RESUMEN
Psychosocial stress during pregnancy has been associated with adverse pregnancy outcomes including preterm birth (PTB). This has not been studied in Puerto Rico, an area with high PTB rates. Our objective was to develop a conceptual model describing the interrelationships between measures of psychosocial stress and depression, a result of stress, among pregnant women in Puerto Rico and to examine their associations with PTB. We used data from the Puerto Rico Testsite for Exploring Contamination Threats pregnancy cohort (PROTECT, N = 1,047) to examine associations among depression and different continuous measures of psychosocial stress using path analysis. Psychosocial stress during pregnancy was assessed using validated measures of perceived stress, negative life experiences, neighborhood perceptions and social support. Logistic regression was used to examine associations between psychosocial stress measures in tertiles and PTB. Perceived stress, negative life experiences, and neighborhood perceptions influenced depression through multiple pathways. Our model indicated that perceived stress had the strongest direct effect on depression, where one standard deviation (SD) increase in perceived stress was associated with a 57% SD increase in depression. Negative life experiences were directly but also indirectly, through perceived stress, associated with depression. Finally, neighborhood perceptions directly influenced negative life experiences and perceived stress and consequently had an indirect effect on depression. Psychosocial stress was not associated with PTB across any of the measures examined. Our study examined interrelationships between multiple measures of psychosocial stress and depression among a pregnant Puerto Rican population and identified negative neighborhood perceptions as important upstream factors leading to depression. Our findings highlight the complex relationship between psychosocial stress measures and indicate that psychosocial stress and depression, assessed using 5 different scales, were not associated with PTB. Future research should investigate other environmental and behavioral risk factors contributing to higher rates of PTB in this population.
Asunto(s)
Depresión/psicología , Mujeres Embarazadas/psicología , Nacimiento Prematuro/epidemiología , Estrés Psicológico/epidemiología , Adulto , Depresión/epidemiología , Depresión/fisiopatología , Femenino , Humanos , Recién Nacido , Recien Nacido Prematuro , Embarazo , Resultado del Embarazo/psicología , Nacimiento Prematuro/fisiopatología , Puerto Rico/epidemiología , Características de la Residencia , Factores de Riesgo , Apoyo Social , Estrés Psicológico/fisiopatología , Estrés Psicológico/psicologíaRESUMEN
The aim of this review is to present the beliefs related to sexual activity during pregnancy. We identified 13 studies (3,122 participants). The main positive beliefs about sex in pregnancy were that it makes labor easier, promotes marital harmony, prevents infidelity, and improves fetal well-being. Negative beliefs were more frequent: that sex could harm the unborn child (cause injuries, miscarriage, or fetal infection) and endanger the pregnancy or maternal health (cause membrane rupture, bleeding, preterm labor, and maternal infection). These findings are useful to clinicians and educational program developers.
Asunto(s)
Coito/fisiología , Conocimientos, Actitudes y Práctica en Salud , Conducta Sexual/fisiología , Parejas Sexuales/psicología , Conducta de Elección , Femenino , Humanos , Recién Nacido , Masculino , Embarazo , Complicaciones del Embarazo/psicología , Resultado del Embarazo/psicología , Trimestres del Embarazo/fisiologíaRESUMEN
The manifestation of anxiety during pregnancy can be caused by multiple factors and may have emotional and physical consequences for both the mother and the fetus. The prevalence of gestational anxiety has grown in recent years, making the development of studies for its comprehension essential. Thus, the aim of this investigation was to evaluate the effects of predictable and unpredictable chronic stressors on the anxiety profile of rats in three distinct stages of pregnancy (1st, 2nd and 3rd weeks). Wistar dams were divided into three groups: control, social separation and unpredictable chronic stress. Behavioral assessments were conducted in the Elevated Plus-Maze at the end of the 1st, 2nd and 3rd weeks of gestation. The results showed that there was increased anxiety in the proximity of parturition in control dams. Chronic stressors differentially affected the behavior of pregnant rats according to the gestational period where they were applied: social separation decreased anxiety at the end of the 3rd week, while unpredictable chronic stress caused increased anxiety, especially at the end of the 2nd gestational week. These results show that there is a critical time during pregnancy for the onset of anxiety in control rats, depending on the gestational stage. The exposure to different types of chronic stressors may result in distinct behaviors related to this disorder.
