Adverse perinatal outcomes associated with homelessness and substance use in pregnancy
Adverse perinatal outcomes associated with homelessness and substance use in pregnancy
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DOI：
10.1503/cmaj.050406
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发表时间：
2005-09-13
影响因子：
14.6
通讯作者：
Ray, JG
中科院分区：
文献类型：
--
作者：
Little, M;Shah, R;Ray, JG
背景资料：怀孕期间无家可归的妇女可能面临营养不良、暴力和药物使用的风险，但其新生儿的健康状况尚未得到系统的评估。我们进行了一项研究，以提供加拿大妇女谁是无家可归或边缘居住在怀孕期间，以及伴随物质使用的影响围产期不良后果的风险的初步估计。方法：我们从2002年10月至2004年12月在市中心的一家医院进行了一项回顾性队列研究，涉及怀孕期间无家可归或住房不足的妇女（n= 80），物质使用者（n= 59）或两者都没有（n= 3756）。我们注意到新生儿的措施，如出生体重和胎龄;主要的研究结果是早产前37周的妊娠，出生体重小于2000 g和小于胎龄的出生。无家可归或住房不足与比值比相关（根据母亲年龄、妊娠和目前吸烟者调整）为2.9（95%置信区间[ CI] 1.4 - 6.1）早产，6.9（95% CI 2.4- 20.0）婴儿出生体重低于2000 g和3.3（95% CI 1.1 - 10.3）新生儿小于胎龄分娩。调整后的优势比，在怀孕期间使用的物质是相似的。在住房不足或无家可归的状态和母亲使用药物的组合存在下，调整后的风险估计值为5.9（95% CI 1.9 - 18.5），16.6（95% CI 3.5 - 79.3）和5.6（95%CI 1.1 - 28.7）。解释：无家可归和母亲使用物质可能会通过早产和低出生体重降低新生儿的幸福感。
Background: Women who are homeless during pregnancy may be exposed to poor nutrition, violence and substance use, yet the health status of their newborn infants has not been systematically evaluated. We undertook a study to provide preliminary estimates of the risk of adverse perinatal outcomes among Canadian women who are homeless or marginally housed during pregnancy, and the effect of concomitant substance use.Methods: We conducted a retrospective cohort study at a single downtown hospital from October 2002 to December 2004, involving women who, during pregnancy, were homeless or underhoused ( n= 80), substance users ( n= 59) or neither ( n= 3756). We noted neonatal measures such as birth weight and gestational age; the main study outcomes were preterm birth before 37 weeks' gestation, birth weight less than 2000 g and small for gestational age at birth.Results: Homelessness or inadequate housing was associated with an odds ratio ( adjusted for maternal age, gravidity and being a current smoker of tobacco) of 2.9 ( 95% confidence interval [ CI] 1.4 - 6.1) for preterm delivery, 6.9 ( 95% CI 2.4- 20.0) for infant birth weight under 2000 g and 3.3 ( 95% CI 1.1 - 10.3) for delivery of a newborn small for gestational age. Adjusted odds ratios for substance use during pregnancy were similar. In the combined presence of an underhoused or homeless state and maternal substance use, the adjusted risk estimates were 5.9 ( 95% CI 1.9 - 18.5), 16.6 ( 95% CI 3.5 - 79.3) and 5.6 ( 95% CI 1.1 - 28.7), respectively.Interpretation: Homelessness and maternal substance use may reduce neonatal well- being through prematurity and low birth weight.