Gariepy Aileen, Lundsberg Lisbet S, Vilardo Nicole, Stanwood Nancy, Yonkers Kimberly, Schwarz Eleanor B
Department of Obstetrics, Gynecology and Reproductive Sciences, Yale School of Medicine, New Haven, CT.
Department of Obstetrics, Gynecology and Reproductive Sciences, Yale School of Medicine, New Haven, CT.
Contraception. 2017 May;95(5):491-499. doi: 10.1016/j.contraception.2017.02.001. Epub 2017 Feb 8.
The objective was to quantify the association of pregnancy context and health-related quality of life (HRQoL).
English- or Spanish-speaking women, aged 16-44, with pregnancies <24 weeks' gestation were enrolled in this cross-sectional study between June 2014 and June 2015. Participants completed self-assessments of pregnancy "context," including timing, intention, wantedness, desirability, happiness, and planning (measured with the London Measure of Unplanned Pregnancy). HRQoL was measured using the Patient Reported Outcomes Measurement Information System Global Short Form. Associations between measures of pregnancy context and HRQoL scores in the lowest tertile were examined using multivariable logistic regression to adjust for potential confounding variables.
We enrolled 161 participants (mean age=27.2±6.6 years). Only 14% self-identified as White, non-Hispanic; 42% Hispanic; 37% Black, non-Hispanic; and 7% multiracial. Most (79%) participants were unmarried, and 75% were parenting. Mean gestational age was 9±4.6 weeks. In unadjusted models, women reporting mixed feelings about wanting to have a baby, an undesired pregnancy or feeling unhappy about learning of their pregnancy more frequently had low mental and physical HRQoL compared to women reporting wanted, desired, happy pregnancies. Women with an unplanned pregnancy or pregnancy occurring at the wrong time also had lower physical HRQoL than women reporting pregnancies that were planned or happened at the right time. However, after multivariate adjustment, including history of depression, pregnancy contexts were not associated with low mental or physical HRQoL.
After adjusting for multiple confounders, pregnancy context is not significantly associated with HRQoL.
The focus on pregnancy intention in public health programs may not sufficiently assess multidimensional aspects of pregnancy context and may not align with patient-centered outcomes such as HRQoL.
本研究旨在量化妊娠背景与健康相关生活质量（HRQoL）之间的关联。
2014年6月至2015年6月期间，对年龄在16 - 44岁、妊娠小于24周且以英语或西班牙语为母语的女性进行了这项横断面研究。参与者完成了对妊娠“背景”的自我评估，包括妊娠时间、妊娠意愿、妊娠意愿程度、妊娠期望、妊娠幸福感以及妊娠计划（采用伦敦意外妊娠量表进行测量）。使用患者报告结局测量信息系统全球简表对HRQoL进行测量。通过多变量逻辑回归分析妊娠背景测量指标与最低三分位数HRQoL得分之间的关联，以调整潜在的混杂变量。
我们招募了161名参与者（平均年龄 = 27.2±6.6岁）。只有14%的参与者自我认定为非西班牙裔白人；42%为西班牙裔；37%为非西班牙裔黑人；7%为多种族。大多数（79%）参与者未婚，75%的参与者正在养育子女。平均孕周为9±4.6周。在未调整的模型中，与报告妊娠意愿强烈、期望妊娠且妊娠幸福感高的女性相比，报告对生育有复杂情感、意外妊娠或得知妊娠后感到不开心的女性，其心理和生理HRQoL较低。意外妊娠或妊娠时间不当的女性，其生理HRQoL也低于报告妊娠计划得当或妊娠时间合适的女性。然而，在进行多变量调整（包括抑郁病史）后，妊娠背景与心理或生理HRQoL低下并无关联。
在调整多个混杂因素后，妊娠背景与HRQoL无显著关联。
公共卫生项目中对妊娠意愿的关注可能无法充分评估妊娠背景的多维度方面，也可能与以患者为中心的结局（如HRQoL）不一致。