Asunto(s)
Ansiedad , Embarazo/psicología , Ratas Wistar/psicología , Aislamiento Social , Estrés Psicológico , Animales , Enfermedad Crónica , Conducta Exploratoria , Femenino , Resultado del Embarazo/psicología , Pruebas Psicológicas , Distribución Aleatoria , IncertidumbreRESUMEN
The scope of this article was to investigate whether intercessory prayer (IP) influences the adverse outcomes of pregnancies. A double-blind, randomized clinical trial was conducted with 564 pregnant women attending a prenatal public health care service. The women were randomly assigned to an IP group or to a control group (n = 289 per group). They were simultaneously and randomly assigned to practice prayer off-site or not. The following parameters were evaluated: Apgar scores, type of delivery and birth weight. The mean age of the women was 25.1 years of age (± 7.4), and the average gestational age was 23.4 weeks (± 8.1). The average number of years of schooling for the women was 8.1 years (± 3.1). The women in the IP and control groups presented a similar number of adverse medical events with non-significant p. No significant differences were detected in the frequency of adverse outcomes in pregnant women who practiced IP and those in the control group.
Este artigo tem por objetivo investigar se a oração intercessória influencia os desfechos adversos das mulheres grávidas. Foi realizado ensaio clínico randomizado duplo-cego com uma população de 564 gestantes que frequentavam Serviço de pré-natal de serviço público de saúde. As gestantes foram aleatoriamente designadas para grupo de intercessão ou grupo controle (n = 289 por grupo). Foram avaliados os seguintes parâmetros: índice de Apgar, tipo de parto, peso ao nascer. A idade média das mulheres foi de 25,1 anos (±7,4) e a idade gestacional média foi de 23,4 semanas (± 8,1). A média de anos de escolaridade foi de 8,1 anos (± 3,1). As mulheres que receberam intervenção (Oração intercessória) e grupo controle exibiram um número similar de eventos adversos, com p não significativo. Não encontramos diferença significativa entre os desfechos adversos na gestação entre os grupos que receberam oração intercessória e no grupo controle.
Asunto(s)
Adulto , Femenino , Humanos , Embarazo , Adulto Joven , Complicaciones del Embarazo/psicología , Resultado del Embarazo/psicología , Religión , Método Doble CiegoRESUMEN
The scope of this article was to investigate whether intercessory prayer (IP) influences the adverse outcomes of pregnancies. A double-blind, randomized clinical trial was conducted with 564 pregnant women attending a prenatal public health care service. The women were randomly assigned to an IP group or to a control group (n = 289 per group). They were simultaneously and randomly assigned to practice prayer off-site or not. The following parameters were evaluated: Apgar scores, type of delivery and birth weight. The mean age of the women was 25.1 years of age (± 7.4), and the average gestational age was 23.4 weeks (± 8.1). The average number of years of schooling for the women was 8.1 years (± 3.1). The women in the IP and control groups presented a similar number of adverse medical events with non-significant p. No significant differences were detected in the frequency of adverse outcomes in pregnant women who practiced IP and those in the control group.
