Marital status: association with social and economic circumstances, psychological state and outcomes of pregnancy.

We examined the association of marital status with economic, social and psychological factors and with the outcomes of pregnancy (defined as onset of labour, type of delivery, live and still births and birthweight). The study population was 1431 white women consecutively booking for antenatal care. Birth registrations were inspected. Of 278 women who were unmarried during pregnancy, 61 per cent were cohabiting, 26 per cent were living with adults other than the father and 13 per cent were living alone. Compared with the married women, unmarried women overall were, on average, younger, less educated, of lower social class, in poorer economic circumstances, more dependent on state support and less satisfied with their living arrangements. Irrespective of age and social class, they were less likely to have planned the pregnancy, more likely to smoke and drink, to book later for antenatal care and to miss more appointments. In general, unmarried women were more likely to have some indication of depression and to experience more serious life events during the pregnancy. Controlling for age and social class, the categories 'married', 'cohabiting' and 'on their own' showed significant trends from best to worst. Those living with adults other than the father showed intermediate results. There were no significant effects of marital status, controlled for age and social class, and associated social, economic and psychological circumstances on outcomes of pregnancy. Forty-one per cent of births to women on their own, 35 per cent to women living with other adults and 11 per cent to women cohabiting during pregnancy were registered by only one parent.(ABSTRACT TRUNCATED AT 250 WORDS)     

Psychosocial resources and persistent smoking in early pregnancy--a population study of women in their first pregnancy in Sweden.

STUDY OBJECTIVE: To test the stress hypothesis by characterising women during their first pregnancy who continue to smoke in early pregnancy in comparison with women who quit smoking, with special reference to psychosocial factors like social network, social support, demands, and control in work and daily life. DESIGN: The study is based on a cohort of primigravidas followed during pregnancy. Data were collected by self administered questionnaires during the pregnant womens' first antenatal visit at about 12 weeks. SETTING: The study was performed in the antenatal clinics in the city of Malmö, Sweden. PARTICIPANTS: The participants were all primigravidas living in the city of Malmö, Sweden, over a one year period, 1991-92. A total of 872 (87.7%) of the 994 invited women agreed to participate. The population of this study on smoking includes all primigravidas who at the time of conception were smoking (n = 404, 46.3%). MAIN RESULTS: At the first antenatal visit (63.6% (n = 257) of the prepregnancy smokers were still smoking (a total smoking prevalence of 29.5%). The pregnant smokers were on average younger and had a lower educational level. The highest relative risk (RR) of continued smoking was found among unmarried women RR 2.7 (95% confidence interval) (1.5, 4.8), women having unplanned pregnancies RR 2.2 (1.2, 4.0) and those with a low social participation RR 1.6 (1.0, 2.7), low instrumental support RR 2.6 (1.2, 6.0), low support from the child's father RR 2.1 (1.0, 4.2) and those exposed to job strain RR = 2.3 (1.1, 4.8). The associations were independent of potential confounders such as age, educational level, nationality, cohabiting status, passive smoking, and previous years of smoking. CONCLUSIONS: This study supports the stress hypothesis. Smoking can be one way women handle stress when demands become too great. In order to reduce smoking among pregnant women, maternity centre resources need to be focused more on women with low psychosocial resources who are at highest risk for continued smoking. It is also important to involve actively the woman's partner or other important people in the woman's social network.     

The effects of racial density and income incongruity on pregnancy outcomes

This study shows that living in a better area reduces the risk of adverse pregnancy outcomes but, among African-American women, living in an area in which they are in a racial minority may increase the risk. Using the 1991 cohort of single infants born to African-American women in Chicago, we measured census tract socioeconomic status and defined women as having "positive income incongruity" if they lived in wealthier tracts than the average African-American woman of comparable education and marital status. We examined whether or not the effect of positive income incongruity differed according to whether or not African-American women lived in predominantly black, or mixed tracts. Among the women living in predominantly black census tracts, positive income incongruity was associated with a lower risk of low birth weight (odds ratio (OR)=0.91) and preterm delivery (OR=0.83). These effects were modest, but statistically significant for gestation (p-value=0.01). In contrast, among the women living in mixed tracts positive income incongruity was not associated with low birth weight (OR=1.04) or preterm delivery (OR=1.11). In mixed areas the expected benefits of positive income incongruity are completely offset by the racial density effect, suggesting that the positive effects of a better socioeconomic context may be countered for minority women by the adverse effects of racism or racial stigma.     

