School of Nursing and Midwifery, The Aga Khan University, Karachi, Pakistan.
Faculty of Health Sciences, School of Nursing, Queen's University, Kingston, Ontario, Canada.
PLoS One. 2023 Mar 30;18(3):e0282582. doi: 10.1371/journal.pone.0282582. eCollection 2023.
We determined whether dimensions of psychosocial distress during pregnancy individually and collectively predicted preterm birth (PTB) in Pakistani women as it may be misleading to extrapolate results from literature predominantly conducted in high-income countries.
This cohort study included 1603 women recruited from four Aga Khan Hospital for Women and Children in Sindh, Pakistan. The primary binary outcome of PTB (i.e., livebirth before 37 completed weeks' gestation) was regressed on self-reported symptoms of anxiety (Pregnancy-Related Anxiety (PRA) Scale and Spielberger State-Trait Anxiety Inventory Form Y-1), depression (Edinburgh Perinatal Depression Scale (EPDS)), and covariates such as chronic stress (Perceived Stress Scale) assessed with standardized question and scales with established language equivalency (Sindhi and Urdu).
All 1603 births occurred between 24 and 43 completed weeks' gestation. PRA was a stronger predictor of PTB than other types of antenatal psychosocial distress conditions. Chronic stress had no effect on the strength of association between PRA and PTB and a slight but non-significant effect on depression. A planned pregnancy significantly lowered risk of PTB among women who experienced PRA. Aggregate antenatal psychosocial distress did not improve model prediction over PRA.
Like studies in high-income countries, PRA became a strong predictor of PTB when considering interactive effects of whether the current pregnancy was planned. Women's resilience and abilities to make sexual and reproductive health decisions are important to integrate in future research. Findings should be generalized with caution as socio-cultural context is a likely effect modifier. We did not consider protective/strength-oriented factors, such as resilience among women.
我们旨在确定孕期心理社会压力的各个维度是否会单独或共同预测巴基斯坦女性的早产（PTB），因为从主要在高收入国家进行的文献中推断结果可能具有误导性。
本队列研究纳入了来自巴基斯坦信德省四家 Aga Khan 妇女儿童医院的 1603 名女性。主要的二分结局是早产（即妊娠 37 周前的活产），它与自我报告的焦虑症状（孕期相关焦虑量表（PRA）和 Spielberger 状态特质焦虑量表 Y-1）、抑郁（爱丁堡产后抑郁量表（EPDS））以及用标准化问卷和具有既定语言等效性的量表评估的慢性压力（感知压力量表）等因素相关。
所有 1603 例分娩均发生在妊娠 24 周至 43 周之间。PRA 是早产的预测因素，比其他类型的产前心理社会压力状况更为显著。慢性压力对 PRA 和 PTB 之间关联的强度没有影响，但对抑郁有轻微但无统计学意义的影响。有计划的妊娠显著降低了经历 PRA 的女性发生 PTB 的风险。产前心理社会压力的综合状况并没有提高 PRA 的预测能力。
与高收入国家的研究一样，当考虑当前妊娠是否计划时，PRA 成为早产的强有力预测因素。女性的适应能力和做出性与生殖健康决策的能力对于未来的研究非常重要。由于社会文化背景可能是一个重要的调节因素，因此应该谨慎推广这些发现。我们没有考虑到女性的保护/优势因素，如适应力。