Asunto(s)
Complicaciones del Embarazo/psicología , Resultado del Embarazo/psicología , Religión , Adulto , Método Doble Ciego , Femenino , Humanos , Embarazo , Adulto JovenRESUMEN
INTRODUCTION: Pregnancy has been shown to increase women’s vulnerability to mental disorders. Common mental disorders (CMDs) have been studied both in the general population and in pregnant vs. non-pregnant women. During pregnancy, CMDs have been considered a potential predictor of obstetric and infant outcomes. METHODS: A search was conducted on the PubMed/MEDLINE, LILACS, and SciELO databases to find relevant articles written in English, Spanish, and Portuguese. No limit was established for year of publication, but only studies involving human beings were included. RESULTS: A total of 25 articles were selected. There was a consensus among studies that the mean prevalence of CMD during pregnancy is 20%. There was also agreement that the occurrence of CMDs during pregnancy is a predictor of postpartum depression and anxiety disorders and that the disorder remains underdiagnosed and undertreated. As for the positive association between CMDs and obstetric and infant complications, results are still conflicting. In lower-income countries, frequently there is an association between CMD and perinatal changes. It is argued that some confounding factors, such as sociodemographic and cultural differences, health and maternal conditions, and type of instruments used, probably contribute to this lack of consensus. CONCLUSION: We believe that the conflicting results found in the literature are caused by differences in methodology and sociodemographic factors that influence the development of CMDs. Despite these differences, our findings underscore the need for depression and anxiety disorders during pregnancy to be studied and better identified by all professionals who provide antenatal care (AU)
INTRODUÇÃO: Estudos têm mostrado que a gravidez torna a mulher mais vulnerável a transtornos mentais. Os transtornos mentais comuns (TMCs) têm sido estudados tanto na população geral quanto em mulheres grávidas versus não grávidas. Durante a gravidez, os TMCs são considerados um potencial fator preditivo de desfechos obstétricos e perinatais. MÉTODOS: Uma pesquisa foi realizada nas bases de dados PubMed/MEDLINE, LILACS e SciELO em busca de artigos relevantes publicados em inglês, espanhol e português. Não foi estabelecido um limite para ano de publicação, mas apenas estudos envolvendo humanos foram incluídos. RESULTADOS: Um total de 25 artigos foram selecionados. Houve consenso entre os estudos de que a prevalência média de TMC durante a gravidez é de 20%. Também houve consenso de que a ocorrência de TMCs durante a gravidez é um fator preditivo de depressão pós-parto e transtornos de ansiedade, e de que o transtorno não vem sendo diagnosticado nem tratado. Com relação à associação positiva entre TMCs e desfechos obstétricos e perinatais, os resultados ainda são conflitantes. Em países de baixa renda, frequentemente se observa uma associação entre TMC e alterações perinatais. Argumenta-se que alguns fatores de confusão, tais como diferenças sociodemográficas e culturais, condições de saúde e maternas e tipo de instrumento usado, provavelmente contribuem para essa falta de consenso. CONCLUSÃO: Acreditamos que os resultados conflitantes encontrados na literatura são causados por diferenças na metodologia e fatores sociodemográficos que influenciam o desenvolvimento de TMCs. Apesar dessas diferenças, nossos achados salientam a necessidade de que a depressão e os transtornos da ansiedade durante a gravidez sejam estudados e melhor identificados por todos os profissionais que prestam cuidados pré-natais (AU)
Asunto(s)
Humanos , Femenino , Embarazo , Recién Nacido , Lactante , Resultado del Embarazo/psicología , Desarrollo Infantil , Trastornos Mentales/psicología , Madres/psicología , Embarazo/psicología , Áreas de Pobreza , Países Desarrollados , Mujeres Embarazadas/psicología , Países en Desarrollo , Salud del LactanteRESUMEN
OBJECTIVE: To evaluate the long-term reproductive consequences that affect women who have experienced potentially life-threatening or life-threatening (near-miss) maternal complications. INTRODUCTION: Although advances have been made in reducing maternal death, few studies have investigated the long-term repercussions of significant events such as severe maternal morbidity and maternal near-misses. These repercussions may be long-lasting and negatively affect quality of life. METHODS: A total of 382 women who had experienced a potentially life-threatening pregnancy-related condition within the last five years were analyzed in this retrospective cohort study. A control group of 188 women who gave birth without complications was also included. Trained interviewers contacted the subjects by telephone and completed a pre-coded, structured questionnaire on reproductive health. Data were analyzed using odds ratios adjusted for age. The main outcome measures were occurrence and outcome of subsequent pregnancies. RESULTS: The estimated risk of becoming infertile as a result of tubal ligation or hysterectomy was 3.5 times higher in women who experienced a maternal near-miss or severe maternal morbidity during the index pregnancy as compared to controls. Likewise, the risk of complications in subsequent pregnancies was five times greater in women who had experienced severe maternal morbidity. However, no differences were found in the occurrence or number of subsequent pregnancies or perinatal outcome. CONCLUSION: The occurrence of a life-threatening or potentially life-threatening maternal condition reduces future reproductive potential and increases the risk of complications in subsequent pregnancies.
