低收入妇女意外怀孕的社会心理状况和产前护理。
Psychosocial status and prenatal care of unintended pregnancies among low-income women.
机构信息
Division of General Academic Pediatrics, Department of Pediatrics, Massachusetts General Hospital for Children, 125 Nashua Street, Suite 860, Boston, MA, 02114, USA.
Department of Obstetrics and Gynecology, MGH, Boston, MA, USA.
出版信息
BMC Pregnancy Childbirth. 2020 Oct 12;20(1):615. doi: 10.1186/s12884-020-03302-2.
BACKGROUND
Nearly half of all pregnancies in the United States are reported as unintended and rates are highest among women of low socioeconomic status. The purpose of this study was to examine the associations between unintended pregnancies and maternal mental health and timing of prenatal care among low-income women.
METHODS
In this cross-sectional study, 870 women, whom were participating in the First 1000 Days program in three community health centers in the Boston area, were enrolled at their first prenatal visit from August 2016 - September 2017. We assessed pregnancy intention by self-report using the Pregnancy Risk Assessment Monitoring System. We used self-reported survey information and electronic health record data to assess the following outcomes: current stress, current depression, and timing of initial prenatal visit. We used multivariable logistic regression models to examine associations and adjusted for sociodemographic factors.
RESULTS
Women were a mean (SD) age of 29.3 (6.1), and 39.2% reported that their pregnancy was unintended. 50.6% of women were Hispanic, 28.4% were White, 10.1% were Black, and 10.9% were other races. 78.9% of women reported an annual household income <$50,000. Overall, 26.7% of women reported current stress, 8.2% reported current depression, and 18.3% of women initiated prenatal care after their first trimester. In multivariable analyses, women with unintended pregnancies had higher odds of experiencing current stress (OR: 1.72; 95% CI: 1.22, 2.41), current depression (OR: 1.83; 95% CI: 1.04, 3.20), and initiation of prenatal care post-first trimester (OR: 1.84; 95% CI: 1.23, 2.74).
CONCLUSIONS
Unintended pregnancies were associated with current stress and depression, and delayed prenatal care in this sample of low-income women suggesting the importance of identifying high-risk women and tailoring interventions to support women's needs.
TRIAL REGISTRATION
ClinicalTrials.gov (NCT03191591; Retrospectively registered on June 19, 2017).
背景
在美国，近一半的妊娠属于意外妊娠，而社会经济地位较低的女性的意外妊娠率最高。本研究旨在探讨低收入女性意外妊娠与产妇心理健康和产前护理时间的关系。
方法
在这项横断面研究中，共有 870 名女性参加了波士顿地区三个社区健康中心的“第一千天计划”，于 2016 年 8 月至 2017 年 9 月首次产前就诊时入组。我们通过妊娠风险评估监测系统（Pregnancy Risk Assessment Monitoring System）的自我报告来评估妊娠意向。我们使用自我报告的调查信息和电子健康记录数据来评估以下结果：当前压力、当前抑郁和初始产前就诊时间。我们使用多变量逻辑回归模型来检验相关性，并调整了社会人口统计学因素。
结果
女性的平均（标准差）年龄为 29.3（6.1）岁，39.2%的女性报告其妊娠为意外妊娠。50.6%的女性为西班牙裔，28.4%为白人，10.1%为黑人，10.9%为其他种族。78.9%的女性报告家庭年收入<50000 美元。总体而言，26.7%的女性报告当前存在压力，8.2%报告当前抑郁，18.3%的女性在孕早期后才开始产前护理。在多变量分析中，意外妊娠的女性出现当前压力（优势比：1.72；95%置信区间：1.22，2.41）、当前抑郁（优势比：1.83；95%置信区间：1.04，3.20）和孕早期后开始产前护理的可能性更高（优势比：1.84；95%置信区间：1.23，2.74）。
结论
在本低收入女性样本中，意外妊娠与当前压力和抑郁有关，且产前护理延迟，这表明确定高危女性并针对女性需求定制干预措施的重要性。
试验注册
ClinicalTrials.gov（NCT03191591；于 2017 年 6 月 19 日回顾性注册）。
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