Maternal Mental and Physical Health Outcomes after Stillbirth and Infant Death

描述(申请人提供)：这项研究的目标是改善死产和婴儿死亡后失去亲人的母亲的心理保健和结局。在美国，每100名活产婴儿中，就有1-2名母亲怀孕并伴有死产或婴儿死亡，非裔美国母亲面临的风险尤其高。这些毁灭性的事件是典型的创伤和改变生活的经历，使幸存的父母在接下来的几年里面临长期悲伤和精神并发症的高风险。关于围产期损失对幸存母亲的长期心理健康影响，人们知之甚少。此外，虽然超过70%的丧偶母亲在死产后一年内再次怀孕，但尚不清楚丧亲造成的心理健康变化如何影响随后的产前健康行为或失去亲人后的妊娠结局。这项拟议的研究既利用了纵向数据分析，也利用了对丧亲和非丧亲母亲的多年邮寄调查。研究A将胎儿或婴儿死亡后10年的孕产妇和胎儿/婴儿健康数据联系起来，以检查精神和身体健康障碍、随后几年的医疗保健成本和利用情况，以及新发产妇精神疾病的风险。研究B将对失去亲人的母亲和未失去亲人的对照组进行纵向调查，以收集有关精神健康和随时间推移的治疗、身体健康、悲伤和丧亲、失去亲人时的医院护理以及后续怀孕期间的生殖健康和健康行为的信息。 与公共卫生相关：虽然胎儿/婴儿死亡并不常见，但每100名母亲中仍有一名以上会受到影响，并可能对失去亲人的母亲产生深远影响，还可能影响她们以后怀孕的结果。这项研究的结果可能有助于确定创伤死亡后精神疾病风险最高的人群，衡量医院护理对产妇精神发病率的影响，量化失去创伤后数年的产妇保健经济成本，并改善后续怀孕的胎儿结局。

DESCRIPTION (provided by applicant): The goal of this research is to improve mental health care and outcomes of bereaved mothers after stillbirth and infant death. For every 100 live births in the United States, 1-2 mothers have a pregnancy complicated by a stillbirth or infant death, and African-American mothers are at particularly high risk. These devastating events are typically traumatic and life-altering experiences which put surviving parents at high risk for prolonged grief and psychiatric complications in the subsequent years. Little is known about the long-term mental health impact of perinatal loss on surviving mothers. In addition, while more than 70% of bereaved mothers are pregnant again within a year after a stillbirth, it is not known how mental health changes due to bereavement affect subsequent prenatal health behaviors or pregnancy outcomes after the loss. The proposed research utilizes both a longitudinal data analysis and a multi-year mail survey of bereaved and non-bereaved mothers. Study A links maternal and fetal/infant health datasets over 10 years following fetal or infant death to examine mental and physical health disorders, health care costs and utilization in subsequent years, and risk of new onset maternal mental illness. Study B will survey bereaved mothers and non-bereaved controls longitudinally to gather information about mental health and treatment over time, physical health, grief and bereavement, hospital care at the time of loss, and reproductive health and health behaviors during subsequent pregnancies. PUBLIC HEALTH RELEVANCE: While fetal/infant death is uncommon, it still affects more than one mother out of 100 and can profoundly impact bereaved mothers and may impact the outcomes of their subsequent pregnancies as well. Findings from this research may potentially help to identify populations of women at highest risk for mental illness after a traumatic loss, measure the impact of hospital care on maternal psychiatric morbidity, quantify the economic costs of maternal health care in the years following a loss, and improve fetal outcomes in subsequent pregnancies.