Psychosocial stress and its relation to maternal and infant outcomes among women with disabilities

残疾妇女的心理社会压力及其与母婴结局的关系

• 批准号: 10616481
• 负责人: JEANNE L ALHUSEN
• 金额: $ 36.79万
• 依托单位: UNIVERSITY OF VIRGINIA
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-04-01 至 2026-03-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10616481
• 关键词: Access to Information; Address; Admission activity; Affect; Attitude; Birth; Caring; Critical Care; Data; Development; Disabled Persons; Disparity; Domestic Violence; Evaluation; Evidence based intervention; Female of child bearing age; Focus Groups; Foundations; Future; Goals; Health; Health Personnel; Health Promotion; Healthcare; Healthcare Systems; Incidence; Individual; Infant; Intervention; Interview; Knowledge; Low Birth Weight Infant; Mediating; Mental Depression; Mental disorders; Methods; Mood Disorders; Morbidity - disease rate; Mothers; Neonatal Intensive Care Units; Nurse Midwives; Nurses; Outcome; Perinatal; Perinatal Care; Phase; Physicians; Policies; Predictive Factor; Pregnancy; Pregnancy Outcome; Pregnant Women; Premature Birth; Prenatal care; Provider; Psychosocial Stress; Recommendation; Reporting; Research; Research Personnel; Resources; Risk; Risk Assessment; Risk Factors; Role; Sampling; System; Testing; Tobacco; Underserved Population; Violence; Woman; Women' s Group; adverse birth outcomes; adverse pregnancy outcome; barrier to care; clinical practice; contextual factors; depressive symptoms; design; disability; disparity reduction; ethnic diversity; experience; illicit drug use; improved; infant outcome; intimate partner violence; maternal outcome; mortality; perinatal health; perinatal outcomes; perinatal period; population based; pregnant; preventive intervention; protective factors; racial diversity; risk mitigation; sociodemographics; substance use; symptomatology; unintended pregnancy; violence prevention; women with disabilities

Women with disabilities are increasingly becoming pregnant, and may be as likely to become pregnant as women without disabilities. Growing research suggests pregnancy in women with disability is associated with an increased risk for adverse perinatal outcomes. Although a few studies have examined disability-related disparities in adverse birth outcomes, finding increased risk of low birthweight, preterm birth, and neonatal intensive care unit admission, the mechanisms for these associations are not well understood. One plausible mechanism is the increased risk of psychosocial stress experienced by women with disabilities in the perinatal period. Women with disabilities are at heightened risk for intimate partner violence (IPV) and mood disorders, yet the extent to which these risks affect pregnancy outcomes has not been studied. A more comprehensive understanding of psychosocial stress, namely IPV and depressive symptomatology, and its relation to adverse birth outcomes is critically needed to reduce morbidity and mortality rates among disabled mothers and their infants, reduce disparities in perinatal care between women with and without disabilities, inform the design of effective evidence-based interventions for this understudied and underserved population of women, and generate recommendations for clinical practice and policy change. To address this gap, we propose to systematically examine the association between psychosocial stress and adverse birth outcomes. Using a mixed method approach, we will: 1) examine the association between psychosocial stress (i.e., perinatal IPV and depressive symptomatology) and adverse birth outcomes (i.e., low birthweight, preterm birth) by analyzing data from PRAMS Phase 9 across women with and without disabilities; 2) explore the experiences and barriers to comprehensive perinatal care through individual interviews with ethnically and racially diverse pregnant and new mothers with diverse disabilities; and 3) explore facilitators and barriers (e.g., disability-related knowledge, attitudes, and pregnancy care experience) to the provision of comprehensive perinatal health care to women with disabilities through focus groups and individual in-depth interviews with health care providers who care for pregnant women with disabilities with the goal of improving perinatal care for this underserved group of women. This research will also serve as the foundation for the development and evaluation of future prevention interventions, including our own team’s planned submission to adapt, tailor, and test existing successful health promotion interventions to prevent violence and its related sequelae among women with disability, thereby optimizing pregnancy outcomes for women of childbearing age living with disability.

越来越多的残疾妇女怀孕，她们怀孕的可能性可能与残疾妇女一样大。 没有残疾的妇女。越来越多的研究表明，残疾妇女怀孕与以下因素有关： 围产期不良结局的风险增加。虽然有一些研究已经检查了与残疾有关的 不良出生结局的差异，发现低出生体重、早产和新生儿 尽管在重症监护室入院时，这些关联的机制还不太清楚。一个貌似有理 这一机制是残疾妇女在围产期经历心理社会压力的风险增加 期残疾妇女遭受亲密伴侣暴力和情绪障碍的风险更高， 然而，这些风险对怀孕结果的影响程度尚未得到研究。更全面 了解心理社会压力，即IPV和抑郁症，及其与不良反应的关系， 降低残疾母亲的发病率和死亡率， 减少残疾妇女和非残疾妇女在围产期护理方面的差距， 对这一研究不足和服务不足的妇女群体采取有效的循证干预措施， 为临床实践和政策变化提供建议。为了弥补这一差距，我们建议 系统地研究心理社会压力和不良生育结果之间的关系。使用 混合方法的方法，我们将：1）检查心理社会压力之间的关联（即，围产期IPV 和抑郁症）和不利的出生结果（即，低出生体重，早产）， 来自PRAMS第9阶段的残疾和非残疾妇女数据; 2）探索经验和障碍 通过对不同族裔和种族的孕妇和孕妇进行个别访谈， 有各种残疾的新母亲;和3）探索促进者和障碍（例如，残疾相关知识， 对向妇女提供全面围产期保健的态度和孕期保健经验 通过焦点小组和与照顾残疾人的卫生保健提供者进行的个人深入访谈， 残疾孕妇，目标是改善这一服务不足群体的围产期护理， 妇女这项研究也将作为今后预防工作的发展和评价的基础 干预措施，包括我们自己的团队计划提交，以适应，定制和测试现有的成功的健康 采取促进干预措施，防止残疾妇女遭受暴力及其相关后遗症， 优化育龄残疾妇女的妊娠结局。