Identifying urban built environment factors in pregnancy care and maternal mental health outcomes.
Identifying urban built environment factors in pregnancy care and maternal mental health outcomes.
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DOI：
10.1186/s12884-021-04056-1
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发表时间：
2021-09-04
影响因子：
3.1
通讯作者：
Pathak J
中科院分区：
文献类型：
--
作者：
Zhang Y;Tayarani M;Wang S;Liu Y;Sharma M;Joly R;RoyChoudhury A;Hermann A;Gao OH;Pathak J
与建筑环境有关的风险因素与妇女的心理健康和预防保健有关。本研究旨在确定与城市环境中产前护理和随后的妊娠相关结局变化相关的建筑环境因素。 在一项回顾性观察研究中，我们描述了与患者居住社区的各种建筑环境因素相关的产前护理事件的类型和频率。与生活在较高质量建筑环境中的女性相比，我们假设生活在较低质量建筑环境中的女性会经历不同模式的临床事件，这可能会增加不良结果的风险。使用机器学习，我们进行了模式检测，以表征产前护理中有关遭遇类型，临床问题和药物处方的变异性。结构方程模型被用来测试建成环境，产前护理的变化，和妊娠结局之间的关联。主要结果是产后抑郁症（PPD）诊断在分娩后1年内。暴露是患者居住社区的建筑环境质量。研究纳入了2015年至2017年在城市学术医疗中心进行现场分娩的孕妇（n = 8，949）的电子健康记录（EHR）数据。我们发现了产前护理模式，归纳为三种常见类型。经历过产前护理模式的妇女PPD率最高，更有可能居住在土地使用均匀，步行能力较低，空气污染物浓度较低，零售楼层比例较低的社区，调整年龄，社区平均教育水平，婚姻状况和收入不平等。在城市环境中，多功能和步行社区被发现与PPD的风险较低相关。调查结果可能会告知城市设计政策，并提供认识的患者的居住社区和健康的怀孕协会的护理提供者。在线版本包含补充材料，可通过10.1186/s12884-021-04056-1获得。
Risk factors related to the built environment have been associated with women’s mental health and preventive care. This study sought to identify built environment factors that are associated with variations in prenatal care and subsequent pregnancy-related outcomes in an urban setting. In a retrospective observational study, we characterized the types and frequency of prenatal care events that are associated with the various built environment factors of the patients’ residing neighborhoods. In comparison to women living in higher-quality built environments, we hypothesize that women who reside in lower-quality built environments experience different patterns of clinical events that may increase the risk for adverse outcomes. Using machine learning, we performed pattern detection to characterize the variability in prenatal care concerning encounter types, clinical problems, and medication prescriptions. Structural equation modeling was used to test the associations among built environment, prenatal care variation, and pregnancy outcome. The main outcome is postpartum depression (PPD) diagnosis within 1 year following childbirth. The exposures were the quality of the built environment in the patients’ residing neighborhoods. Electronic health records (EHR) data of pregnant women (n = 8,949) who had live delivery at an urban academic medical center from 2015 to 2017 were included in the study. We discovered prenatal care patterns that were summarized into three common types. Women who experienced the prenatal care pattern with the highest rates of PPD were more likely to reside in neighborhoods with homogeneous land use, lower walkability, lower air pollutant concentration, and lower retail floor ratios after adjusting for age, neighborhood average education level, marital status, and income inequality. In an urban setting, multi-purpose and walkable communities were found to be associated with a lower risk of PPD. Findings may inform urban design policies and provide awareness for care providers on the association of patients’ residing neighborhoods and healthy pregnancy. The online version contains supplementary material available at 10.1186/s12884-021-04056-1.
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影响因子：
4.5
作者：
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通讯作者：
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影响因子：
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作者：
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DOI：
10.1016/s0140-6736(17)31958-x
发表时间：
2017-10-14
期刊：
Lancet (London, England)
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