Dowell Caitlin McMillen, Mejia Gloria C, Preen David B, Segal Leonie
Health Economics and Social Policy, Australian Centre for Precision Health, School of Health Sciences, University of South Australia, Australia.
School of Population and Global Health, University of Western Australia, Australia.
SSM Popul Health. 2018 Nov 17;7:008-8. doi: 10.1016/j.ssmph.2018.11.008. eCollection 2019 Apr.
Improved birth weight outcomes have been reported for infants of mothers imprisoned during pregnancy relative to similarly disadvantaged mothers, however, findings are equivocal and evidence is lacking from jurisdictions outside the United States.
To investigate whether maternal imprisonment during pregnancy is a determinant of low birth weight (<2500 g) for Indigenous and non-Indigenous infants in Western Australia.
A longitudinal sample of 41,910 singleton infants born in Western Australia (October 1985-December 2013), was identified with linked administrative data and examined by five mutually exclusive categories of maternal corrections history; (i) imprisonment in pregnancy, (ii) imprisonment before pregnancy, (iii) first imprisonment after birth, (iv) community-based corrections record without imprisonment at any time, and (v) no corrections record at any time. Univariate and multivariate Poisson regression was performed to determine key risk factors for low birth weight. Prevalence of risk factors were calculated by maternal corrections history.
After adjusting for other significant pregnancy risks, maternal imprisonment before (Indigenous RR 2.02, 95%CI 1.84-2.22, p<.001; non-Indigenous RR 2.48, 95%CI 1.98-3.12, p<.001) or during (Indigenous RR 1.96, 95%CI 1.68-2.29, p<.001; non-Indigenous RR 2.12, 95%CI 1.48-3.03, p<.001) pregnancy remained strong determinants of low birth weight, and carried greater risk than imprisonment after birth (Indigenous RR 1.58, 95%CI 1.44-1.74, p<.001; non-Indigenous RR 1.75, 95%CI 1.51-2.04, p<.001) or community-based corrections orders (Indigenous RR 1.32, 95%CI 1.21-1.43, p<.001; non-Indigenous RR 1.40, 95%CI 1.05-1.88, p<.001), relative to no corrections record. Pregnancy risk factors more prevalent amongst infants whose mothers were imprisoned before or during pregnancy included substance-use related service contacts, hospitalisation for injury, mental health service contacts, and having a sibling in contact with the child protection system.
Western Australian infants with mothers imprisoned before or during pregnancy experience elevated risk of low birth weight and exposure to maternal substance use, injury and mental distress in pregnancy.
与处境同样不利的母亲相比，孕期被监禁母亲的婴儿出生体重情况有所改善，但研究结果并不明确，且美国以外地区缺乏相关证据。
调查孕期母亲被监禁是否是西澳大利亚州原住民和非原住民婴儿低出生体重（<2500克）的一个决定因素。
利用关联行政数据确定了41910名单胎婴儿的纵向样本，这些婴儿于1985年10月至2013年12月在西澳大利亚州出生，并按母亲惩教历史的五个相互排斥的类别进行了检查；（i）孕期被监禁，（ii）孕前被监禁，（iii）产后首次被监禁，（iv）有社区惩教记录但从未被监禁，以及（v）从未有惩教记录。进行单变量和多变量泊松回归以确定低出生体重的关键风险因素。按母亲惩教历史计算风险因素的患病率。
在对其他重大妊娠风险进行调整后，孕前（原住民相对风险2.02，95%置信区间1.84 - 2.22，p<0.001；非原住民相对风险2.48，95%置信区间1.98 - 3.12，p<0.001）或孕期（原住民相对风险1.96，95%置信区间1.68 - 2.29，p<0.001；非原住民相对风险2.12，95%置信区间1.48 - 3.03，p<0.001）被监禁的母亲仍然是低出生体重的有力决定因素，并比产后被监禁（原住民相对风险1.58，95%置信区间1.44 - 1.74，p<0.001；非原住民相对风险1.75，95%置信区间1.51 - 2.04，p<0.001）或社区惩教令（原住民相对风险1.32，95%置信区间1.21 - 1.43，p<0.001；非原住民相对风险1.40，95%置信区间1.05 - 1.88，p<0.001）带来更大风险，相对于无惩教记录而言。在母亲孕前或孕期被监禁的婴儿中，更普遍的妊娠风险因素包括与物质使用相关的服务接触、因伤住院、心理健康服务接触以及有兄弟姐妹与儿童保护系统有接触。
母亲在孕前或孕期被监禁的西澳大利亚州婴儿，出生体重低以及孕期接触母亲物质使用、受伤和精神困扰的风险升高。
