Johns Hopkins University School of Medicine, Baltimore, MD, USA.
J Interpers Violence. 2020 Jan;35(1-2):476-495. doi: 10.1177/0886260516685708. Epub 2017 Jan 6.
Adverse perinatal outcomes are a significant contributor to neonatal and infant deaths. Mental illness, substance use disorders, and interpersonal trauma are often prevalent within obstetrical populations. Previous literature has documented the individual associations between these psychosocial factors and adverse perinatal outcomes. The co-occurrence of these three psychosocial factors might represent a syndemic among pregnant women, although they have not been described as such in the literature. Analysis of the interrelatedness and aggregate effect of these factors may allow for a more effective screening process that may reduce adverse perinatal outcomes. The objective of this article is to examine whether psychosocial factors (mental illness, substance use disorders, and interpersonal trauma) were independently and synergistically associated with adverse perinatal outcomes. This is a retrospective cohort study of 1,656 pregnant women at a single institution. Perinatal outcome and psychosocial data were abstracted from each participant's electronic medical record. Univariate and bivariate analyses, and multiple logistic regression were performed. Mean age was 27.5 ( = 6.2) years. The majority was Black (60.6%) and single (58%). Psychosocial factors were reported in 35% of women. The incidence of adverse perinatal outcomes increased with greater number of psychosocial factors: 21.2% if no psychosocial factor, 27.0% if one psychosocial factor, 27.4% if two, and 35.3% if all three (for trend, = .01). Women who reported all three psychosocial factors had twice the odds of adverse perinatal outcomes (adjusted odds ratio = 2.04, 95% confidence interval = [1.09, 3.81], = .03) compared with those who reported none. Our data suggest there is a synergistic relationship between the psychosocial factors that is associated with increased adverse perinatal outcomes. A validated screening tool is needed to stratify patient's risk of adverse perinatal outcomes based on psychosocial factors. Such screening could lead to tailored interventions that could decrease adverse perinatal outcomes.
不良围产期结局是导致新生儿和婴儿死亡的一个重要因素。精神疾病、物质使用障碍和人际创伤在产科人群中常常普遍存在。先前的文献记录了这些社会心理因素与不良围产期结局之间的个体关联。这些三种社会心理因素的同时发生可能代表孕妇中的一种综合征，尽管它们在文献中尚未被描述为综合征。分析这些因素的相互关系和综合效应可能会实现更有效的筛查过程，从而减少不良围产期结局。本文的目的是检验社会心理因素（精神疾病、物质使用障碍和人际创伤）是否与不良围产期结局独立且协同相关。这是一项对单家机构的 1656 名孕妇进行的回顾性队列研究。围产期结局和社会心理数据从每位参与者的电子病历中提取。进行了单变量和双变量分析以及多变量逻辑回归。平均年龄为 27.5（ = 6.2）岁。大多数是黑人（60.6%）和单身（58%）。35%的女性报告有社会心理因素。不良围产期结局的发生率随着社会心理因素数量的增加而增加：如果没有社会心理因素，发生率为 21.2%；如果有一种社会心理因素，发生率为 27.0%；如果有两种，发生率为 27.4%；如果三种都有，发生率为 35.3%（趋势检验， =.01）。与没有报告任何社会心理因素的女性相比，报告所有三种社会心理因素的女性不良围产期结局的几率增加了一倍（调整后的优势比 = 2.04，95%置信区间 = [1.09，3.81]， =.03）。我们的数据表明，这些社会心理因素之间存在协同关系，与增加的不良围产期结局相关。需要一种经过验证的筛查工具来根据社会心理因素对患者不良围产期结局的风险进行分层。这种筛查可以导致针对特定患者的干预措施，从而减少不良围产期结局。
