生活应激源、妊娠高血压疾病与早产。
Life stressors, hypertensive disorders of pregnancy, and preterm birth.
机构信息
Division of Public Health, University of Utah, Salt Lake City, UT, USA.
出版信息
J Psychosom Obstet Gynaecol. 2022 Mar;43(1):42-50. doi: 10.1080/0167482X.2020.1778666. Epub 2020 Jun 22.
BACKGROUND
Stress-induced pregnancy complications are thought to represent a significant cause of maternal morbidity and mortality; little is known regarding types of stress most predictive of adverse outcomes.
METHODS
We used Utah PRAMs 2012-2014 data to evaluate links between preconception life stressors and prevalence of hypertensive disorders of pregnancy (HDP) and pre-term labor (PTB) (births <37 weeks gestational age, and very PTB <33 weeks). We categorized 12 specific stressful events into 4 groups: partner, traumatic, financial, and emotional. Adjusted prevalence ratios (aPRs) and 95% confidence intervals (CIs) were estimated controlling for important sociodemographic, lifestyle, and pregnancy history factors.
RESULTS
4,378 mothers completed the survey. 26.6%, 12.2%, 32.2%, and 28.4% reported partner, traumatic, financial, and emotional-related stress. Reporting any of the 4-types of life stress was linked with increased prevalence of HDP (aPR: 1.46 [95% CI: 0.96, 2.22]) after adjusting for age, race/ethnicity, BMI, education, prior diagnosis of high blood pressure, and prior history of preterm labor. The strongest association was observed for financial stress (aPR: 1.50 [95% CI: 1.03, 2.18]). Financial stress was also associated with increased prevalence of very PTB (aPR: 1.61 [95% CI: 1.03, 2.51]) after adjustment.
CONCLUSION
Women reporting financial stress, including job loss, pay reduction, or difficulty paying bills, had increased prevalence of HDP and very PTB.
背景
应激引起的妊娠并发症被认为是导致产妇发病率和死亡率的重要原因；然而，关于最能预测不良结局的应激类型知之甚少。
方法
我们使用犹他州 PRAMs 2012-2014 年的数据，评估孕前生活应激源与妊娠高血压疾病（HDP）和早产（PTB）（<37 周妊娠龄分娩，非常早产<33 周）的患病率之间的关系。我们将 12 种特定的应激事件分为 4 组：伴侣相关、创伤相关、经济相关和情绪相关。控制重要的社会人口统计学、生活方式和妊娠史因素后，估计调整后的患病率比（aPR）和 95%置信区间（CI）。
结果
4378 名母亲完成了调查。26.6%、12.2%、32.2%和 28.4%报告了伴侣相关、创伤相关、经济相关和情绪相关的应激。在调整年龄、种族/族裔、BMI、教育程度、先前高血压诊断和早产史后，报告任何 4 种类型的生活应激与 HDP 患病率增加相关（aPR：1.46[95%CI：0.96，2.22]）。经济应激与非常早产的患病率增加也有关联（aPR：1.61[95%CI：1.03，2.51]）。
结论
报告经济压力（包括失业、减薪或难以支付账单）的女性 HDP 和非常早产的患病率增加。
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