Physiological, Psychosocial, Behavioral, Socio-demographic Risk Factors and Antepartum Bed Rest Associated with Gestational Age at Birth and Postpartum Depression in High Risk Pregnant Women

Preterm birth is the leading cause of perinatal mortality and morbidity in the United States (US). Nearly 75% of infant mortality in the US is associated with preterm birth. In New York State, 12.2% of births in 2009 were preterm and 8.2% were low birth weight. Women with preterm infants also have a higher rate of postpartum depression. The purposes of the study were to: 1) determine the physiological, psychosocial, behavioral and socio-demographic risk factors that predict gestational age at birth and postpartum depression; 2) assess whether antepartum bed rest moderates the relationship between risk factors and gestational age at birth and postpartum depression; and 3) compare gestational age at birth, birth weight, length of NICU stay and postpartum depression of high risk women with bed rest to those without bed rest. The Human Response Model guided the study. This study was a secondary analysis and retrospective population-based study of 2004-2008 New York State Pregnancy Risk Assessment Monitoring System (PRAMS) database which selected subjects using stratified systematic random sampling. The sample consisted of 1438 high risk pregnant women had an average age of 29 years, 69% had <15 years of education, 66% were white, 15% were black and 19 % were white, non white Hispanic or mixed race. The average gestational age at birth was 32 weeks and the mean infant birth weight was 1789.81 grams with the most infants spending > 6 days in the NICU. The strongest predictors of gestational age at birth included premature rupture of membranes, maternal BMI, vaginal bleeding, preterm labor, number of prenatal visits, attending childbirth classes, and Medicaid delivery. The strongest predictors of postpartum depression were severe nausea and vomiting, pregnancy teeth problems, assisted reproductive technology, pregnancy kidney/bladder infection, arguing with partner, smoking, multivitamins intake, marital status, WIC participation, and income. Bed rest moderated the relationship between physiological and psychosocial risk factors and gestational age at birth. Infant gestational age and birth weight for women treated with bed rest were significantly lower than women not treated with bed rest. Study results may assist health stakeholders to develop targeted strategies to prevent or minimize preterm birth at statewide level.

Name thesis:degree_name

Doctor of Philosophy

Level thesis:degree_level

doctoral

Discipline thesis:degree_discipline

Nursing

Grantor dc:publisher

Case Western Reserve University School of Graduate Studies

Year dc:date

2013

Author dc:creator

• Omar, Abeer Elkotb

Contributors dc:contributor

• Maloni, Judith

• Nursing
• Obstetrics
• Health
• Health Care
• Public Health
• Sociology

Statement dc:rights

• unrestricted
• This thesis or dissertation is protected by copyright: some rights reserved. It is licensed for use under a Creative Commons license. Specific terms and permissions are available from this document's record in the OhioLINK ETD Center.

Language dc:language

English

Repository record dc:identifier

http://rave.ohiolink.edu/etdc/view?acc_num=case1363115178

OAI identifier oai:identifier

oai:etd.ohiolink.edu:case1363115178