Maternal depressive symptoms, sleep, and odds of spontaneous early birth: implications for racial inequities in birth outcomes.
Maternal depressive symptoms, sleep, and odds of spontaneous early birth: implications for racial inequities in birth outcomes.
复制标题
母亲抑郁症状、睡眠和自然早产的几率：对出生结果种族不平等的影响。
作者：
Christian,LisaM;Webber,Shannon;Gillespie,Shannon;Strahm,AnnaM;Schaffir,Jonathan;Gokun,Yevgeniya;Porter,Kyle
研究目的足月前分娩影响了37%的美国出生，包括约40万例早产（<37周）和> 100万例早产（37-38周）。大约70%的妊娠期缩短病例是自发的，没有医学上的原因。阐明可改变的行为因素将有相当大的临床影响。MethodsThis study examined role of depression symptoms and sleep quality in predicting odds of spontaneous shortening gestation among 317 women（135名黑人，182名白色人）在怀孕中期完成心理社会评估。黑人女性自发性妊娠缩短的几率是白色女性的1.89倍（OR [95% CI] = 1.89 [1.01，3.53]，p= 0.046）。仅报告主观睡眠质量差（PSQI > 6）或仅报告抑郁症状升高（CES-D ≥ 16）的女性与无任何风险因素的女性相比，自发性缩短妊娠的几率无统计学显著差异。然而，患有睡眠不良和抑郁症状共病的女性比没有任何危险因素的女性表现出明显更高的自发性缩短妊娠的几率（39.2% vs 15.7% [OR（95%CI）= 2.69（1.27，5.70）]，p= 0.01）。黑人女性中符合这两个风险因素标准的比例更高（23%的黑人女性对11%的白色女性;p= 0.004），较低比例的人没有经历任何风险因素（40.7%的黑人妇女对64.3%的白色妇女; p< 0.001）的平均值结论主观睡眠质量差和抑郁症状的叠加效应，同时存在这两种危险因素的妇女的妊娠。共病暴露率的种族不平等与妊娠期缩短的不平等相对应。未来的实证研究和干预措施应考虑这些常见的共病暴露的相互影响。
Study ObjectivesDelivery prior to full term affects 37% of US births, including ~400,000 preterm births (<37 weeks) and >1,000,000 early term births (37–38 weeks). Approximately 70% of cases of shortened gestation are spontaneous—without medically-indicated cause. Elucidation of modifiable behavioral factors would have considerable clinical impact.MethodsThis study examined the role of depressive symptoms and sleep quality in predicting the odds of spontaneous shortened gestation among 317 women (135 black, 182 white) who completed psychosocial assessment in mid-pregnancy.ResultsAdjusting for key covariates, black women had 1.89 times higher odds of spontaneous shortened gestation compared to White women (OR [95% CI] = 1.89 [1.01, 3.53],p= 0.046). Women who reported only poor subjective sleep quality (PSQI > 6) or only elevated depressive symptoms (CES-D ≥ 16) exhibited no statistically significant differences in odds of spontaneous shortened gestation compared to those with neither risk factor. However, women with comorbid poor sleep and depressive symptoms exhibited markedly higher odds of spontaneous shortened gestation than those with neither risk factor (39.2% versus 15.7% [OR (95% CI) = 2.69 (1.27, 5.70)],p= 0.01). A higher proportion of black women met criteria for both risk factors (23% of black women versus 11% of white women;p= 0.004), with a lower proportion experiencing neither risk factor (40.7% of black versus 64.3% of white women;p< 0.001).ConclusionsAdditive effects of poor subjective sleep quality and depressive symptoms were observed with markedly higher odds of spontaneous shortened gestation among women with both risk factors. Racial inequities in rates of comorbid exposure corresponded with inequities in shortened gestation. Future empirical studies and intervention efforts should consider the interactive effects of these commonly co-morbid exposures.