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怀孕的社会背景、尊重孕产妇护理、健康状况的生物标志物以及产后心理健康不平等:一项范围综述

The Social Context of Pregnancy, Respectful Maternity Care, Biomarkers of Weathering, and Postpartum Mental Health Inequities: A Scoping Review.

作者信息

Basile-Ibrahim Bridget, Combellick Joan, Mead Thomas L, Sorensen Alee, Batten Janene, Schafer Robyn

机构信息

School of Nursing, Yale University, Orange, CT 06477, USA.

Biomedical Libraries, Dartmouth College, Hanover, NH 03755, USA.

出版信息

Int J Environ Res Public Health. 2024 Apr 15;21(4):480. doi: 10.3390/ijerph21040480.

Abstract

Mental health disorders are the number one cause of maternal mortality and a significant maternal morbidity. This scoping review sought to understand the associations between social context and experiences during pregnancy and birth, biological indicators of stress and weathering, and perinatal mood and anxiety disorders (PMADs). A scoping review was performed using PRISMA-ScR guidance and JBI scoping review methodology. The search was conducted in OVID Medline and Embase. This review identified 74 eligible English-language peer-reviewed original research articles. A majority of studies reported significant associations between social context, negative and stressful experiences in the prenatal period, and a higher incidence of diagnosis and symptoms of PMADs. Included studies reported significant associations between postpartum depression and prenatal stressors (n = 17), socioeconomic disadvantage (n = 14), negative birth experiences (n = 9), obstetric violence (n = 3), and mistreatment by maternity care providers (n = 3). Birth-related post-traumatic stress disorder (PTSD) was positively associated with negative birth experiences (n = 11), obstetric violence (n = 1), mistreatment by the maternity care team (n = 1), socioeconomic disadvantage (n = 2), and prenatal stress (n = 1); and inverse association with supportiveness of the maternity care team (n = 5) and presence of a birth companion or doula (n = 4). Postpartum anxiety was significantly associated with negative birth experiences (n = 2) and prenatal stress (n = 3). Findings related to associations between biomarkers of stress and weathering, perinatal exposures, and PMADs (n = 14) had mixed significance. Postpartum mental health outcomes are linked with the prenatal social context and interactions with the maternity care team during pregnancy and birth. Respectful maternity care has the potential to reduce adverse postpartum mental health outcomes, especially for persons affected by systemic oppression.

摘要

心理健康障碍是孕产妇死亡的首要原因,也是孕产妇发病的一个重要因素。本综述旨在了解孕期和分娩期间的社会背景与经历、压力和健康恶化的生物学指标以及围产期情绪和焦虑障碍(PMADs)之间的关联。采用PRISMA-ScR指南和JBI综述方法进行了一项范围综述。检索在OVID Medline和Embase中进行。本综述确定了74篇符合条件的英文同行评审原创研究文章。大多数研究报告了社会背景、产前的负面和压力经历与PMADs诊断和症状的较高发生率之间存在显著关联。纳入的研究报告了产后抑郁症与产前应激源(n = 17)、社会经济劣势(n = 14)、负面分娩经历(n = 9)、产科暴力(n = 3)以及产科护理人员的虐待(n = 3)之间存在显著关联。与分娩相关的创伤后应激障碍(PTSD)与负面分娩经历(n = 11)、产科暴力(n = 1)、产科护理团队的虐待(n = 1)、社会经济劣势(n = 2)和产前压力(n = 1)呈正相关;与产科护理团队的支持性(n = 5)以及有分娩陪伴者或导乐(n = 4)呈负相关。产后焦虑与负面分娩经历(n = 2)和产前压力(n = 3)显著相关。与压力和健康恶化的生物标志物、围产期暴露和PMADs之间关联的研究结果(n = 14)具有混合意义。产后心理健康结果与产前社会背景以及孕期和分娩期间与产科护理团队的互动有关。尊重产妇的护理有可能减少产后不良心理健康结果,特别是对于受系统性压迫影响的人群。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/99c8/11049830/84a6a10b75d5/ijerph-21-00480-g001.jpg

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