Departments of Family Science and Health Policy and Management, School of Public Health, University of Maryland, the Department of Sociology, University of Maryland, and the Maryland Population Research Center, College Park, Maryland.
Obstet Gynecol. 2020 Apr;135(4):821-831. doi: 10.1097/AOG.0000000000003745.
To examine whether depression, intimate partner violence, and other psychosocial stressors were independently associated with effectiveness level of postpartum contraception among women who recently had an unintended birth.
We analyzed cross-sectional data from PRAMS (the Pregnancy Risk Assessment Monitoring System) to identify women who had an unintended birth between 2012 and 2015. The effectiveness level of the contraceptive method was coded into one of five categories based on the postpartum contraceptive method that women were using: none, less effective (withdrawal, rhythm, condoms, or other barrier), moderately effective (pill, patch, ring, or shot), long-acting reversible contraception (LARC; intrauterine devices or implants), and sterilization (female or male sterilization). Multinomial logistic regression was used to examine whether prepregnancy depression or elevated postpartum depressive symptoms, intimate partner violence before or during pregnancy, and number of psychosocial stressors before birth were associated with effectiveness level of method (compared with no method), in models adjusted for sociodemographics, pregnancy context, and postpartum context.
Complete data were available for 56,445 (88.2%) of the 64,030 eligible women: 24.2% experienced depression; 5.3% experienced intimate partner violence; and 16.8% experienced five or more psychosocial stressors around the time of pregnancy or birth. In adjusted models, experiencing intimate partner violence and more stressors lowered women's relative risk of using sterilization, LARC, moderately effective methods, and less-effective contraceptive methods relative to no method use. Only prepregnancy depression was associated with using sterilization compared with no method use.
Experiencing intimate partner violence and having more psychosocial stressors were each independently associated with not using a postpartum contraceptive method. Standardized screening for psychosocial factors during prenatal and postpartum care should be integrated, and practices that encourage the discussion of patients' psychosocial experiences and postpartum contraception use together are warranted.
考察抑郁、亲密伴侣暴力以及其他心理社会压力源是否与近期意外分娩的妇女产后避孕有效性独立相关。
我们分析了 PRAMS（妊娠风险评估监测系统）的横断面数据，以确定 2012 年至 2015 年期间意外分娩的女性。根据女性使用的产后避孕方法，将避孕方法的有效性水平编码为以下五个类别之一：无、效果较差（体外排精、自然避孕法、避孕套或其他屏障法）、效果中等（避孕药、贴片、环或注射剂）、长效可逆避孕（宫内节育器或植入物）和绝育（女性或男性绝育）。多变量逻辑回归用于考察孕前抑郁或产后抑郁症状升高、怀孕前或怀孕期间的亲密伴侣暴力以及产前的心理社会压力源数量是否与方法的有效性水平相关（与无方法相比），在调整了社会人口统计学、妊娠背景和产后背景的模型中进行分析。
共有 64030 名符合条件的女性中的 56445 名（88.2%）提供了完整数据：24.2%的女性经历了抑郁；5.3%的女性经历了亲密伴侣暴力；16.8%的女性在怀孕或分娩前后经历了五个或更多的心理社会压力源。在调整后的模型中，经历亲密伴侣暴力和更多的压力源降低了女性使用绝育、长效可逆避孕、中等有效方法和效果较差的避孕方法的相对风险，与不使用任何方法相比。只有孕前抑郁与使用绝育相比与不使用任何方法相关。
经历亲密伴侣暴力和更多的心理社会压力源都与不使用产后避孕方法独立相关。应整合产前和产后护理中心理社会因素的标准化筛查，有必要采取鼓励讨论患者心理社会经历和产后避孕使用的实践。
