Facilitators and Barriers to Health Promoting Practices During Pregnancy

描述（由申请人提供）：许多因素影响孕妇及其胎儿的健康，并最终可能影响婴儿的结局。积极的健康做法是指妇女在怀孕期间为优化孕产妇和胎儿健康而采取的行为；然而，是什么影响了妇女在怀孕期间保持这些做法还不完全清楚。提出的描述性、纵向混合方法研究旨在加强我们对包括母胎依恋（MFA）和母亲身体和情绪健康在内的因素如何影响怀孕期间健康实践的理解，这些因素对健康结果不良的风险较高。早产、低出生体重和其他不良后果方面的许多健康差异都与面临恶劣社会、经济和健康条件的种族和族裔群体有关。此外，这些弱势群体在怀孕期间和产后身体健康状况不佳（肥胖、妊娠糖尿病和先兆子痫）和精神健康状况不佳（抑郁、创伤后应激障碍[PTSD]）的风险增加。将进行一项描述性、纵向混合方法研究，在妊娠24-28周期间收集定量数据，一组非洲裔美国妇女将参加同时进行的定性访谈，这将加强我们对少数民族妇女在怀孕期间倾向于采取积极保健做法的影响因素的理解。增加MFA已显示增加怀孕期间的保健做法；然而，有限的研究主要集中在已婚白人女性身上。了解MFA水平对那些母婴预后不良风险较高的妇女的影响，以及妇女的健康状况如何影响MFA是至关重要的。具体目标是：1 .检查产妇特征和产妇身心健康对怀孕期间保健做法和婴儿健康结果的影响；2 .分析产妇特征和产妇身心健康对产妇特征和产妇身心健康的影响；3 .分析产妇特征、产妇身心健康和产妇特征对怀孕期间保健做法和婴儿健康结果的影响；4 .分析产妇特征和产妇身心健康对怀孕期间保健做法和婴儿健康结果的影响；探讨妇女对MFA的看法，包括促进或阻碍依恋的因素以及怀孕期间的保健做法。作为致力于为公众服务的保健专业人员，我们必须关注并致力于消除种族和族裔群体之间存在的怀孕结果差异。为实现这一目标，至关重要的是要确定差异存在的地方，改进护理最能改善妊娠结局的地方，以及个人生活方式的改变最能与改善的医疗保健相互作用，以优化妊娠和婴儿结局。

Description (provided by applicant): Many factors influence the health of pregnant women and their fetuses and, ultimately, may affect infant outcomes. Positive health practices are those behaviors a woman engages in while pregnant to optimize maternal and fetal health; however, what influences a woman to maintain these practices during pregnancy is not fully understood. The proposed descriptive, longitudinal mixed methods study seeks to enhance our understanding of how factors including maternal-fetal attachment (MFA), and maternal physical and emotional health impact health practices in pregnancy in a population at higher risk for poor health outcomes. Many of the health disparities in preterm delivery, low birth weight and other poor outcomes are associated with those racial and ethnic groups exposed to poor social, economic and health conditions. Furthermore, these vulnerable populations are at increased risk of poor physical health (obesity, gestational diabetes, and preeclampsia) and poor mental health (depression, post-traumatic stress disorder [PTSD]) during pregnancy, and in the post-partum period. A descriptive, longitudinal mixed methods study will be conducted with quantitative data collected between 24-28 weeks gestation and a sub-group of African-American women will participate in concurrent qualitative interviews which will enhance our understanding, in ethnic minorities, of what influences a woman's inclination to engage in positive health practices during pregnancy. Increased MFA has shown to increase health practices during pregnancy; however, the limited research has largely focused on married White women. It is critical to understand the implications of MFA levels in those women at higher risk for poor maternal-fetal and infant outcomes, and how a woman's health status influences MFA. Specific aims are: 1: to examine the impact of MFA on health practices during pregnancy and infant health outcomes, 2: to analyze the influence of maternal characteristics and maternal physical and emotional health on MFA, 3: to analyze the influence of maternal characteristics, maternal physical and emotional health, and MFA on health practices during pregnancy and infant outcomes, and 4: to explore women's perceptions of MFA including factors which foster or discourage attachment as well as health practices during pregnancy. As health care professionals committed to serving the public, we must be concerned and devoted to eliminating the well-documented disparities in pregnancy outcomes which exist between racial and ethnic groups. To achieve this, it is critical to identify where the disparities exist, where improvements in nursing can most improve pregnancy outcomes, and where individual life style changes can best interact with improved health care to optimize both pregnancy and infant outcomes.