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| 題名: | Examination of the risk factors associated with adverse pregnancy outcomes and parental emotional disturbances during perinatal periods |
| 作者: | 貝若珊
Raushan Alibekova |
| 貢獻者: | 陳怡樺 |
| 關鍵詞: | 吸菸,二手菸暴露,憂鬱,焦慮,孕產期,不孕症,妊娠結果,產檢,低出生體重,早產
Smoking,Secondhand smoke exposure,Depression,Anxiety;Perinatal periods Infertility,Pregnancy outcome,Prenatal care,Low birth weight,Preterm birth |
| 日期: | 2016-06-07 |
| 上傳時間: | 2018-10-01 11:31:11 (UTC+8) |
| 摘要: | Purpose:
Adverse pregnancy and delivery outcomes, and psychological disturbances of women and their spouses are common complications of the perinatal periods. The purpose of our investigations was to explore the association of potentially modifiable risk factors with adverse outcomes in high-risk pregnancies and parental perinatal mental illnesses. The first study aimed to examine the effects of various measures of prenatal care on adverse pregnancy outcomes in women with history of infertility. The aim of the second study was to explore whether the paternal smoking status is longitudinally associated with maternal and paternal depression and anxiety from early pregnancy to 6 months postpartum.
Methods:
In the first project a retrospective cohort study was undertaken by linking 2 large nationwide population-based datasets, the National Health Insurance Research Database and Taiwan Birth Certificate Registry. The study sample included 15,056 women with an infertility diagnosis and 60,224 randomly selected women matched to the study sample by maternal age without infertility. Conditional logistic regression models were performed for the analysis.
The second study is a prospective cohort study of pregnant women and their partners. The sample consisted of 533 consecutive couples. Depressive and anxiety symptoms were assessed by self-report questionnaires at five time points: 1st, 2nd, 3rd trimester of pregnancy, 1 and 6 months postpartum. Paternal smoking at baseline was categorized into 3 groups: non-smoker, smoking but not in the mother’s presence, and smoking in the mother’s presence. Generalized estimating equations were used for the analyses.
Results:
The first study findings showed that women diagnosed with infertility respectively had 1.39 (95% CI, 1.06~1.83), 1.15 (95% CI, 1.08~1.24), 1.13 (95% CI, 1.08~1.18), and 1.08 (95% CI, 1.05~1.12) higher odds of having very low birth weight babies, preterm births, labor complications, and cesarean sections, compared to women without infertility. Inadequate numbers of total and major prenatal visits and late initiation of prenatal care increased the risks of adverse pregnancy outcomes in women with infertility, especially the risk of a very low birth weight baby. However, no significant associations were found for the risks of adverse birth outcomes in infertile women with adequate prenatal care compared to fertile women with adequate care.
As for the second study, we found that fathers who smoked in the mother’s presence had higher depressive (regression coefficient=1.0, 95% confidence interval (CI) 0.3~1.8) and anxiety symptoms (3.0, 95% CI 1.2~4.7) during perinatal periods, compared to non-smoking fathers. Paternal smoking in the mother’s presence also increased risk of maternal disturbances, especially for depression during pregnancy (1.2, 95% CI 0.1~2.3) and anxiety during the postpartum period (3.4, 95% CI 0.6~6.3). No significant association was found between paternal smoking but not in the mother’s presence and maternal emotional disturbances. Paternal smoking but not in the mother’s presence affected only paternal anxiety, especially in the postpartum period (regression coefficient 2.7, 95% CI 0.7~4.7), compared to non-smoking fathers.
Conclusions:
The findings of the first study suggest that adequate prenatal care can reduce the risk of adverse pregnancy outcomes in women with infertility. Findings of our second study have implications for public health interventions regarding the need to at least restrict the father’s smoking to outside the presence of the pregnant wife during perinatal periods, if quitting smoking is tentatively unattainable. These findings have important clinical and public health implications because both prenatal care utilization and smoking are potentially modifiable. |
| 描述: | 博士論文
委員-陳娟瑜
委員-楊浩然
委員-莊坤洋
委員-莊 ?? 智
指導教授-陳怡樺 |
| 資料類型: | thesis |
| 顯示於類別: | [公共衛生學系暨研究所] 碩博論文
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