Feldman P J, Dunkel-Schetter C, Sandman C A, Wadhwa P D
Department of Epidemiology and Public Health, University College London, United Kingdom.
Psychosom Med. 2000 Sep-Oct;62(5):715-25. doi: 10.1097/00006842-200009000-00016.
Low birth weight is a primary cause of infant mortality and morbidity. Results of previous studies suggest that social support may be related to higher birth weight through fetal growth processes, although the findings have been inconsistent. The purpose of this investigation was to test a model of the association between a latent prenatal social support factor and fetal growth while taking into account relations between sociodemographic and obstetric risk factors and birth weight.
A prospective study was conducted among 247 women with a singleton, intrauterine pregnancy receiving care in two university-affiliated prenatal clinics. Measures of support included support from family, support from the baby's father, and general functional support. Sociodemographic characteristics were also assessed. Birth outcome and obstetric risk information were abstracted from patients' medical charts after delivery.
Structural equation modeling analyses showed that a latent social support factor significantly predicted fetal growth (birth weight adjusted for length of gestation) with infant sex, obstetric risk, and ethnicity in the model. Marital status and education were indirectly related to fetal growth through social support. The final model with social support and other variables accounted for 31% of the variance in fetal growth.
These findings suggest that prenatal social support is associated with infant birth weight through processes involving fetal growth rather than those involving timing of delivery. Biological and behavioral factors may contribute to the association between support and fetal growth, although these mechanisms need to be further explored. These results pave the way for additional research on fetal growth mechanisms and provide a basis for support intervention research.
低出生体重是婴儿死亡和发病的主要原因。以往研究结果表明,社会支持可能通过胎儿生长过程与较高的出生体重相关,尽管研究结果并不一致。本研究的目的是检验一个潜在的产前社会支持因素与胎儿生长之间的关联模型,同时考虑社会人口统计学和产科风险因素与出生体重之间的关系。
对在两家大学附属产前诊所接受护理的247名单胎宫内妊娠妇女进行了一项前瞻性研究。支持措施包括来自家庭的支持、来自婴儿父亲的支持和一般功能支持。还评估了社会人口统计学特征。分娩后从患者病历中提取出生结局和产科风险信息。
结构方程模型分析表明,在该模型中,一个潜在的社会支持因素显著预测了胎儿生长(根据妊娠期调整的出生体重),同时考虑了婴儿性别、产科风险和种族。婚姻状况和教育程度通过社会支持与胎儿生长间接相关。包含社会支持和其他变量的最终模型解释了胎儿生长变异的31%。
这些发现表明,产前社会支持通过涉及胎儿生长的过程而非分娩时间的过程与婴儿出生体重相关。生物学和行为因素可能促成了支持与胎儿生长之间的关联,尽管这些机制需要进一步探索。这些结果为进一步研究胎儿生长机制铺平了道路,并为支持性干预研究提供了基础。