Williamson H A, LeFevre M, Hector M
Department of Family and Community Medicine, University of Missouri-Columbia, School of Medicine 65212.
J Fam Pract. 1989 Nov;29(5):489-94; discussion 494-6.
The association between stressful life changes, social supports, and serious complications of pregnancy was measured in 513 women obtaining prenatal care in four rural family practices. Those women whose life change score (LCS) increased from the second to the third trimester had a significantly higher rate of poor outcomes (neonatal death, transfer to a neonatal intensive care unit, birthweight less than 2500 g or 5-minute Apgar score less than 7) than those whose LCS did not increase (9.2% vs 3.9%, P = .015). This effect of increasing stress was present even after controlling for demographic and standard obstetric risk factors. High life change scores at 20 weeks' gestation and 34 weeks' gestation were not individually associated with poor outcomes. Those with low social support did not have a statistically significant higher rate of complications, and social support did not buffer the adverse effects of increasing stress. This study shows that serious and clinically important complications of pregnancy are related to stressful life change independent of biomedical risk.
在四家乡村医疗诊所接受产前护理的513名女性中，对生活压力变化、社会支持与妊娠严重并发症之间的关联进行了评估。与生活变化得分（LCS）未增加的女性相比，那些LCS从孕中期到孕晚期有所增加的女性，不良结局（新生儿死亡、转入新生儿重症监护病房、出生体重低于2500克或5分钟阿氏评分低于7分）的发生率显著更高（9.2%对3.9%，P = 0.015）。即使在控制了人口统计学和标准产科风险因素之后，压力增加的这种影响依然存在。妊娠20周和34周时生活变化得分高与不良结局并无单独关联。社会支持水平低的女性并发症发生率并未在统计学上显著更高，而且社会支持也未能缓冲压力增加带来的不利影响。这项研究表明，妊娠严重且具有临床重要性的并发症与生活压力变化有关，与生物医学风险无关。
