Psychosocial stress and its relation to maternal and infant outcomes among women with disabilities

残疾妇女的心理社会压力及其与母婴结局的关系

• 批准号: 10393139
• 负责人: JEANNE L ALHUSEN
• 金额: $ 23.03万
• 依托单位: UNIVERSITY OF VIRGINIA
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-07-01 至 2026-03-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10393139
• 关键词: Address; Admission activity; Affect; Attitude; Caring; Data; Data Analyses; Development; Disabled Persons; Evaluation; Evidence based intervention; Female of child bearing age; Focus Groups; Foundations; Future; Goals; Health Personnel; Health Promotion; Healthcare; Individual; Infant; Intervention; Interview; Knowledge; Low Birth Weight Infant; Mental Depression; Methods; Mood Disorders; Morbidity - disease rate; Mothers; Neonatal Intensive Care Units; Perinatal; Perinatal Care; Phase; Policies; Pregnancy; Pregnancy Outcome; Pregnant Women; Premature Birth; Prenatal care; Psychosocial Stress; Recommendation; Research; Risk; Risk Factors; Role; Testing; Underserved Population; Woman; Women' s Group; adverse birth outcomes; clinical practice; depressive symptoms; design; disability; disparity reduction; ethnic diversity; experience; improved; infant outcome; intimate partner violence; maternal outcome; mortality; perinatal health; perinatal outcomes; perinatal period; population based; pregnant; preventive intervention; protective factors; racial diversity; symptomatology; violence prevention; women with disabilities

Women with disabilities are increasingly becoming pregnant, and may be as likely to become pregnant as women without disabilities. Growing research suggests pregnancy in women with disability is associated with an increased risk for adverse perinatal outcomes. Although a few studies have examined disability-related disparities in adverse birth outcomes, finding increased risk of low birthweight, preterm birth, and neonatal intensive care unit admission, the mechanisms for these associations are not well understood. One plausible mechanism is the increased risk of psychosocial stress experienced by women with disabilities in the perinatal period. Women with disabilities are at heightened risk for intimate partner violence (IPV) and mood disorders, yet the extent to which these risks affect pregnancy outcomes has not been studied. A more comprehensive understanding of psychosocial stress, namely IPV and depressive symptomatology, and its relation to adverse birth outcomes is critically needed to reduce morbidity and mortality rates among disabled mothers and their infants, reduce disparities in perinatal care between women with and without disabilities, inform the design of effective evidence-based interventions for this understudied and underserved population of women, and generate recommendations for clinical practice and policy change. To address this gap, we propose to systematically examine the association between psychosocial stress and adverse birth outcomes. Using a mixed method approach, we will: 1) examine the association between psychosocial stress (i.e., perinatal IPV and depressive symptomatology) and adverse birth outcomes (i.e., low birthweight, preterm birth) by analyzing data from PRAMS Phase 9 across women with and without disabilities; 2) explore the experiences and barriers to comprehensive perinatal care through individual interviews with ethnically and racially diverse pregnant and new mothers with diverse disabilities; and 3) explore facilitators and barriers (e.g., disability-related knowledge, attitudes, and pregnancy care experience) to the provision of comprehensive perinatal health care to women with disabilities through focus groups and individual in-depth interviews with health care providers who care for pregnant women with disabilities with the goal of improving perinatal care for this underserved group of women. This research will also serve as the foundation for the development and evaluation of future prevention interventions, including our own team’s planned submission to adapt, tailor, and test existing successful health promotion interventions to prevent violence and its related sequelae among women with disability, thereby optimizing pregnancy outcomes for women of childbearing age living with disability.

越来越多的残疾妇女怀孕，并且怀孕的可能性可能与 越来越多的研究表明，残疾妇女的怀孕与以下因素有关。 尽管有一些研究调查了与残疾相关的情况，但围产期不良结局的风险增加。 不良出生结果的差异，发现低出生体重、早产和新生儿的风险增加 进入重症监护病房后，这些关联的机制尚不清楚。 机制是残疾妇女在围产期经历心理社会压力的风险增加 残疾妇女在卫生间面临亲密伴侣暴力（IPV）和情绪障碍的风险， 然而，这些风险对妊娠结局的影响程度尚未得到更全面的研究。 了解心理社会压力，即 IPV 和抑郁症状学及其与不良反应的关系 迫切需要出生结果来降低残疾母亲及其她们的发病率和死亡率 婴儿，减少残疾妇女和非残疾妇女之间围产期护理的差异，为设计 针对这一未被充分研究和服务不足的妇女群体采取有效的循证干预措施，以及 为临床实践和政策变化提出建议。为了解决这一差距，我们建议： 彻底检查社会心理压力与不良分娩结果之间的关联。 采用混合方法，我们将： 1) 检查心理社会压力（即围产期 IPV 和抑郁症状）和不良出生结局（即低出生体重、早产） 来自 PRAMS 第 9 阶段的残疾和非残疾妇女的数据 2) 探索经验和障碍； 通过对民族和种族不同的孕妇和种族进行单独访谈，提供全面的围产期护理 患有不同残疾的新妈妈；3) 探索促进因素和障碍（例如，与残疾相关的知识、 态度和怀孕护理经验）以向妇女提供全面的围产期保健 通过焦点小组和与照顾残疾人的医疗保健提供者进行个人深入访谈 残疾孕妇的目标是改善这一服务不足的群体的围产期护理 这项研究还将作为未来预防措施的制定和评估的基础。 干预措施，包括我们自己的团队计划提交的内容，以适应、定制和测试现有的成功健康状况 促进干预措施，防止残疾妇女遭受暴力及其相关后遗症，从而 优化育龄残疾妇女的妊娠结局。