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Maternal Mental Health and Substance Use: An Examination of their Role in Pregnancy Health Behaviors and Birth Outcomes.

机译：孕产妇心理健康和物质使用：检查其在怀孕健康行为和出生结局中的作用。

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摘要

Objective. To characterize maternal mental health from a surveillance perspective and to specifically focus on maternal mental health and its potential relationship with prenatal substance use by: describing the co-occurrence of maternal mood and prenatal substance use; exploring the independent and interactive associations of maternal mood and prenatal substance use with infant health outcomes; and examining the relationship between maternal mood, stressful life events and prenatal tobacco cessation and maternal mood, stressful life events, postpartum depression and postpartum tobacco relapse. A qualitative study of methamphetamine use during pregnancy was designed to describe the experiences of pregnant women who had used methamphetamine immediately prior to or during pregnancy, with a specific focus on their mental health history.;Methods. Surveillance data from the Minnesota Pregnancy Risk Assessment Monitoring System (PRAMS), an on-going written/telephone survey of women who recently delivered live births in Minnesota linked to birth certificate data, comprised the dataset used to examine substance use, maternal mental health and infant health outcomes, as well as the tobacco cessation/relapse analyses. It is considered representative of Minnesota's recent mothers and infants.;The Maternal Methamphetamine Study evolved from a community-based, participatory research model. Primary data collection and analysis focused on a small sample of women located in urban and rural settings in Minnesota. Qualitative methods were used to describe a population of women in out-patient therapy for methamphetamine use through county-based treatment programs. Data collection tools were designed in collaboration with researchers from the Minnesota Department of Health (MDH), Children's Hospitals and Clinics and Hennepin County Medical Center (HCMC). Qualitative data were obtained through in-person or telephone interviews and quantitative data through self-administered, written questionnaires.;The University of Minnesota Institutional Review Board (IRB) reviewed both studies. The PRAMS questionnaire has been previously reviewed and approved by the Centers for Disease Control and Prevention (CDC) and MDH IRBs. The secondary analyses of PRAMS data qualified for IRB exemption, as it uses existing data and does not contain personal identifiers. The methamphetamine project was approved by the University of Minnesota IRB.;Conclusions. Low maternal mood co-occurred with substance use during pregnancy, which has profound implications for the health of women and their infants. Low maternal mood during pregnancy and tobacco use were interactively associated with a two-fold higher risk of low birthweight births. Women who reported low mood during pregnancy and who abstained from alcohol use during the third trimester of pregnancy were twice as likely to have a preterm delivery compared to women who reported higher mood levels. Low mood levels and stress were associated with decreased likelihood of tobacco cessation during pregnancy. Women with a history of methamphetamine addiction reported personal and familial histories of psychological problems. In addition, methamphetamine was described as a remedy for low energy, low