Côté-Arsenault Denise
School of Nursing, University of Rochester, New York 13104, USA.
Nurs Res. 2007 Mar-Apr;56(2):108-16. doi: 10.1097/01.NNR.0000263970.08878.87.
Pregnancies after perinatal loss are known to be anxiety-filled. Stress in pregnancy and the response to it, often seen as anxiety and depression, have known negative consequences for obstetric outcomes, parenting, and infant behaviors. Women have reported fluctuating emotions in response to events in their subsequent pregnancies, but these pregnancies have not been studied longitudinally.
To test Lazarus' theory of stress, coping, and emotions in this population, and to understand the patterns of threat appraisal, coping, and emotional states of women across pregnancy after perinatal loss.
In this predictive correlational study, 82 women pregnant after loss (PAL) were followed, and the study was guided longitudinally by Lazarus' theory of stress, coping, and emotions. Obstetric and loss history, and assigned fetal personhood were gathered at intake (Time 1). Measures completed at 10-week intervals (one time each trimester) included Moneyham Threat Index (threat appraisal), Ways of Coping Checklist-Revised (relative coping), Pregnancy Anxiety Scale (pregnancy anxiety), Multiple Affect Adjective Checklist-Revised (emotional states), and Stress in Life (stress). Time 3 sample size was 70.
Threat appraisal was correlated with assigned fetal personhood and gestational age of past loss. Pregnancy subsequent to loss was perceived as a threat, and threat appraisal strongly predicted pregnancy anxiety. Pregnancy anxiety, reported at moderate levels on average, decreased over time; threat appraisal, coping, and other emotions were stable across pregnancy. Coping did not mediate these effects, but relative coping was correlated with emotional status as theorized, with problem-focused coping used more than emotion-focused coping.
Women find pregnancy after loss stressful and a threat, and this appraisal remains across pregnancy. Because pregnancy anxiety is common, and highest in early pregnancy, providers should address worries and fears with all women early in PAL. Interventions must be tested in future studies.
围产期丧子后再次怀孕往往充满焦虑。孕期压力及其反应，常表现为焦虑和抑郁，已知会对产科结局、养育子女及婴儿行为产生不良后果。女性报告称，在后续孕期中，她们的情绪会因各种事件而波动，但这些孕期情况尚未得到纵向研究。
在这一人群中检验拉扎勒斯的压力、应对及情绪理论，并了解围产期丧子后女性在整个孕期的威胁评估、应对方式及情绪状态模式。
在这项预测性相关性研究中，对82名丧子后怀孕（PAL）的女性进行了跟踪，该研究以拉扎勒斯的压力、应对及情绪理论为纵向指导。在入组时（时间1）收集产科和丧子史以及赋予胎儿的人格地位。每10周（每个孕期一次）完成的测量包括莫尼汉威胁指数（威胁评估）、修订后的应对方式清单（相对应对方式）、孕期焦虑量表（孕期焦虑）、修订后的多种情绪形容词清单（情绪状态）以及生活压力量表（压力）。时间3的样本量为70。
威胁评估与赋予胎儿的人格地位及既往丧子的孕周相关。丧子后的怀孕被视为一种威胁，且威胁评估强烈预测孕期焦虑。孕期焦虑平均处于中等水平，且随时间下降；威胁评估、应对方式及其他情绪在整个孕期保持稳定。应对方式并未调节这些影响，但相对应对方式与理论上的情绪状态相关，以问题为中心的应对方式比以情绪为中心的应对方式使用得更多。
女性认为丧子后怀孕有压力且是一种威胁，这种评估在整个孕期持续存在。由于孕期焦虑很常见，且在孕早期最高，医疗服务提供者应在PAL早期就与所有女性讨论她们的担忧和恐惧。干预措施必须在未来的研究中进行检验。