Asunto(s)
Complicaciones del Embarazo/psicología , Resultado del Embarazo/psicología , Calidad de Vida/psicología , Adulto , Estudios de Casos y Controles , Estudios de Cohortes , Escolaridad , Femenino , Humanos , Embarazo , Complicaciones del Embarazo/mortalidad , Estudios Retrospectivos , Adulto JovenRESUMEN
OBJECTIVE: To evaluate the long-term reproductive consequences that affect women who have experienced potentially life-threatening or life-threatening (near-miss) maternal complications. INTRODUCTION: Although advances have been made in reducing maternal death, few studies have investigated the long-term repercussions of significant events such as severe maternal morbidity and maternal near-misses. These repercussions may be long-lasting and negatively affect quality of life. METHODS: A total of 382 women who had experienced a potentially life-threatening pregnancy-related condition within the last five years were analyzed in this retrospective cohort study. A control group of 188 women who gave birth without complications was also included. Trained interviewers contacted the subjects by telephone and completed a pre-coded, structured questionnaire on reproductive health. Data were analyzed using odds ratios adjusted for age. The main outcome measures were occurrence and outcome of subsequent pregnancies. RESULTS: The estimated risk of becoming infertile as a result of tubal ligation or hysterectomy was 3.5 times higher in women who experienced a maternal near-miss or severe maternal morbidity during the index pregnancy as compared to controls. Likewise, the risk of complications in subsequent pregnancies was five times greater in women who had experienced severe maternal morbidity. However, no differences were found in the occurrence or number of subsequent pregnancies or perinatal outcome. CONCLUSION: The occurrence of a life-threatening or potentially life-threatening maternal condition reduces future reproductive potential and increases the risk of complications in subsequent pregnancies.
Asunto(s)
Adulto , Femenino , Humanos , Embarazo , Adulto Joven , Complicaciones del Embarazo/psicología , Resultado del Embarazo/psicología , Calidad de Vida/psicología , Estudios de Casos y Controles , Estudios de Cohortes , Escolaridad , Complicaciones del Embarazo/mortalidad , Estudios RetrospectivosRESUMEN
OBJECTIVE: To estimate the association between common mental disorders (CMD) during pregnancy and risk of low birth weight (LBW) or preterm birth (PTB). METHODS: A prospective cohort study was conducted with 831 pregnant women from antenatal clinics in primary healthcare in São Paulo, Brazil. The clinical interview schedule-revised and demographic questionnaires were administered between the 20th and 30th weeks of gestation. Information on infant weight and gestational age at birth were obtained from hospital records. Univariate analyses were used to examine the association between the main exposure and main outcomes. Statistical associations were examined with χ(2) tests. Adjusted odds ratios (OR) and 95% confidence intervals (CI) for the main outcomes were obtained using a multivariable logistic regression model. RESULTS: The prevalence of CMD during gestation was 33.6 (95% CI: 30.4-36.9). The follow-up rate was 99.5%. Sixty three (7.6%) newborns were classified as LBW and 56 (6.9%) were classified as PTB. CMD during pregnancy was not associated with risk of PTB (adjusted OR:1.03, 95% CI: 0.57-1.88) or LBW (adjusted OR:1.09, 95% CI: 0.62-1.91). CONCLUSIONS: CMD prevalence is high among low-income and low-risk pregnant women attended by public health services in a middle-income country, but not confer an increased risk for adverse obstetric outcome.
