Bitonti Francesca, Mazza Angelo, Barchitta Martina, Maugeri Andrea, Magnano San Lio Roberta, Favara Giuliana, La Mastra Claudia, La Rosa Maria Clara, Galvani Fabiola, Pappalardo Elisa, Ettore Carla, Ettore Giuseppe, Mertoli Federico, Schillaci Carmela Elita, Agodi Antonella
Department of Economics and Business, University of Catania, 95129, Catania, Italy.
Department of Medical and Surgical Sciences and Advanced Technologies "GF Ingrassia", University of Catania, 95123, Catania, Italy.
Popul Health Metr. 2025 May 30;23(1):21. doi: 10.1186/s12963-025-00382-0.
Pregnancy is a period marked by significant physiological and psychological changes in women and increased fetal nutritional requirements, necessitating maternal adaptation and behavior modifications. Clinicians and health institutions recommend pregnant women engage in healthy practices, such as smoking and alcohol cessation, folic acid consumption, vaccinations, and the like. As behavioral changes in general, the individual's conduct during pregnancy is also influenced not only by personal socio-economic status but also by the socio-economic conditions of the individual's area of residence. This mechanism is recognized by the social epidemiological approach and relates to the concept of neighborhood effect on individual health-related choices. Leveraging such considerations, the work aims to explore the association between selected behaviors recommended by clinicians during pregnancy and specific contextual variables in the residential areas where pregnant women live.
Data from the "MAMI-MED" cohort, recruiting pregnant women during the first prenatal visit at a hospital in Catania (Italy), were analyzed. The cohort provides a valuable resource for investigating the relationship between various exposures during pregnancy and the health outcomes of both mothers and infants. Geocoding techniques were employed to link individual-level data to selected contextual variables related to education, income, unemployment, and housing costs in the participants' residential areas. Mann-Whitney test, Kruskal-Wallis tests, logistic regressions and mixtures of regressions models with concomitant variables are implemented 1) to investigate the associations between contextual covariates and individual responses, 2) to assess the presence of latent sub-groups of the population reacting differently to the same contextual factors.
The results of Mann-Whitney and Kruskal-Wallis tests, and logistic regressions indicated that neighborhood's socio-economic characteristics, such as educational level and unemployment rate, are associated with women's behaviors during pregnancy, smoking cessation in particular. Results from the logistic regression for BMI showed that obese and overweight individuals tend to live in neighborhoods where the percentage of individuals holding at least a bachelor's degree is comparatively lower. A mixture of regressions predicting individual BMI detected the presence of two latent groups in the population under analysis. The main finding seems to suggest that people living in worse socio-economic environments have a higher sensitivity to changes in education conditions, with respect to individuals living in better-off neighborhoods.
These findings highlight the importance of considering social and contextual dimensions in understanding and promoting healthy behaviors during pregnancy.
怀孕是一个女性生理和心理发生重大变化且胎儿营养需求增加的时期，这就需要孕妇进行适应和行为调整。临床医生和医疗机构建议孕妇养成健康的习惯，比如戒烟戒酒、补充叶酸、接种疫苗等等。一般来说，作为行为变化，个体在孕期的行为不仅受其个人社会经济地位的影响，还受其居住地区社会经济状况的影响。这种机制已得到社会流行病学方法的认可，并且与邻里效应影响个人健康相关选择的概念有关。基于这些考虑，这项研究旨在探讨临床医生建议的孕期特定行为与孕妇居住地区的特定环境变量之间的关联。
对来自“MAMI - MED”队列的数据进行了分析，该队列在意大利卡塔尼亚的一家医院招募首次产前检查的孕妇。该队列是研究孕期各种暴露因素与母婴健康结局之间关系的宝贵资源。采用地理编码技术将个体层面的数据与参与者居住地区与教育、收入、失业和住房成本相关的选定环境变量联系起来。实施了曼 - 惠特尼检验、克鲁斯卡尔 - 沃利斯检验、逻辑回归以及带有伴随变量的回归模型混合分析，1）以研究环境协变量与个体反应之间的关联，2）评估人群中对相同环境因素反应不同的潜在亚组的存在情况。
曼 - 惠特尼检验、克鲁斯卡尔 - 沃利斯检验以及逻辑回归的结果表明，邻里的社会经济特征，如教育水平和失业率，与女性孕期行为有关，尤其与戒烟有关。BMI的逻辑回归结果显示，肥胖和超重个体往往居住在拥有至少本科学历的人口比例相对较低的社区。预测个体BMI的回归模型混合分析在被分析人群中检测到两个潜在群体。主要发现似乎表明，与生活在富裕社区的个体相比，生活在社会经济环境较差地区的人对教育条件变化的敏感度更高。
这些发现凸显了在理解和促进孕期健康行为时考虑社会和环境维度的重要性。
