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Obesity and postpartum depression: Does prenatal care utilization make a difference?

机译：肥胖和产后抑郁：产前保健利用是否有所作为？

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摘要

Using a national continuing population-based survey known as Pregnancy Risk Assessment Monitoring System (PRAMS), this study sought to determine the role that PNC utilization plays in the relationship between pre-pregnancy BMI and PPD symptoms. Two years of data, 2004 and 2005 were analyzed among women from 16 states. Two specific aims were examined: (1) the association between pre-pregnancy BMI and PPD symptoms, and (2) the association between pre-pregnancy BMI and PPD symptoms after considering PNC utilization as a moderating variable. It was predicted for the first specific aim that the odds for PPD symptoms would increase as pre-pregnancy BMI increased. For the second objective, it was predicted that the association from the first specific aim would carry over and remain the same (e.g., obese pre-pregnancy BMI would have the highest odds for PPD symptoms), but that within each pre-pregnancy BMI group, the odds for PPD symptoms would decrease as PNC utilization increased (within obese pre--pregnancy BMI, inadequate PNC would have higher odds than intermediate PNC). The general premise for PNC utilization acting as a moderating variable in this study was that PNC can help address the changes that occur during pregnancy with regards to pre-pregnancy BMI (as a biological and psychosocial stressor). Thus, delivering PNC incorporating nutrition, weight and shape changes, and addressing a woman's concerns about her weight and shape would in-turn, reduce the odds of PPD symptoms.;Since the sample used in this study included women from all pregnancy risk statuses, two risk-adjustment approaches were carried out to identify an association between pre-pregnancy BMI and PPD symptoms, and a moderating effect of PNC. One approach included all women in the dataset and used statistical analyses to risk-adjust for pregnancy risk status, and the other approach modified the design of the study by truncating the population of women to include healthy pregnancies only. Results initially showed an association between obesity and PPD symptoms, and PNC and PPD symptoms among the bivariate and multivariate analyses. However, the inclusion of a variety of control variables into the multivariate models removed these associations. Overall, for both approaches, there was no indication of a moderating effect of PNC utilization. However, results from the analyses showed that many of the women were significantly affected by a variety of medical and obstetric problems, many of which were high-risk. It is recommended that future research investigate the possible association of these problems with PPD symptoms. For practice, it is suggested that PNC providers identify the medical and obstetric problems faced by their patients, focus on both the physical and the potential psychosocial consequences of those problems, and establish suitable interventions accordingly.
机译：本研究使用称为人口风险评估监测系统（PRAMS）的全国人口连续调查，试图确定PNC利用在孕前BMI与PPD症状之间的关系中所扮演的角色。分析了来自16个州的女性2004年和2005年的两年数据。研究了两个具体目标：（1）孕前BMI与PPD症状之间的关联，以及（2）在考虑将PNC利用率作为调节变量后，孕前BMI与PPD症状之间的关联。为第一个特定目标预测，PPD症状的几率会随着孕前BMI的增加而增加。对于第二个目标，预计与第一个特定目标的关联会延续并保持不变（例如，肥胖的孕前BMI对PPD症状的机率最高），但在每个孕前BMI组内，随着PNC使用率的增加，PPD症状的几率会降低（在肥胖的孕妇BMI内，PNC不足会比中级PNC的几率高）。在本研究中，PNC利用作为调节变量的一般前提是，PNC可以帮助解决怀孕期间就孕前BMI（作为生理和社会心理压力源）而发生的变化。因此，提供包含营养，体重和体形变化的PNC，并解决女性对其体重和体形的担忧，将依次减少PPD症状的发生率。；由于本研究中使用的样本包括来自所有妊娠风险状态的女性，进行了两种风险调整方法来确定孕前BMI与PPD症状之间的关联以及PNC的调节作用。一种方法包括数据集中的所有妇女，并使用统计分析对妊娠风险状况进行风险调整，另一种方法是通过截断妇女人群以仅包括健康怀孕来修改研究设计。结果最初显示，肥胖与PPD症状之间存在关联，双变量和多变量分析中PNC和PPD症状之间存在关联。但是，在多变量模型中包含各种控制变量会删除这些关联。总体而言，对于这两种方法，都没有迹象表明PNC的使用有调节作用。但是，分析结果表明，许多妇女受到各种医学和产科问题的严重影响，其中许多是高风险的。建议将来的研究调查这些问题与PPD症状的可能联系。作为实践，建议PNC提供者确定患者所面临的医疗和产科问题，同时关注这些问题的生理和潜在心理社会后果，并据此建立适当的干预措施。

著录项

  • 作者

    Sundaram, Swathy.;

  • 作者单位

    University of Florida.;

  • 授予单位 University of Florida.;
  • 学科 Health Sciences Obstetrics and Gynecology.;Health Sciences Health Care Management.
  • 学位 Ph.D.
  • 年度 2009
  • 页码 207 p.
  • 总页数 207
  • 原文格式 PDF
  • 正文语种 eng
  • 中图分类
  • 关键词

  • 入库时间 2022-08-17 11:38:25

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