Asunto(s)
Retardo del Crecimiento Fetal , Trastornos Mentales , Resultado del Embarazo/psicología , Nacimiento Prematuro , Adolescente , Adulto , Brasil , Estudios de Cohortes , Femenino , Retardo del Crecimiento Fetal/etiología , Retardo del Crecimiento Fetal/psicología , Edad Gestacional , Registros de Hospitales , Humanos , Recién Nacido de Bajo Peso/psicología , Recién Nacido , Trastornos Mentales/complicaciones , Trastornos Mentales/epidemiología , Trastornos Mentales/fisiopatología , Trastornos Mentales/psicología , Embarazo , Complicaciones del Embarazo/etiología , Complicaciones del Embarazo/fisiopatología , Complicaciones del Embarazo/psicología , Nacimiento Prematuro/etiología , Nacimiento Prematuro/psicología , Prevalencia , Estudios ProspectivosAsunto(s)
Parto Domiciliario/psicología , Partería/métodos , Madres/psicología , Parto Normal/psicología , Relaciones Enfermero-Paciente , Resultado del Embarazo/psicología , Anécdotas como Asunto , Femenino , Parto Domiciliario/enfermería , Humanos , Recién Nacido , Parto Normal/enfermería , Rol de la Enfermera , Embarazo , Puerto Rico , Apoyo SocialRESUMEN
CONTEXT AND OBJECTIVE: Previous adverse pregnancy outcomes (recurrent spontaneous abortion, fetal death, preterm birth or early neonatal death) can affect the quality of life of pregnant women. The objective of this study was to compare the quality of life and the prevalence of symptoms of anxiety and depression among pregnant women with and without these antecedents. DESIGN AND SETTING: An analytical cross-sectional study was performed in four settings (two high-risk and two low-risk prenatal clinics) in the city of Campinas, São Paulo, Brazil. METHODS: A total of 240 women were interviewed by a single investigator between the 18th and 24th weeks of gestation: 120 women with prior adverse pregnancy outcomes (group 1) and 120 women with no such history (group 2), matched according to their numbers of living children. Sociodemographic variables were collected and two questionnaires were used: the Short Form-36 quality-of-life questionnaire and the Depression and Anxiety Scale. RESULTS: The women in group 1 had lower scores in all the items on the quality-of-life questionnaire. Depression and anxiety were more frequent in group 1 (P < 0.0001). An inverse correlation was found between the Short Form-36 domains and anxiety and depression. CONCLUSIONS: Women with histories of recurrent spontaneous abortion, fetal death, preterm birth or early neonatal death seem to have poorer quality of life and more symptoms of anxiety and depression during their subsequent pregnancy, compared with those without such antecedents.
Asunto(s)
Ansiedad/epidemiología , Depresión/epidemiología , Acontecimientos que Cambian la Vida , Resultado del Embarazo/psicología , Calidad de Vida , Aborto Espontáneo/psicología , Adulto , Brasil/epidemiología , Métodos Epidemiológicos , Femenino , Muerte Fetal , Humanos , Embarazo , Nacimiento Prematuro/psicología , Factores SocioeconómicosRESUMEN
CONTEXT AND OBJECTIVE: Previous adverse pregnancy outcomes (recurrent spontaneous abortion, fetal death, preterm birth or early neonatal death) can affect the quality of life of pregnant women. The objective of this study was to compare the quality of life and the prevalence of symptoms of anxiety and depression among pregnant women with and without these antecedents. DESIGN AND SETTING: An analytical cross-sectional study was performed in four settings (two high-risk and two low-risk prenatal clinics) in the city of Campinas, São Paulo, Brazil. METHODS: A total of 240 women were interviewed by a single investigator between the 18th and 24th weeks of gestation: 120 women with prior adverse pregnancy outcomes (group 1) and 120 women with no such history (group 2), matched according to their numbers of living children. Sociodemographic variables were collected and two questionnaires were used: the Short Form-36 quality-of-life questionnaire and the Depression and Anxiety Scale. RESULTS: The women in group 1 had lower scores in all the items on the quality-of-life questionnaire. Depression and anxiety were more frequent in group 1 (P < 0.0001). An inverse correlation was found between the Short Form-36 domains and anxiety and depression. CONCLUSIONS: Women with histories of recurrent spontaneous abortion, fetal death, preterm birth or early neonatal death seem to have poorer quality of life and more symptoms of anxiety and depression during their subsequent pregnancy, compared with those without such antecedents.
