与出生和婴儿之间的关系。(A)产妇年龄和出生体重之间的粗略(未经调整的)关系。(B)产妇年龄与产后12个月内因意外伤害入院的婴儿百分比之间的粗略(未经调整)关系。

在最初评估的2520501个新生儿中,有2137103符合条件,并纳入了出生结局分析。在符合条件的新生儿中,青少年母亲(<20岁)所生婴儿93279例(4.4%),既往青少年母亲所生婴儿168186(7.9%),有精神疾病或行为问题住院史母亲所生婴儿51312例(2.4%),有不良住院史母亲所生婴儿58107例(2.7%),居住在高度贫困地区的母亲所生婴儿580631例(27.2%),1377706例(64.5%)出生于无上述危险因素的母亲。有这些危险因素的母亲所生的婴儿比没有这些危险因素的母亲所生的婴儿结局更差。有精神健康或行为状况的母亲所生的孩子比那些没有这些情况的母亲所生的孩子轻124克(95%置信区间114-134克)。与年龄较大的母亲相比,少女母亲所生婴儿意外受伤入院比年长母亲多3.6%(95%CI 3.3~3.9%),每10000婴儿中多死亡10.2例(95%CI 7.5~12.9)。

具有每种风险因素的母亲与没有这种风险因素的母亲比较

卫生保健服务应积极应对孕前心理社会风险因素。研究表明,需要在怀孕前、怀孕期间和怀孕后采取有效的干预措施,以减轻下游卫生服务的负担,防止对儿童的长期不良影响。

这项基于人群的队列研究对英国英格兰国家卫生服务医院5年多的200多万对母婴数据进行了检查。这项研究显示,怀孕前20周的社会心理危险因素与低出生体重、早产及产后出院12个月期间受伤和死亡的风险大大增加有关妇小于20岁是一个重要的风险因素,但不论产妇年龄如何,怀孕前因吸毒或酗酒、自残或暴力、精神健康或行为状况而住院的产妇也很重要。这些群体可能从怀孕前和怀孕期间的健康和社会干预中受益。了解哪些妇女最易受伤害,以及如何及时查明她们以便进行干预,是有效制订和确定早期保健和社会支助方案的目标的第一步。

原文出处:

Harron Katie,Gilbert Ruth,Fagg Jamie et al. Associations between pre-pregnancy psychosocial risk factors and infant outcomes: a population-based cohort study in England.[J] .Lancet Public Health, 2021, 6: e97-e105.

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    2021-12-27 szhvet
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    2021-10-14 zhouqu_8
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    2021-11-07 howi
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    2021-03-22 goodbing

    顶刊就是不一样,质量很高,内容精彩!学到很多

    0