孕产妇围产期脆弱的研究进展

doi:10.3761/j.issn.0254-1769.2024.22.018

摘要/Abstract

摘要：

孕产妇受各种生理、心理和社会压力等因素的影响，围产期脆弱发生率较高，严重影响其及婴儿的身心健康，关注围产期脆弱，有助于降低母婴不良结局的风险。该文从围产期脆弱的概念、类别、评估工具、影响因素、干预措施及效果等方面进行综述，并提出相关建议，以期为制订孕产妇围产期脆弱的管理方案提供参考。

关键词: 孕产妇, 围产期脆弱, 影响因素分析, 产科护理, 综述

Abstract:

Pregnant women are affected by various biological，psychological and social pressures，and the incidence of perinatal vulnerability is relatively high. The existence of perinatal vulnerability seriously affects the physical and mental health of pregnant women and infants. Attention to perinatal vulnerability can help reduce the risk of adverse maternal and infant outcomes. This paper reviews the concept，classification，assessment tools，influencing factors，intervention measures，limitations and prospects of perinatal vulnerability，providing references for formulating management programs of perinatal vulnerability.

Key words: Pregnant Woman, Perinatal Vulnerability, Root Cause Analysis, Obstetrical Nursing, Review

李玉培, 薛秀娟, 李灵, 郭迎坤, 乔建红. 孕产妇围产期脆弱的研究进展[J]. 中华护理杂志, 2024, 59(22): 2799-2804.

LI Yupei, XUE Xiujuan, LI Ling, GUO Yingkun, QIAO Jianhong. Research progress on maternal perinatal vulnerability[J]. Chinese Journal of Nursing, 2024, 59(22): 2799-2804.