CONTEXTO E OBJETIVO: O antecedente de resultados gestacionais adversos (aborto espontâneo recorrente, óbito fetal, prematuridade ou óbito neonatal precoce) pode afetar a qualidade de vida das gestantes. O objetivo deste estudo foi comparar a qualidade de vida e a prevalência de sintomas de ansiedade e depressão em gestantes com e sem estes antecedentes. TIPO DE ESTUDO E LOCAL: Um estudo transversal analítico foi realizado em quatro locais (duas clínicas de pré-natal de alto risco e duas de pré-natal de baixo risco), na cidade de Campinas, São Paulo, Brasil. MÉTODOS: Duzentas e quarenta mulheres foram entrevistadas por um único investigador entre 18 e 24 semanas de gestação: 120 tinham antecedentes gestacionais adversos (grupo 1) e 120 não tinham tal história (grupo 2), pareadas por número de filhos vivos. Variáveis sócio-demográficas foram coletadas e dois questionários foram usados: o de qualidade de vida (Questionário Short Form-36) e a Escala de Depressão e Ansiedade. RESULTADOS: As mulheres do grupo 1 obtiveram escores mais baixos em todos os itens do questionário de qualidade de vida. Depressão e ansiedade foram mais frequentes no grupo 1 (P < 0,0001). Foi encontrada uma correlação inversa entre os domínios do Short Form-36 e ansiedade e depressão. CONCLUSÕES: Mulheres com antecedente de aborto espontâneo recorrente, óbito fetal, prematuridade ou óbito neonatal precoce parecem ter pior qualidade de vida e mais sintomas de ansiedade e depressão durante a gestação subsequente quando comparadas com mulheres sem esses antecedentes.
Asunto(s)
Adulto , Femenino , Humanos , Embarazo , Ansiedad/epidemiología , Depresión/epidemiología , Acontecimientos que Cambian la Vida , Resultado del Embarazo/psicología , Calidad de Vida , Aborto Espontáneo/psicología , Brasil/epidemiología , Métodos Epidemiológicos , Muerte Fetal , Nacimiento Prematuro/psicología , Factores SocioeconómicosRESUMEN
BACKGROUND: Both violence and depression during pregnancy have been linked to adverse neonatal outcomes, particularly low birth weight. The aim of this study was to investigate the independent and interactive effects of these maternal exposures upon neonatal outcomes among pregnant adolescents in a disadvantaged population from Sao Paulo, Brazil. METHODS: 930 consecutive pregnant teenagers, admitted for delivery were recruited. Violence was assessed using the Californian Perinatal Assessment. Mental illness was measured using the Composite International Diagnostic Interview (CIDI). Apgar scores of newborns were estimated and their weight measured. RESULTS: 21.9% of mothers reported lifetime violence (2% during pregnancy) and 24.3% had a common mental disorder in the past 12 months. The exposures were correlated and each was associated with low education. Lifetime violence was strongly associated with Common Mental Disorders. Violence during pregnancy (PR = 2.59(1.05-6.40) and threat of physical violence (PR = 1.86(1.03-3.35) and any common mental disorders (PR = 2.09 (1.21-3.63) (as well as depression, anxiety and PTSD separately) were independently associated with low birth weight. CONCLUSION: Efforts to improve neonatal outcomes in low income countries may be neglecting two important independent, but correlated risk factors: maternal experience of violence and common mental disorder.