Infant health consequences of childbearing by teenagers and older mothers

The association of childbearing at early and late ages with various adverse outcomes of pregnancy was explored in data collected in the 1980 National Natality and Fetal Mortality Surveys. The characteristics of interest for teenage mothers were marital status at conception and the trimester of pregnancy in which prenatal care was begun. For married mothers aged 30 years and older, the variables considered were employment status and occupation during the year preceding childbirth and smoking status before and during pregnancy. The pregnancy outcome variables analyzed were the same for both groups of mothers: fetal loss, low birth weight, and low 1-minute Apgar scores. Although more than half of all births to teenage mothers were to unmarried women, an additional one-quarter of these births were to women who married between the time of conception and the birth of the child. Generally there was little difference in outcomes for teenage mothers who were married at the time of delivery, regardless of their marital status at the time of conception. Pregnancy outcomes for teenagers who did not marry prior to delivery were considerably less favorable. Nearly 90 percent of women aged 30-34 years who had a first birth in 1980 were employed during the year before delivery, an extraordinarily high labor force participation rate. More than half of these employed mothers were in professional occupations, consistent with their very high levels of educational attainment. Although the analysis is limited by the small numbers of births involved, it appears that professionally employed women generally have the best pregnancy outcomes. When mother's smoking status is taken into account,nonsmokers had more favorable outcomes, with births to professionally employed mothers generally most favored.     

Unmarried mothers as a high-risk group for adverse pregnancy outcomes

A total of 36,608 singleton births occurring to Black mothers in the District of Columbia in 1980–84 were examined. Infants of unmarried mothers had a 34 percent higher incidence of low birthweight and a 35 percent higher neonatal mortality rate than infants born to married mothers. To delineate the independent effect of marital status, a logit model was fit to 23,461 births occurring to mothers over 19 years of age. Despite controlling on maternal age, educational attainment and adequacy of prenatal care, the odds ratio for low birthweight was 1.18 for the infants of unmarried mothers. Supplemental analyses showed that if mothers were drug addicted or had their first delivery before age 18, the marital status differentials in the birthweights of their infants were no longer significant. These results indicate the importance of unmarried status as a demographic risk factor, and the need for discerning specific high-risk behaviors associated with life styles of unmarried mothers.Feroz Ahmed, PhD is Senior Research Associate, Institute for Urban Affairs and Research, Howard University.     

Adolescents' pregnancy intentions: relations to life situations and caretaking behaviors prenatally and 2 years postpartum.

PURPOSE: This study explores if and how adolescents' pregnancy intentions relate to life situations and health-related behaviors prenatally and up to 2 years postpartum. METHODS: Adolescent girls who reported that they had "wanted a baby" (n = 75) as their reason for pregnancy were compared with those who reported that the pregnancy "just happened" (n = 79) at four separate time periods: prenatally, at 6 and 24 months postpartum, and at 18 months postpartum for teens who became pregnant again subsequent to the study pregnancy. RESULTS: Those who stated that they wanted a baby were more likely to be Hispanic, married, and out of school before becoming pregnant. They were less likely to receive welfare as their primary means of support and to have run away from home in the past than teens who stated that their pregnancy just happened. Self-reported reason for pregnancy was unrelated to repeat pregnancy by 18 months postpartum, but those who had wanted the study baby were less likely to undergo elective termination of a subsequent pregnancy and less likely to become pregnant by a different partner. The groups diverged at 24 months postpartum when those who wanted a baby were more likely to be married to the father of the baby, be financially supported by him, receive child care assistance from him, and have attempted or succeeded at breastfeeding the study child. CONCLUSION: Self-reported reason for pregnancy reveals many important characteristics of pregnant adolescents both at the time of presentation and up to 2 years postpartum. Young women in this study who reported intentional pregnancy seem to fare better with regard to their financial status and their relationship with the father of the baby.     

Risk of preterm delivery and hypertensive disorders of pregnancy in relation to maternal co-morbid mood and migraine disorders during pregnancy

We evaluated the risks of preterm delivery and hypertensive disorders of pregnancy among pregnant women with mood and migraine disorders, using a cohort study of 3432 pregnant women. Maternal pre-pregnancy or early pregnancy (<20 weeks gestation) mood disorder and pre-pregnancy migraine diagnoses were ascertained from interview and medical record review. We fitted generalised linear models to derive risk ratios (RR) and 95% confidence intervals (CI) of preterm delivery and hypertensive disorders of pregnancy for women with isolated mood, isolated migraine and co-morbid mood-migraine disorders, respectively. Reported RR were adjusted for maternal age, race/ethnicity, marital status, parity, smoking status, chronic hypertension or pre-existing diabetes mellitus, and pre-pregnancy body mass index. Women without mood or migraine disorders were defined as the reference group. The risks for preterm delivery and hypertensive disorders of pregnancy were more consistently elevated among women with co-morbid mood-migraine disorders than among women with isolated mood or migraine disorder. Women with co-morbid disorders were almost twice as likely to deliver preterm (adjusted RR=1.87, 95% CI 1.05, 3.34) compared with the reference group. There was no clear evidence of increased risks of preterm delivery and its subtypes with isolated migraine disorder. Women with mood disorder had elevated risks of pre-eclampsia (adjusted RR=3.57, 95% CI 1.83, 6.99). Our results suggest an association between isolated migraine disorder and pregnancy-induced hypertension (adjusted RR=1.42, 95% CI 1.00, 2.01). This is the first study examining perinatal outcomes in women with co-morbid mood-migraine disorders. Pregnant women with a history of migraine may benefit from screening for depression during prenatal care and vigilant monitoring, especially for women with co-morbid mood and migraine disorders.     

