Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Women &, Infants Hospital of Rhode Island, Alpert Medical School of Brown University, 101 Dudley St, Providence, RI, 02905, USA.
Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, University of Massachusetts Chan Medical School, Worcester, MA, USA.
BMC Pregnancy Childbirth. 2023 Oct 25;23(1):752. doi: 10.1186/s12884-023-06063-w.
Individuals with an increased body mass index (BMI) (≥ 30 kg/m2) experience higher rates of perinatal mental health disorders than individuals with BMI < 30. Personal experience of decreased control over labor has been associated with the development postpartum mood and anxiety disorders. However, no studies have investigated the association between BMI and experience of control over labor. This study aimed to assess perceived control over labor and compare patients with BMI ≥ 30 to those with BMI < 30.
We performed a secondary analysis of a cross-sectional study of postpartum patients who delivered at term (37-41 weeks gestation). Postpartum, participants completed the Labour Agentry Scale (LAS), a validated tool to assess perceived control over labor/birth. Demographic, maternal health history and obstetric/neonatal outcomes were abstracted from the patient chart. Bivariate analyses were performed between those with BMI < 30 and those with BMI ≥ 30 using Fisher's exact test. Continuous LAS scores were compared between patients with BMI < 30 and BMI ≥ 30 using Wilcoxon rank-sum tests. Higher LAS scores indicate higher perceived control over labor. Multivariable linear regression was then performed to account for confounding factors identified a priori.
There was no difference in LAS between those with BMI ≥ 30 and BMI < 30. When stratified by World Health Organization (WHO) class of BMI, those with BMI ≥ 40 had a significantly lower LAS scores than those with BMI < 30 (147 vs. 163, p = 0.02), however, this finding was no longer significant after controlling for length of labor and cesarean birth.
Only participants with the highest BMI experienced decreased control over labor, and this finding was no longer significant after controlling for mode of delivery and length of labor. Further research into the experience of birthing people with BMI ≥ 30 is critical to understand the increased risk of perinatal mood disorders among this population.
体重指数（BMI）较高的个体（≥30kg/m2）比 BMI<30 的个体经历更高的围产期心理健康障碍发生率。个人对分娩控制能力下降的体验与产后情绪和焦虑障碍的发展有关。然而，尚无研究调查 BMI 与分娩控制体验之间的关联。本研究旨在评估对分娩的控制感，并将 BMI≥30 的患者与 BMI<30 的患者进行比较。
我们对足月（37-41 周妊娠）分娩的产后患者进行了一项横断面研究的二次分析。产后，参与者完成了劳动代理量表（LAS），这是一种评估对分娩/出生控制感的有效工具。从患者病历中提取人口统计学、产妇健康史以及产科/新生儿结局数据。使用 Fisher 确切检验对 BMI<30 和 BMI≥30 的患者进行了二变量分析。使用 Wilcoxon 秩和检验比较 BMI<30 和 BMI≥30 的患者的 LAS 评分。LAS 评分越高，表明对分娩的控制感越高。然后进行多变量线性回归，以解释预先确定的混杂因素。
BMI≥30 和 BMI<30 的患者之间的 LAS 评分没有差异。按世界卫生组织（WHO）BMI 分类分层时，BMI≥40 的患者的 LAS 评分明显低于 BMI<30 的患者（147 对 163，p=0.02），但在校正分娩时间和剖宫产分娩后，这一发现不再具有统计学意义。
只有 BMI 最高的患者经历了分娩控制能力下降，而在校正分娩方式和分娩时间后，这一发现不再具有统计学意义。进一步研究 BMI≥30 的产妇的分娩体验对于理解该人群围产期情绪障碍风险增加至关重要。