Asunto(s)
Trastornos Mentales/psicología , Resultado del Embarazo/psicología , Embarazo en Adolescencia/psicología , Violencia/psicología , Poblaciones Vulnerables/psicología , Adolescente , Adulto , Puntaje de Apgar , Brasil/epidemiología , Femenino , Humanos , Recién Nacido , Trastornos Mentales/epidemiología , Madres/psicología , Madres/estadística & datos numéricos , Embarazo , Mujeres Embarazadas/psicología , Factores de Riesgo , Encuestas y Cuestionarios , Violencia/estadística & datos numéricosRESUMEN
OBJECTIVE: To recognize the significance of fetal loss for women who have experienced it, starting from an understanding of the pregnancy process, based on their reports. METHODS: This was a qualitative analysis study based on the histories of seven women who experienced fetal loss in the town of Arujá, State of São Paulo, between July 1998 and June 1999. The women were identified from the death certificates of stillborn infants born within the study period, which were obtained from the Civil Registry Office of Arujá. The methodological procedures involved the utilization of the techniques of oral history-taking to gather data and content analysis to evaluate the material collected. The interviews were recorded, fully transcribed and subsequently prepared for analysis. RESULTS: The findings were analyzed as two points: the circumstantial context of the pregnancy and the impact after the loss, with the adoption of specific thematic categories. The first of these encompassed the woman's perception of the pregnancy, her awareness of the coming of the new baby, health problems up to the time of the loss, and the health service attendance. The significance of the loss for the women in this study was made evident along three central lines: the loss of a part of herself, attribution of the fatality to divine intervention and changes in attitude towards life. The social support network for these women was built on two pillars: family and church. Support from the health services was practically nonexistent. Finally, they all expressed their will to live and the need to work, study and even have another pregnancy. CONCLUSIONS: There needs to be a change in general concepts in the mission to attend to such women. The attendance provided by the healthcare services needs to be humanized. The need for multiprofessional follow-up of healthcare service users who suffered fetal loss was very evident. The importance of a support network for women who have gone through this problem was also shown.
Asunto(s)
Muerte Fetal , Resultado del Embarazo/psicología , Actitud , Femenino , Humanos , Lactante , Entrevistas como Asunto , Embarazo , Investigación CualitativaRESUMEN
PURPOSE: To determine social and behavioral consequences of pregnancy and how these differed according to the pregnancy outcome (live birth or abortion) 1 year after the event. METHODS: This was a prospective study of two groups of young women aged 12-18 years, one attending prenatal services and the other admitted for abortion complications at the same hospital in northeast Brazil. Adolescents who gave birth were subsequently classified as having intended or unintended pregnancies, and those who aborted were divided between those who terminated their pregnancies and those who miscarried. Baseline data were collected between 1995 and 1997 from all teens who met the eligibility criteria. Information was collected through one-on-one interviews using a questionnaire that was structured and precoded. Multiple logistic regression was used to identify characteristics that predicted outcomes at 1 year. RESULTS: Teens who terminated their pregnancies were the most likely to be in school or working 1 year later. They also showed the greatest increase in self-esteem. The young mothers, however, had the highest self-esteem but perceived the impact of pregnancy on their lives as being more negative than they did initially. Group affiliation was not associated with the quality of partner relationships, which tended to deteriorate over time. The young mothers used contraception at 1 year at higher rates and had experienced fewer subsequent pregnancies than the two abortion groups. CONCLUSIONS: The experience of adolescent pregnancy for this group of teens produced mixed findings, some more negative than others. Interventions to decrease the adolescent's desire to have a baby will have to be tailored differently from those designed to prevent an unintended pregnancy, but both are needed.
