Level Rachel A, Zhang Yingzhe, Tiemeier Henning, Estabrook Ryne, Shaw Daniel S, Leve Leslie D, Wakschlag Lauren S, Reiss David, Neiderhiser Jenae M, Massey Suena H
Department of Psychology, The Pennsylvania State University, University Park, PA, USA.
Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
Arch Womens Ment Health. 2024 Apr;27(2):301-308. doi: 10.1007/s00737-023-01396-z. Epub 2023 Nov 23.
Not all pregnant individuals want to become parents and "parenting intention" can also vary within individuals during different pregnancies. Nevertheless, the potential impact of parenting intention on health-related behavior during pregnancy has been heavily underexplored. In this study, we employed a within-person between pregnancy design to estimate the effect of parenting-specific influences on smoking, separate from pregnancy-specific and individual-level influences. We quantified within-mother differences in smoking during pregnancies of infants they reared (n = 84) versus pregnancies of infants they placed for adoption at birth (n = 65) using multivariate mixed-effects Poisson regression models. Mean cigarettes/day declined as the pregnancy progressed regardless of whether infants were reared or placed. However, participants smoked fewer cigarettes/day during reared pregnancies. Relative to "adopted" pregnancies, smoking during "reared" pregnancies was lower by 24%, 41%, and 54% in first (95% CI 0.64-0.90; p = 0.001), second (95% CI 0.48-0.72; p < 0.001), and third trimesters (95% CI 0.36-0.59; p < 0.001), respectively, independent of between-pregnancy differences in maternal age, fetal sex, parity, and pregnancy complications. Female sex and nulliparity were protective. Parenting intention was associated with a protective effect on pregnancy smoking independent of pregnancy-specific influences and individual characteristics. Failure to consider the impact of parenting intention on health-related behavior during pregnancy could perpetuate an unrealistic expectation to "do what's best for the baby" and stigmatize women with unintended or unwanted pregnancies.
并非所有怀孕的人都想成为父母，而且“育儿意愿”在不同孕期的个体中也可能有所不同。然而，育儿意愿对孕期健康相关行为的潜在影响一直未得到充分研究。在本研究中，我们采用了孕期内个体间设计，以估计育儿特定影响对吸烟的作用，将其与孕期特定影响和个体水平影响区分开来。我们使用多变量混合效应泊松回归模型，对她们抚养的婴儿的孕期（n = 84）与出生时被送去领养的婴儿的孕期（n = 65）内母亲吸烟的差异进行了量化。无论婴儿是被抚养还是被领养，平均每天吸烟量都随着孕期的进展而下降。然而，参与者在抚养婴儿的孕期中每天吸烟较少。相对于“领养”的孕期，在“抚养”的孕期中，第一孕期（95%可信区间0.64 - 0.90；p = 0.001）、第二孕期（95%可信区间0.48 - 0.72；p < 0.001）和第三孕期（95%可信区间0.36 - 0.59；p < 0.001）的吸烟量分别低24%、41%和54%，这与母亲年龄、胎儿性别、产次和孕期并发症的孕期间差异无关。女性和未生育状态具有保护作用。育儿意愿与对孕期吸烟的保护作用相关，独立于孕期特定影响和个体特征。未能考虑育儿意愿对孕期健康相关行为的影响可能会使“为宝宝做最好的事情”这一不切实际的期望持续存在，并使意外怀孕或非意愿怀孕的女性受到污名化。