self-esteem, depression and anxiety. Women stated they could accomplish more while on methamphetamine and it helped them cope with the demands of daily life. Thus, mental health problems and substance use co-occurred, which may have potential adverse consequences for pregnant women. More study of this complex relationship, and the resulting effects on women and their children, is important for long-term maternal and child health.;Limitations. The two data sources define depressive symptoms differently, with different data collection methods. Thus, comparability between the study populations is difficult. This further reflects the lack of a gold standard measure for prenatal depression and depressive symptoms and the difficulty of measuring such symptoms during pregnancy. The question related to maternal mood during pregnancy from PRAMS is not considered a standard screening question and requires caution when interpreting results. Additionally, the women participating in the methamphetamine study are a select group of women who were identified through drug treatment programs.;Public Health Implications. This proposal suggests that mental health may be important over the course of a pregnancy and during the postpartum. The innovative nature of this project relates to its exploration of maternal mental health and substance use concurrently, and their potential joint contributions to adverse maternal and infant health outcomes. In addition, it is one of the first studies to describe pregnant women in recovery from methamphetamine addiction. The results from these manuscripts provide information for local, state and federal public health agencies for program development and research allocation, and could influence their confidence in surveillance data designed to track maternal mental health.
机译：目的。从监视的角度描述孕产妇心理健康的特征，并特别关注孕产妇心理健康及其与产前物质使用的潜在关系，方法是：描述产妇情绪和产前物质使用的共存；探索孕产妇情绪和产前物质使用与婴儿健康结果之间的独立和互动联系；并检查了母亲情绪，压力性生活事件和产前戒烟与母亲情绪，压力性生活事件，产后抑郁和产后烟草复发之间的关系。对怀孕期间使用甲基苯丙胺的定性研究旨在描述怀孕前或怀孕期间使用甲基苯丙胺的孕妇的经历，特别关注其心理健康史。明尼苏达州怀孕风险评估监控系统（PRAMS）的监视数据是一项持续的书面/电话调查，该调查与明尼苏达州最近在分娩的活产妇女的出生证相关联，包括用于检查药物使用，孕产妇心理健康和婴儿健康状况以及戒烟/复发分析。它被认为是明尼苏达州最近的母亲和婴儿的代表。孕妇甲基苯丙胺研究是从基于社区的参与性研究模型演变而来的。初步数据收集和分析的重点是位于明尼苏达州城市和农村地区的一小部分妇女。使用定性方法描述了通过县级治疗计划接受甲苯丙胺门诊治疗的妇女人数。数据收集工具是与明尼苏达州卫生部（MDH），儿童医院和诊所以及亨内平县医学中心（HCMC）的研究人员合作设计的。定性数据是通过面对面或电话访谈获得的，定量数据是通过自我管理的书面调查表获得的。明尼苏达大学机构审查委员会（IRB）审查了两项研究。疾病预防和控制中心（CDC）和MDH IRB之前已审核并批准了PRAMS调查表。对有资格获得IRB豁免的PRAMS数据的辅助分析，因为它使用现有数据并且不包含个人标识符。甲基苯丙胺项目经明尼苏达大学IRB批准；结论。孕妇在孕期使用毒品会降低母亲的情绪，这对妇女及其婴儿的健康有着深远的影响。孕妇在怀孕期间的情绪低落和吸烟与低出生体重儿的两倍高发生交互作用有关。与那些情绪水平较高的妇女相比，那些在妊娠期间情绪低落且在妊娠晚期不喝酒的妇女发生早产的可能性是其两倍。情绪低落和压力与怀孕期间戒烟的可能性降低有关。有甲基苯丙胺成瘾史的妇女报告有心理问题的个人和家族史。此外，甲基苯丙胺被描述为低能量，低自尊，抑郁和焦虑的一种疗法。妇女表示，在服用甲基苯丙胺的同时，他们可以取得更多成就，这有助于她们应对日常生活的需求。因此，精神健康问题和物质使用同时发生，可能对孕妇产生潜在的不利影响。对这种复杂关系及其对妇女及其子女的影响进行更多的研究，对于长期的母婴健康至关重要。这两个数据源使用不同的数据收集方法对抑郁症状的定义不同。因此，研究人群之间的可比性是困难的。这进一步反映出缺乏针对产前抑郁和抑郁症状的金标准测量方法，以及在怀孕期间难以测量此类症状的方法。 PRAMS与孕期孕妇情绪有关的问题不被视为标准筛查问题，在解释结果时需要谨慎。此外，参加甲基苯丙胺研究的妇女是通过药物治疗计划确定的一部分妇女。；对公共健康的影响。该建议表明，心理健康在怀孕过程中和产后可能很重要。该项目的创新性质涉及同时探索孕产妇心理健康和药物使用，以及它们对不利于孕产妇和婴儿健康的潜在共同贡献。此外，这是描述孕妇从甲基苯丙胺成瘾中恢复的最早研究之一。这些手稿的结果为地方，州和联邦公共卫生机构的计划开发和研究分配提供了信息，并可能会影响他们对旨在追踪孕产妇心理健康的监测数据的信心。

著录项

  • 作者

    Gyllstrom, Marilyn Elizabeth.;

  • 作者单位

    University of Minnesota.;

  • 授予单位 University of Minnesota.;
  • 学科 Health Sciences Mental Health.;Health Sciences Obstetrics and Gynecology.;Health Sciences Epidemiology.
  • 学位 Ph.D.
  • 年度 2010
  • 页码 259 p.
  • 总页数 259
  • 原文格式 PDF
  • 正文语种 eng
  • 中图分类
  • 关键词

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