Asunto(s)
Complicaciones del Embarazo/psicología , Resultado del Embarazo/psicología , Embarazo en Adolescencia/psicología , Embarazo no Deseado/psicología , Aborto Inducido/psicología , Adolescente , Brasil/epidemiología , Niño , Estudios de Cohortes , Toma de Decisiones , Femenino , Humanos , Modelos Logísticos , Embarazo , Complicaciones del Embarazo/epidemiología , Resultado del Embarazo/epidemiología , Embarazo en Adolescencia/estadística & datos numéricos , Atención Prenatal/métodos , Proyectos de InvestigaciónRESUMEN
A double-blind prospective study was conducted to compare the predictive value of a prenatal biomedical risk scale (PBRS) and a prenatal biopsychosocial risk assessment (PBRAS) with respect to low birthweight. All obstetric patients at seven health centers located in Argentina, Colombia, Honduras, and Uruguay from November 1992 through January 1994 whose initial prenatal visits occurred between the 14th and 28th week of gestation were invited to participate. Information was obtained on 979 mother-infant pairs. High PBRS scores showed sensitivity of 62.1% and specificity of 81.3%, positive predictive value (PPV) of 45.3% and negative predictive value (NPV) of 89.5%, with respect to low birthweight. With the addition of the psychosocial factors (PBRAS), sensitivity of 75.7% and specificity of 76.1%, PPV of 55.1% and NPV of 88.9% were observed. The prospective cohort design of this study provides a strong basis for conclusion that an evaluation of the prenatal biopsychosocial risk (as operationalized by the PBRAS) adjusted for other variables such as length of gestation, neonatal APGAR, perinatal mortality, socioeconomic status, drinking and smoking improves the positive predictive value of the assessment of women who may give birth to newborns with low birthweight (P < 0.01).
Asunto(s)
Recién Nacido de Bajo Peso , Complicaciones del Embarazo/epidemiología , Resultado del Embarazo/epidemiología , Embarazo/psicología , Adolescente , Adulto , Método Doble Ciego , Femenino , Humanos , Recién Nacido , Complicaciones del Embarazo/psicología , Resultado del Embarazo/psicología , Estudios Prospectivos , Medición de Riesgo , Sensibilidad y EspecificidadRESUMEN
This article presents the methodology and baseline findings of a large multicenter trial involving four countries from Latin America (Argentina, Brazil, Cuba, and Mexico). The study was a randomized, controlled, single-masked trial to investigate the impact of social support during pregnancy on perinatal outcomes. Pregnant women with gestational ages between 15 and 22 weeks were screened in health facilities in the four countries. Those presenting with one or more risk factors for having a low-birthweight baby were invited to join the trial. A total of 2235 women--between 500 and 600 in each country--were randomized into an intervention (n = 1110) or a control (n = 1125) group. Both groups were comparable in terms of nearly all baseline variables. The intervention group received a minimum of four visits at home by a trained health worker who provided direct emotional support, health education, and an attempt to enhance the woman's social support network. Over 90% of all women were evaluated at 36 weeks of pregnancy and soon after delivery, and 85% at the 40th day postpartum. The outcomes under study included intrauterine growth retardation, gestational age, perinatal and maternal morbidity and mortality, labor interventions, psychological distress and characteristics of the social support network, among others. This trial showed that it was possible to select, screen, randomize, visit, and evaluate a large number of women in four Latin American countries using a standardized methodology.
Asunto(s)
Estudios Multicéntricos como Asunto/métodos , Resultado del Embarazo/psicología , Atención Prenatal , Ensayos Clínicos Controlados Aleatorios como Asunto/métodos , Apoyo Social , Adolescente , Adulto , Femenino , Educación en Salud , Humanos , América Latina , Tamizaje Masivo/organización & administración , Evaluación de Resultado en la Atención de Salud , Embarazo , Factores de Riesgo , Método Simple CiegoRESUMEN
This paper describes a study of biomedical and psychosocial risks and the perinatal outcome. Two hundred nineteen pregnant women completed three instruments to identify their biomedical and psychosocial risk: anxiety, family function, life events. Biomedical risk was assessed through analyses of self-reported health histories. Information on complications of pregnancy, labor, and delivery was obtained from the hospital delivery records. In the sample studied, biomedical risk alone was not substantially related to perinatal complications. Four psychosocial items were the best psychosocial predictors of perinatal complications: emotional tension; depressive humor; neurovegetative symptoms of anxiety; and dissatisfaction with the time, space, and money shared with the family (p < 0.05). The interaction between these critical psychosocial items and biomedical risk also reliably predicted complications (p < 0.00001). The results of this study suggest that psychosocial risk assessment alone and in interaction with biomedical risk assessment may significantly improve the ability to identify women who may experience perinatal complications.