未婚流产女青年对医疗保健服务满意度与需求现况分析

目的:了解未婚人工流产女青年对医疗机构服务的满意度和服务需求,为探索青少年友好服务相关措施提供依据。方法:采用匿名问卷调查形式对在医院计划生育门诊接受人工流产手术的未婚女青年1 225例进行调查。结果:①服务满意度:对服务人员的满意度比对候诊时间和就诊环境高,达60%;20岁以下者对就诊环境满意度(45.60%)比20～24岁满意度(50.00%)低,20～24岁组对候诊时间的满意度(37.40%)比20岁以下的(45.60%)低;9.0%未婚人工流产女青年认为医务人员对其存在歧视或者态度冷淡。②需求:对性生殖健康知识最希望了解的前三位为:怀孕与避孕、性生理保健及人工流产后保健;③服务:对于流产希望获得的相关服务主要为人工流产后保健指导、避孕指导、心理咨询指导等;对服务的希望是获得保护隐私(65.96%),性保健知识宣教(36.49%),工作人员友好(35.27%)等。结论:未婚女青年对目前人工流产服务的环境、候诊时间的满意度相对较低,对接受人工流产的相关服务内涵及要求相对较高,提示需要建立满足青春期性生殖保健的友好服务模式。     

Changing paternity and the risk of preterm delivery in the subsequent pregnancy

I studied whether changing a partner, and thus changing the likelihood of human leukocyte antigen (HLA) sharing between mating partners, affects the risk of preterm delivery in the subsequent pregnancy. I identified a total of 128,239 women who had two consecutive births during 1989-1991 through data linkage of the California birth certificates. Paternal date of birth and names on the records of the two consecutive births were compared to determine whether the same father was reported on both records. Three cohorts of women were formed on the basis of the gestational age of their first delivery: <34, 34-36, and >36 weeks. If parental HLA sharing is associated with preterm delivery, the likelihood of HLA sharing was expected to be in a decreasing order from most likely among a <34-week cohort to least likely among a >36-week cohort. Among women in the <34-week cohort, changing partners resulted in a 33% reduction in the risk of early preterm delivery in the subsequent pregnancy compared with those who did not change partners [95% confidence interval (CI), 0.52-0.88]. In contrast, among women in the >36-week cohort, changing partners led to a 16% increase in the risk of early preterm delivery in the subsequent pregnancy (95% CI = 1.04-1.30). Among women in the 34-36-week cohort, changing partners did not affect the risk of preterm delivery (95% CI = 0.78-1.25). These estimates were adjusted for maternal race/ethnicity, age, educational level, prenatal smoking, prenatal care, parity, and interval from birth to conception of the subsequent pregnancy. The findings from this study suggest that the effect of changing paternity depends on the pregnancy outcome with the previous partner and support the hypothesis that parental HLA sharing may be related to preterm delivery.     

未婚早期人工流产女性的心理状况调查研究

目的:调查未婚早期人工流产女性的心理状况,探讨未婚女性心理护理方法。方法:对1 045例未婚人工流产女性在术前1 h进行SCL-90症状自评量表调查,分析不同地区、民族、学历、人工流产次数和手术方式的心理状况的差异。结果:不同地区和手术方式的未婚人工流产女性的心理状况差异无统计学意义(P>0.05),不同民族、学历和人工流产次数其心理状况不同(P<0.05)。结论:未婚人工流产女性普遍存在心理问题,需重视其心理状况;同时应针对民族、学历和人工流产次数不同进行有侧重的心理护理。     

The association of change in maternal marital status between births and adverse pregnancy outcomes in the second birth

