Medical Officer of Health Office, Palagala, Sri Lanka.
Department of Community Medicine, Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka, Saliyapura, Sri Lanka.
BMC Pediatr. 2023 Jan 23;23(1):40. doi: 10.1186/s12887-022-03830-0.
Identifying determinants of birthweight among disadvantaged communities is critical to further reducing the inequitable burden of perinatal health issues in low-and-middle income settings. Therefore, we adopted a bio-psycho-social approach to identify the determinants of birthweight in a mother-infant cohort from a rural setting in Sri Lanka, a lower-middle-income country.
All third-trimester pregnant women with a singleton pregnancy registered for the national antenatal care programme at Ipalogama health division in 2017 were invited for a prospective cohort study. Data was collected using a self-completed questionnaire and data extraction from health records. The mother-infant cohort was followed up until one month after delivery. A principal component analysis was performed using economic, social, and psychological variables, and two composite variables were achieved. Care from husband and household members, perceived wellbeing, frequency of abuse, and affect during the third trimester strongly loaded to the variable 'psychosocial wellbeing'. Monthly income, husband's education level, and use of biomass fuel strongly loaded to the variable 'socioeconomic status'. Hierarchical logistic regression was used to predict factors associated with birthweight. Maternal age, parity, baby's sex, and gestational period at pregnancy registration were entered at the first step. BMI, psychosocial wellbeing, socioeconomic status, hypertensive disorders, and gestational/chronic diabetes were entered at step two. Preterm birth was entered at step three.
532 women were recruited, and 495 were retained at the postpartum follow-up. 421 (74.8%) had reported being abused at least once during the preceding month. Birthweight was approximately normally distributed (mean 2912 g, SD 456.6 g). Low birthweight was present in 72 (14.6%, 95% CI 11.7,17.9), and 46 (9.3%, 95% CI 7.0,12.1) had birthweights > 3500 g. The regression model explained 13.2% of the variance in birthweight. Preterm birth, maternal BMI, and mid-pregnancy psychosocial wellbeing could explain 6.9%(p < 0.001), 3.9(p < 0.001), and 1.2%(p = 0.02) of unique variance, respectively.
In a setting where a large proportion of pregnant women suffer 'abuse' in their homes, psychosocial wellbeing during pregnancy was an important determinant of birthweight of babies. Expanding routine maternal care services, especially at the primary care level, to cater to the psychosocial issues of pregnant women would help reduce inequities in perinatal health.
确定弱势社区中出生体重的决定因素对于进一步降低中低收入国家围产期健康问题的不公平负担至关重要。因此，我们采用生物心理社会方法来确定来自斯里兰卡农村地区的母婴队列中出生体重的决定因素，斯里兰卡是一个中低收入国家。
2017 年，所有在伊帕洛加马卫生部门登记参加国家产前保健计划的单胎妊娠的第三孕期孕妇均受邀参加前瞻性队列研究。使用自填式问卷和健康记录数据提取收集数据。对母婴队列进行了为期一个月的随访。使用经济、社会和心理变量进行主成分分析，并得出两个综合变量。来自丈夫和家庭成员的照顾、幸福感、虐待频率以及第三孕期的情绪强烈加载到“心理社会幸福感”变量中。月收入、丈夫的教育水平和生物质燃料的使用强烈加载到“社会经济地位”变量中。分层逻辑回归用于预测与出生体重相关的因素。母亲年龄、产次、婴儿性别和妊娠登记时的妊娠周期在第一步输入。体重指数、心理社会幸福感、社会经济地位、高血压疾病和妊娠/慢性糖尿病在第二步输入。早产在第三步输入。
共招募了 532 名妇女，其中 495 名在产后随访时保留。421 名（74.8%）至少在过去一个月报告过一次被虐待。出生体重接近正态分布（均值 2912g，标准差 456.6g）。低出生体重为 72 例（14.6%，95%CI 11.7，17.9），46 例（9.3%，95%CI 7.0，12.1）出生体重>3500g。回归模型解释了出生体重的 13.2%的方差。早产、母亲体重指数和妊娠中期心理社会幸福感可分别解释 6.9%（p<0.001）、3.9%（p<0.001）和 1.2%（p=0.02）的独特方差。
在一个很大比例的孕妇在家庭中遭受“虐待”的环境中，怀孕期间的心理社会幸福感是婴儿出生体重的一个重要决定因素。扩大常规产妇保健服务，特别是在初级保健层面，以满足孕妇的心理社会问题，将有助于减少围产期健康的不平等。
