Austad Bjarne, Vie Gunnhild Åberge, Hansen Mari Hegnes, Mørkved Hanna Sandbakken, Getz Linn Okkenhaug, Mjølstad Bente Prytz
General Practice Research Unit, Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, P.O. Box 8905, Trondheim, 7491, Norway, 47 99029992.
JMIR Form Res. 2025 Jun 3;9:e68811. doi: 10.2196/68811.
During pregnancy, self-rated health (SRH) and self-rated mental health (SRMH) are key indicators of health status and predictors of future health care needs. The relationship between pregnant women's health perceptions and their choice of antenatal care providers, midwives, or general practitioners (GPs) is not known. Factors like childhood experiences and socioeconomic status are important determinants of health throughout life. Understanding these health determinants can help health care providers better address the diverse needs of pregnant women.
This study aims to assess how SRH and SRMH during pregnancy are associated with maternal childhood experiences, socioeconomic status, parity, and antenatal care provided by midwives or GPs.
An anonymous, web-based cross-sectional survey was conducted from January to March 2022 among pregnant women in Norway, distributed via Facebook and Instagram. The survey included questions on SRH, SRMH, socioeconomic status, childhood perceptions, and antenatal program participation. Pearson's chi-squared test and logistic regression models were used to explore associations and estimate odds ratios for good SRH and SRMH.
Among 1402 participants, 94.7% (1328/1402) reported good or very good health before pregnancy, dropping to 67.8% (950/1402) during pregnancy (P<.001). Reporting your childhood as good was associated with better SRH compared with those who reported average or difficult childhood (70.2% [755/1076] vs 64% [114/178] vs 53.2% [74/139]; P<.001). This corresponds to 48% lower odds of good SRH for those reporting a difficult childhood compared to those reporting a good childhood (OR 0.52, 95% CI 0.36-0.76). Financial security and higher education were associated with better SRH (both P<.001). First-time mothers reported better SRH than those with previous births (73.9% [533/722] vs 61.4% [417/680]; P<.001). For SRMH, 89.9% (1260/1402) reported good or very good SRMH before pregnancy, decreasing to 73.1% (1024/1401) during pregnancy (P<.001). Women who reported a good childhood, financial security, higher education, and first-time mothers reported better SRMH during pregnancy (P<.001 for all). Nearly all women participated in the antenatal program, regardless of their subjective health, and most expressed satisfaction. Among participants, 55.6% (753/1354) received shared antenatal care, 38.6% (520/1354) were seen only by midwives, and 6% (81/1354) only by GPs. The proportion of women receiving antenatal care solely from a midwife decreased with declining SRH, from 42.6% (78/183) among those with very good SRH to 27.3% (15/55) among those with poor SRH.
A difficult maternal childhood, low socioeconomic status, and having given birth before were associated with poorer SRH and SRMH during pregnancy. Both midwives and GPs played vital roles in providing antenatal care, though few women received antenatal care exclusively from GPs. The likelihood of physician involvement in care increased slightly with worsening health.
在孕期，自我评估健康状况（SRH）和自我评估心理健康状况（SRMH）是健康状况的关键指标以及未来医疗保健需求的预测因素。孕妇的健康认知与其选择产前护理提供者、助产士或全科医生（GP）之间的关系尚不清楚。童年经历和社会经济地位等因素是一生健康的重要决定因素。了解这些健康决定因素有助于医疗保健提供者更好地满足孕妇的多样化需求。
本研究旨在评估孕期的SRH和SRMH如何与母亲的童年经历、社会经济地位、产次以及助产士或全科医生提供的产前护理相关联。
2022年1月至3月，在挪威的孕妇中进行了一项基于网络的匿名横断面调查，通过脸书和照片墙进行分发。该调查包括有关SRH、SRMH、社会经济地位、童年认知和产前项目参与情况的问题。使用Pearson卡方检验和逻辑回归模型来探索关联，并估计良好SRH和SRMH的比值比。
在1402名参与者中，94.7%（1328/1402）报告孕前健康状况良好或非常好，孕期降至67.8%（950/1402）（P<0.001）。与那些报告童年一般或困难的人相比，将童年报告为良好与更好的SRH相关（分别为70.2%[755/1076]、64%[114/178]和53.2%[74/139]；P<0.001）。与报告童年良好的人相比，报告童年困难的人SRH良好的几率低48%（比值比0.52，95%置信区间0.36 - 0.76）。经济保障和高等教育与更好的SRH相关（均P<0.001）。初产妇报告的SRH比经产妇更好（分别为73.9%[533/722]和61.4%[417/680]；P<0.001）。对于SRMH而言，89.9%（1260/1402）报告孕前SRMH良好或非常好，孕期降至73.1%（1024/1401）（P<0.001）。报告童年良好（P<0.001）、经济保障（P<0.001）、高等教育（P<0.001）的女性以及初产妇在孕期报告的SRMH更好。几乎所有女性都参与了产前项目，无论其主观健康状况如何，并且大多数表示满意。在参与者中，55.6%（753/1354）接受了联合产前护理，38.6%（52０/1354）仅由助产士护理，6%（81/1354）仅由全科医生护理。仅由助产士提供产前护理的女性比例随着SRH的下降而降低——从SRH非常好的女性中的42.6%（78/183）降至SRH差的女性中的27.3%（15/55）。
母亲童年困难、社会经济地位低以及既往有生育史与孕期较差的SRH和SRMH相关。助产士和全科医生在提供产前护理方面都发挥了重要作用，尽管很少有女性仅由全科医生提供产前护理。随着健康状况恶化，医生参与护理的可能性略有增加。