The relationships between change in marital status between two consecutive births and adverse pregnancy outcomes at the second birth were investigated using linked Washington State 1980–93 white singleton birth certificates. Women who were married at the first birth had lower low birthweight (LBW) and small-size-for-gestational-age (SGA) rates at that birth than single women, and women married at the second birth had lower LBW, SGA and preterm delivery rates at that birth, regardless of marital status at the first birth. Adjusted relative risks (RR) of LBW and SGA were significantly increased for initially married women who were single at the second birth compared with those who remained married (RR equals; 1.4 and 1.3, respectively). Risks of LBW and SGA were significantly decreased among initially single women who married by the second birth, compared with those remaining single (RR equals; 0.7 for LBW and 0.8 for SGA). We conclude that the largely unstudied subgroup of previously married women is at increased risk for adverse pregnancy outcomes. Public health policy and programmes directed at high-risk mothers and infants should be aware of the specific physical and emotional needs of this group of child-bearing women.     

Factors associated with unintended pregnancy

This research was designed to identify determinants of unintendedpregnancy among women attending family practice or family planning clinics.Survey data were collected from 95 women who were categorized according towhether or not they had experienced an unintended pregnancy. Women reportingunintended pregnancy were younger, reported earlier sexual debut and agreater number of sexual partners than those not having experienced anunintended pregnancy. Those who had avoided unintended pregnancy displayedhigher levels of preventive sexual self-efficacy, had more confidence intheir ability to use contraceptive methods, perceived more negativeconsequences associated with having children in the near future, andbelieved pregnancy among unmarried women to be less acceptable than didwomen who had had unintended pregnancies.     

不同特征女性人工流产时焦虑、抑郁情绪及影响因素

目的:研究不同特征女性人工流产时焦虑、抑郁情绪评估及影响因素。方法:以2019年1-7月在本院择期行人工流产者105例,其中已婚54例、未婚51例,手术流产62例、药物流产43例。采用焦虑自评量表(SAS)和抑郁自评量表(SDS)评价并比较不同特征者人工流产前焦虑及抑郁程度,多因素logistic分析可能影响因素。结果:不同婚姻状态、文化程度、孕次、产次、流产方式者发生术前焦虑及抑郁程度存在差异(P<0.05),不同年龄、流产次数者术前焦虑及抑郁程度评分未见差异(P>0.05);未婚及手术流产者术前焦虑及抑郁情况最高(P<0.05)。多因素分析,流产妇女婚姻状态、文化程度、产次、孕次以及流产方式均为产生术前焦虑情绪的独立危险因素。结论:未婚及手术流产者流产前负面情绪较高,提示临床在行人工流产中,及时开展健康教育,做好咨询工作,降低流产妇女的负面情绪,提升生殖健康质量。     

广州市未婚流动人口人工流产状况及影响因素分析

目的:了解广州市未婚流动人口人工流产状况及其影响因素。方法:采用随机整群抽样方法进行抽样,应用统一的“外来务工未婚女性生殖健康需求与服务调查问卷”,对调查对象进行现场问卷调查。结果:共调查1872名未婚女性流动人口,有过婚前性行为者233名,发生率为12.4%。69人至少有过1次人工流产,人工流产率为29·9%。在实施过人工流产的人群中,32人(46.3%)的妊娠月份超过2个月,21人(30.4%)选择在家中或私人诊所实施手术。人工流产的发生与调查对象的文化程度、收入情况,对人工流产危害的认识,避孕情况及其了解避孕方法的种类有关。结论:未婚流动人口人工流产的发生率较高,与其认知水平和避孕行为密切相关,为流动人口提供及时有效的生殖健康教育和服务将有助于提高其生殖健康认知水平和行为能力,降低人工流产率及其危害。     

未婚人工流产女性非意愿妊娠情况及影响因素研究

目的:了解上海市未婚女性非意愿妊娠状况,探讨非意愿妊娠的影响因素。方法:采用现况研究的方法,应用计算机辅助自填问卷技术,于2009年10月～2010年5月对在上海市3家医院计划生育门诊寻求人工流产的未婚女性进行匿名调查。结果:44.34%被调查者发生过≥2次非意愿妊娠(396/893),其中发生过2次者占71.97%(285/396),发生过3次者占22.47%(89人)。多因素分析显示,在调整了其它可能的影响因素后,年龄大(OR=1.61,95%CI:1.45～1.78)、首次性行为年龄小(OR=0.65,95%CI:0.59～0.71)和未婚同居(OR=1.65,95%CI:1.25～2.19)的未婚女性发生多次非意愿妊娠的危险高;发生多次非意愿妊娠与多性伴(OR=1.38,95%CI:1.00～1.90)有关。结论:未婚流产女性发生多次非意愿妊娠比例高,应加强首次性行为年龄小、多性伴和未婚同居女性的安全性行为教育和流产后服务。