Copper R L, Goldenberg R L, Das A, Elder N, Swain M, Norman G, Ramsey R, Cotroneo P, Collins B A, Johnson F, Jones P, Meier A M
National Institute of Child Health and Human Development Maternal-Fetal Medicine Units Network, Bethesda, Maryland, USA.
Am J Obstet Gynecol. 1996 Nov;175(5):1286-92. doi: 10.1016/s0002-9378(96)70042-x.
Our purpose was to determine whether various measures of poor psychosocial status in pregnancy are associated with spontaneous preterm birth, fetal growth restriction, or low birth weight.
Anxiety, stress, self-esteem, mastery, and depression were assessed at 25 to 29 weeks in 2593 gravid women by use of a 28-item Likert scale. Scores for each psychosocial subscale were determined, and an overall psychosocial score was calculated. Scores were divided into quartiles, and the lowest quartile scores were used to define poor psychosocial status. The percent spontaneous preterm birth, low birth weight, and fetal growth restriction in women with low and high psychosocial scores were compared. Logistic regression analyses provided the odds ratios and 95% confidence intervals.
Analyses revealed that stress was significantly associated with spontaneous preterm birth and with low birth weight with odds ratios of 1.16, p = 0.003, and 1.08, p = 0.02, respectively, for each point on the scale. A low score on the combined scale or on any subscale other than stress did not predict spontaneous preterm birth, fetal growth restriction, or low birth weight. After multivariate adjustment was performed for psychosocial status, substance use, and demographic traits, black race was the only variable significantly associated with spontaneous preterm birth, fetal growth restriction, and low birth weight; stress and low education were associated with spontaneous preterm birth and low birth weight.
Stress was associated with spontaneous preterm birth and low birth weight even after adjustment for maternal demographic and behavioral characteristics. Black race continues to be a significant predictor of spontaneous preterm birth, fetal growth restriction, and low birth weight even after adjustment for stress, substance use, and other demographic factors.
我们的目的是确定孕期各种不良心理社会状态指标是否与自发性早产、胎儿生长受限或低出生体重相关。
采用28项李克特量表，在2593名孕妇孕25至29周时评估焦虑、压力、自尊、掌控感和抑郁情况。确定每个心理社会子量表的得分，并计算总体心理社会得分。得分分为四分位数，最低四分位数得分用于定义不良心理社会状态。比较心理社会得分低和高的女性的自发性早产、低出生体重和胎儿生长受限的百分比。逻辑回归分析提供比值比和95%置信区间。
分析显示，压力与自发性早产和低出生体重显著相关，量表上每增加一分，比值比分别为1.16（p = 0.003）和1.08（p = 0.02）。综合量表或除压力外的任何子量表得分低均不能预测自发性早产、胎儿生长受限或低出生体重。在对心理社会状态、物质使用和人口统计学特征进行多变量调整后，黑人种族是与自发性早产、胎儿生长受限和低出生体重显著相关的唯一变量；压力和低教育程度与自发性早产和低出生体重相关。
即使在调整了母亲的人口统计学和行为特征后，压力仍与自发性早产和低出生体重相关。即使在调整了压力、物质使用和其他人口统计学因素后，黑人种族仍然是自发性早产、胎儿生长受限和低出生体重的重要预测因素。
