Department of Population Health Sciences, Weill Cornell Medicine, 425 East 61st Street, NY, New York, USA.
Department of Emergency Medicine, Weill Cornell Medicine, New York, NY, USA.
BMC Pregnancy Childbirth. 2021 Sep 4;21(1):599. doi: 10.1186/s12884-021-04056-1.
Risk factors related to the built environment have been associated with women's mental health and preventive care. This study sought to identify built environment factors that are associated with variations in prenatal care and subsequent pregnancy-related outcomes in an urban setting.
In a retrospective observational study, we characterized the types and frequency of prenatal care events that are associated with the various built environment factors of the patients' residing neighborhoods. In comparison to women living in higher-quality built environments, we hypothesize that women who reside in lower-quality built environments experience different patterns of clinical events that may increase the risk for adverse outcomes. Using machine learning, we performed pattern detection to characterize the variability in prenatal care concerning encounter types, clinical problems, and medication prescriptions. Structural equation modeling was used to test the associations among built environment, prenatal care variation, and pregnancy outcome. The main outcome is postpartum depression (PPD) diagnosis within 1 year following childbirth. The exposures were the quality of the built environment in the patients' residing neighborhoods. Electronic health records (EHR) data of pregnant women (n = 8,949) who had live delivery at an urban academic medical center from 2015 to 2017 were included in the study.
We discovered prenatal care patterns that were summarized into three common types. Women who experienced the prenatal care pattern with the highest rates of PPD were more likely to reside in neighborhoods with homogeneous land use, lower walkability, lower air pollutant concentration, and lower retail floor ratios after adjusting for age, neighborhood average education level, marital status, and income inequality.
In an urban setting, multi-purpose and walkable communities were found to be associated with a lower risk of PPD. Findings may inform urban design policies and provide awareness for care providers on the association of patients' residing neighborhoods and healthy pregnancy.
与建筑环境相关的风险因素与女性的心理健康和预防保健有关。本研究旨在确定与城市环境中产前护理和随后妊娠相关结局变化相关的建筑环境因素。
在回顾性观察研究中，我们描述了与患者居住社区各种建筑环境因素相关的产前护理事件的类型和频率。与居住在高质量建筑环境中的女性相比，我们假设居住在低质量建筑环境中的女性会经历不同的临床事件模式，这可能会增加不良结局的风险。我们使用机器学习进行模式检测，以描述与遇到类型、临床问题和药物处方有关的产前护理的可变性。结构方程模型用于测试建筑环境、产前护理变化和妊娠结局之间的关联。主要结局是产后 1 年内产后抑郁症（PPD）的诊断。暴露是患者居住社区建筑环境的质量。本研究纳入了 2015 年至 2017 年在城市学术医疗中心分娩的孕妇（n=8949）的电子健康记录（EHR）数据。
我们发现了可以总结为三种常见类型的产前护理模式。在调整年龄、社区平均教育水平、婚姻状况和收入不平等后，经历产前护理模式且 PPD 发生率最高的女性更有可能居住在土地利用单一、步行性低、空气污染物浓度低和零售楼层比例低的社区。
在城市环境中，多用途和可步行的社区与较低的 PPD 风险相关。研究结果可为城市设计政策提供信息，并提高护理提供者对患者居住社区与健康妊娠之间关联的认识。
