Maternal health and birth outcomes in a South African birth cohort study
Maternal health and birth outcomes in a South African birth cohort study
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DOI：
10.1371/journal.pone.0222399
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发表时间：
2019-11-21
期刊：
影响因子：
3.7
通讯作者：
Stein, Dan J.
中科院分区：
文献类型：
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作者：
Zar, Heather J.;Pellowski, Jennifer A.;Stein, Dan J.
背景母亲怀孕期间的身心健康是出生结果的关键决定因素。将低收入和中等收入国家孕产妇身心健康指标与出生结果相结合的前瞻性数据相对较少。我们的目的是在一项非洲出生队列研究（Drakenstein 儿童健康研究）中调查怀孕期间的孕产妇健康及其对出生结果的影响。方法在南非贫困城郊地区的 Mbekweni（主要为非洲黑人人口服务）和 TC Newman（主要为混血血统）这 2 个公共卫生诊所就诊的孕妇在妊娠中期入组，并跟踪分娩过程。所有分娩均在一家公立医院进行。对母亲的社会人口统计、身体和心理社会特征进行了全面评估。使用多变量线性回归模型探讨孕产妇健康与出生结果之间的关联。结果在 3 年多的时间里，1137 名妇女（中位年龄 25.8 岁；21% 感染艾滋病毒）生下了 1143 名活产婴儿。大多数妊娠没有并发症，但少数发生妊娠糖尿病（1%）、贫血（22%）或先兆子痫（2%）。大多数家庭（87%）的月收入低于 350 美元；只有 27% 的妈妈有工作，粮食不安全很常见 (37%)。大多数婴儿（80%）是足月通过阴道分娩出生的； 17% 为早产，主要是晚期早产。只有 74 名（7%）婴儿出生后需要立即住院治疗，并且只有 2 名婴儿感染了艾滋病毒。粮食不安全、社会经济状况、妊娠相关高血压、先兆子痫、妊娠糖尿病和混合血统与婴儿胎龄较低相关，而入组时母亲体重指数与婴儿胎龄较高相关。初产妇或怀孕期间饮酒与婴儿出生体重和头围呈负相关。母亲入组时的BMI与出生体重呈正相关，妊娠糖尿病与出生体重和胎龄头围呈正相关。怀孕期间吸烟与较低的婴儿出生体重有关。 结论 一些可改变的危险因素，包括怀孕期间的食品不安全、吸烟和饮酒，被认为与不良出生结果相关，所有这些因素都可以通过公共卫生干预措施来解决。需要采取干预措施来解决影响出生结果的关键暴露问题，以改善中低收入国家的孕产妇和儿童健康。
BackgroundMaternal physical and mental health during pregnancy are key determinants of birth outcomes. There are relatively few prospective data that integrate physical and mental maternal health measures with birth outcomes in low- and middle-income country settings. We aimed to investigate maternal health during pregnancy and the impact on birth outcomes in an African birth cohort study, the Drakenstein Child Health Study.MethodsPregnant women attending 2 public health clinics, Mbekweni (serving a predominantly black African population) and TC Newman (predominantly mixed ancestry) in a poor peri-urban area of South Africa were enrolled in their second trimester and followed through childbirth. All births occurred at a single public hospital. Maternal sociodemographic, physical and psychosocial characteristics were comprehensively assessed. Multivariable linear regression models were used to explore associations between maternal health and birth outcomes.ResultsOver 3 years, 1137 women (median age 25.8 years; 21% HIV-infected) gave birth to 1143 live babies. Most pregnancies were uncomplicated but gestational diabetes (1%), anaemia (22%) or pre-eclampsia (2%) occurred in a minority. Most households (87%) had a monthly income of less than USD 350; only 27% of moms were employed and food insecurity was common (37%). Most babies (80%) were born by vaginal delivery at full term; 17% were preterm, predominantly late preterm. Only 74 (7%) of babies required hospitalisation immediately after birth and only 2 babies were HIV-infected. Food insecurity, socioeconomic status, pregnancy-associated hypertension, pre-eclampsia, gestational diabetes and mixed ancestry were associated with lower infant gestational age while maternal BMI at enrolment was associated with higher infant gestational age. Primigravida or alcohol use during pregnancy were negatively associated with infant birth weight and head circumference. Maternal BMI at enrolment was positively associated with birth weight and gestational diabetes was positively associated with birth weight and head circumference for gestational age. Smoking during pregnancy was associated with lower infant birth weight.ConclusionSeveral modifiable risk factors including food insecurity, smoking, and alcohol consumption during pregnancy were identified as associated with negative birth outcomes, all of which are amenable to public health interventions. Interventions to address key exposures influencing birth outcomes are needed to improve maternal and child health in low-middle income country settings.