Department of Epidemiology, University of Washington, Seattle, Washington, USA.
Department of Psychiatry and Behavioral Services, School of Medicine, University of Washington, Seattle, Washington, USA.
Paediatr Perinat Epidemiol. 2023 Aug;37(6):489-504. doi: 10.1111/ppe.12978. Epub 2023 Apr 26.
Evidence gaps remain regarding the influence of prenatal psychosocial factors on adverse pregnancy outcomes.
The objective of this study is to evaluate relationships between psychosocial factors and adverse perinatal outcomes among Kenyan women.
We analysed data from a prospective cohort study enrolling HIV-negative women in pregnancy (NCT03070600) in 20 antenatal clinics in Western Kenya. Study nurses assessed depressive symptoms using the Center for Epidemiologic Studies Depression Scale (CESD-10), social support using the Medical Outcomes Survey scale (MOS-SSS), intimate partner violence (IPV) with the Hurt, Insult, Threaten, Scream scale (HITS), and pregnancy outcomes at 6 weeks postpartum. Cox proportional hazards models were used to evaluate relationships between depressive symptoms (moderate-to-severe [MSD, CESD-10 ≥10] and mild-to-severe [Mild-SD, CESD-10 ≥5]), low social support (MOS-SSS <72), and IPV (HITS ≥10) with adverse perinatal outcomes of pregnancy loss, stillbirth, preterm birth (PTB), small for gestational age, and neonatal mortality. We also estimated the population attributable risk.
Among 4153 women, 23.9% (n = 994) had MSD, 54.7% (n = 2273) mild-SD, 37.3% (n = 1550) low social support, and 7.8% (n = 323) experienced IPV. Pregnancy loss was 5-fold higher among women with MSD (adjusted hazard ratio [HR] 5.04, 95% confidence interval [CI] 2.44, 10.42); 37.4% of losses were attributable to MSD. Mild-SD was associated with PTB (HR 1.39, 95% CI 1.03, 1.87). Stillbirth risk more than doubled among women reporting low social support (HR 2.37, 95% CI 1.14, 4.94).
Adverse perinatal outcomes were common and associated with prenatal depressive symptoms and low social support in this large cohort of Kenyan mother-infant pairs.
关于产前心理社会因素对不良妊娠结局的影响，仍存在证据空白。
本研究旨在评估肯尼亚女性的心理社会因素与不良围产期结局之间的关系。
我们分析了一项前瞻性队列研究的数据，该研究纳入了 2018 年在肯尼亚西部 20 家产前诊所妊娠的 HIV 阴性妇女（NCT03070600）。研究护士使用流行病学研究中心抑郁量表（CESD-10）评估抑郁症状，使用医疗结果调查量表（MOS-SSS）评估社会支持，使用伤害、侮辱、威胁、尖叫量表（HITS）评估亲密伴侣暴力（IPV），并在产后 6 周评估妊娠结局。我们使用 Cox 比例风险模型评估抑郁症状（中重度[MSD，CESD-10≥10]和轻度-重度[Mild-SD，CESD-10≥5]）、低社会支持（MOS-SSS<72）和 IPV（HITS≥10）与妊娠丢失、死胎、早产（PTB）、小于胎龄儿和新生儿死亡等不良围产期结局之间的关系。我们还估计了人群归因风险。
在 4153 名女性中，23.9%（n=994）有 MSD，54.7%（n=2273）有 Mild-SD，37.3%（n=1550）有低社会支持，7.8%（n=323）有 IPV。中重度抑郁的女性妊娠丢失风险是轻度抑郁的 5 倍（调整后的风险比[HR]5.04，95%置信区间[CI]2.44，10.42）；37.4%的丢失归因于 MSD。轻度抑郁与 PTB 相关（HR 1.39，95%CI 1.03，1.87）。报告低社会支持的女性死产风险增加一倍以上（HR 2.37，95%CI 1.14，4.94）。
在这项肯尼亚母婴队列的大型研究中，不良围产期结局较为常见，且与产前抑郁症状和低社会支持相关。
