Department of Midwifery and Reproductive Health, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
Midwifery and Reproductive Health Research Center, Department of Midwifery and Reproductive Health, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Vali Asr Ave., Niayesh Cross Road, Niayesh Complex, 1985717443, Tehran, Iran.
BMC Public Health. 2023 Feb 14;23(1):323. doi: 10.1186/s12889-023-15207-8.
Postpartum weight retention (PPWR) causes obesity, chronic diseases, and occurring adverse maternal-fetal and neonatal outcomes. Given the social factors' effect on health and disease and considering the lack of information on social determinants of health (SDH) effects on PPWR, this study was conducted to survey the relationship between SDH and PPWR based on the World Health Organization (WHO) model.
A cross-sectional study was performed on 400 women six months after delivery in 2020. Twelve health centers were randomly selected from the three universities of Medical Sciences in the city of Tehran, Iran. Participants were selected by convenience method and based on eligibility. Questionnaires used included: Lifestyle Profile Health Promoting II, Short Form Postpartum Quality of Life Questionnaire, Multidimensional Scale of Perceived Social Support, Postpartum Social Support, Depression Anxiety Stress Scales, and questionnaires designed by reviewing the literature about breastfeeding, sleep, contraceptive, child health, unhealthy behaviors, postpartum nutritional awareness/beliefs, body satisfaction, access to postpartum care, socioeconomic status, demographic, and obstetric questionnaire. Data analysis was performed in SPSS-23, and the relationship model was examined using the path analysis method in LISREL-8.8.
Path analysis indicated the direct effect of six intermediate factors on PPWR including: gestational weight gain (β = 0.42), access to postpartum care (β = 0.11), postpartum nutritional awareness/beliefs (β=-0.17), anxiety (β = 0.09), sleep duration (β=-0.09), pre-pregnancy body mass index (β = 0.09). Among the structural factors, woman's education and socioeconomic status had an indirect negative effect on PPWR. The model fit indices showed good fit (RMSE = 0/05, GFI = 0.92, CFI = 0.92, χ/df = 2.17).
The results indicate the effect of structural and intermediate determinants of health on PPWR. It is recommended to use the proposed model as an appropriate framework in the research, design, and implementation of programs to prevent and control PPWR.
产后体重滞留（PPWR）会导致肥胖、慢性病，并出现母婴和新生儿不良结局。鉴于社会因素对健康和疾病的影响，并且考虑到缺乏关于健康社会决定因素（SDH）对 PPWR 影响的信息，本研究旨在根据世界卫生组织（WHO）模型调查 SDH 与 PPWR 之间的关系。
2020 年，对伊朗德黑兰市三所医科大学的 12 个卫生中心的 400 名产后六个月的妇女进行了横断面研究。参与者通过便利抽样法和资格选择法进行选择。使用的问卷包括：生活方式概况健康促进 II 问卷、产后生活质量简短问卷、多维感知社会支持量表、产后社会支持量表、抑郁焦虑压力量表以及通过查阅文献设计的关于母乳喂养、睡眠、避孕、儿童健康、不健康行为、产后营养意识/信念、身体满意度、获得产后护理、社会经济地位、人口统计学和产科问卷。数据分析使用 SPSS-23 进行，使用 LISREL-8.8 中的路径分析方法检验关系模型。
路径分析表明，六个中间因素对 PPWR 的直接影响包括：妊娠体重增加（β=0.42）、获得产后护理（β=0.11）、产后营养意识/信念（β=-0.17）、焦虑（β=0.09）、睡眠时长（β=-0.09）、孕前体重指数（β=0.09）。在结构因素中，女性教育和社会经济地位对 PPWR 有间接的负向影响。模型拟合指数显示拟合良好（RMSE=0/05，GFI=0.92，CFI=0.92，χ/df=2.17）。
结果表明健康的结构和中间决定因素对 PPWR 有影响。建议在研究、设计和实施预防和控制 PPWR 的方案时，采用所提出的模型作为适当的框架。