参考文献 40

[1]	Scheele J, Harmsen van der Vliet-Torij HW, Wingelaar-Loomans EM, et al. Defining vulnerability in European pregnant women:a Delphi study[J]. Midwifery, 2020, 86:102708.
[2]	Venkatesh KK, Germann K, Joseph J, et al. Association between social vulnerability and achieving glycemic control among pre-gnant individuals with pregestational diabetes[J]. Obstet Gynecol, 2022, 139(6):1051-1060. DOI PMID
[3]	Coates D, Saleeba C, Howe D. Profile of consumers and their partners of a perinatal and infant mental health?(PIMH) Service in Australia[J]. Health Soc Care Community, 2018, 26(1):e154-e163.
[4]	Kaphle S, Vaughan G, Subedi M. Respectful maternity care in South Asia:what does the eEvidence say? Experiences of care and neglect,associated vulnerabilities and social complexities[J]. Int J Womens Health, 2022, 7(14):847-879.
[5]	McLeish J, Redshaw M. Maternity experiences of mothers with multiple disadvantages in England:a qualitative study[J]. Women Birth, 2019, 32(2):178-184. DOI PMID
[6]	D’haenens F, Helsloot K, Lauwaert K, et al. Towards an integ-rated perinatal care pathway for vulnerable women:the deve-lopment and validation of quality indicators[J]. Midwifery, 2020, 89:102794.
[7]	田蜜, 贺建昌. 从“孕妇” 在医学研究伦理相关法规指南中脆弱性标识的变化谈“弱势受试者”[J]. 中国医学伦理学, 2021, 34(9):1139-1145.
	Tian M, He JC. Discussion on “vulnerable subjects” from the changes of vulnerability markers of “pregnant women” in medical research ethics guidelines[J]. Chin Med Ethics, 2021, 34(9):1139-1145.
[8]	Lessick M, Woodring BC, Naber S, et al. Vulnerability:a conce-ptual model applied to perinatal and neonatal nursing[J]. J Peri-nat Neonatal Nurs, 1992, 6(3):1-14.
[9]	Arcos E, Muñoz LA, Sánchez X, et al. Vulnerability of pregnant women living in a community of Metropolitan Santiago[J]. Rev Med Chil, 2011, 139(6):739-747.
[10]	Kaye DK, Kakaire O, Nakimuli A, et al. Survivors’ understan-ding of vulnerability and resilience to maternal near-miss obstetric events in Uganda[J]. Int J Gynaecol Obstet, 2014, 127(3):265-268. DOI PMID
[11]	Briscoe L, Lavender T, McGowan L. A concept analysis of women’s vulnerability during pregnancy,birth and the postnatal period[J]. J Adv Nurs, 2016, 72(10):2330-2345. DOI PMID
[12]	Hamelin-Brabant L, de Montigny F, Roch G, et al. Perinatal vulnerability and social-support during the postnatal period:a review of the literature[J]. Sante Publique, 2015, 27(1):27-37. PMID
[13]	王静怡, 李一章, 马彬, 等. 高龄产妇产褥期疲乏现状及影响因素分析[J]. 中华护理杂志, 2023, 58(11):1292-1297. DOI URL
	Wang JY, Li YZ, Ma B, et al. Analysis of the current status of puerperal fatigue in women at advanced maternal age and its influencing factors[J]. Chin J Nurs, 2023, 58(11):1292-1297. DOI URL
[14]	樊雪梅, 蒲丛珊, 张爱霞, 等. 孕产妇分娩心理创伤的研究进展[J]. 中华护理杂志, 2022, 57(10):1256-1262. DOI URL
	Fan XM, Pu CS, Zhang AX, et al. Research progress of mater-nal psychological birth trauma[J]. Chin J Nurs, 2022, 57(10):1256-1262.
[15]	蒲丛珊, 夏家爱, 王春华, 等. 妊娠期高血压疾病产妇出院后应对困难现状及影响因素分析[J]. 中华护理杂志, 2023, 58(22):2754-2760. DOI URL
	Pu CS, Xia JA, Wang CH, et al. Analysis of the current situation and influencing factors of the post-discharge coping difficulties in women with hypertensive disorders of pregnancy[J]. Chin J Nurs, 2023, 58(22):2754-2760. DOI URL
[16]	Davenport MH, Khurana R, Thornton JS, et al. “It’s going to affect our lives,our sport and our career”:time to raise the bar for pregnant and postpartum athletes[J]. Br J Sports Med, 2023, 57(14):893-894.
[17]	Hetherington E, Tough S, McNeil D, et al. Vulnerable women’s perceptions of individual versus group prenatal care:results of a cross-sectional survey[J]. Matern Child Health J, 2018, 22(11):1632-1638.
[18]	Huskisson EC. Measurement of pain[J]. Lancet, 1974, 2(7889):1127-1131. DOI PMID
[19]	Fontein Kuipers YJ, Mestdagh E. The experiential knowledge of migrant women about vulnerability during pregnancy:a woman-centred mixed-methods study[J]. Women Birth, 2022, 35(1):70-79.
[20]	Molenaar JM, van der Meer L, Bertens LCM, et al. Defining vulnerability subgroups among pregnant women using pre-pregnancy information:a latent class analysis[J]. Eur J Public Health, 2023, 33(1):25-34.
[21]	Valerio VC, Downey J, Sgaier SK, et al. Black-White dispari-ties in maternal vulnerability and adverse pregnancy out-comes:an ecological population study in the United States,2014-2018[J]. Lancet Reg Health Am, 2023, 20:100456.
[22]	Salazar EG, Montoya-Williams D, Passarella M, et al. County-level maternal vulnerability and preterm birth in the US[J]. JAMA Netw Open, 2023, 6(5):e2315306.
[23]	Quispel C, Schneider TA, Bonsel GJ, et al. An innovative screen-and-advice model for psychopathology and psychosocial pro-blems among urban pregnant women:an exploratory study[J]. J Psychosom Obstet Gynaecol, 2012, 33(1):7-14.
[24]	Amuli K, Decabooter K, Talrich F, et al. Born in Brussels screening tool:the development of a screening tool measuring antenatal psychosocial vulnerability[J]. BMC Public Health, 2021, 21(1):1522.
[25]	Gemayel DJ, Wiener KKK, Saliba AJ. Development of a conce-ptual framework that identifies factors and challenges impac-ting perinatal fathers[J]. Heliyon, 2018, 4(7):e00694.
[26]	Malebranche M, Nerenberg K, Metcalfe A, et al. Addressing vulnerability of pregnant refugees[J]. Bull World Health Organ, 2017, 95(9):611-611A.
[27]	DiPietro JA, Voegtline KM. The gestational foundation of sex differences in development and vulnerability[J]. Neuroscience, 2017, 342:4-20. DOI PMID
[28]	Lucas DN, Bamber JH. Pandemics and maternal health:the in-direct effects of COVID-19[J]. Anaesthesia, 2021, 76(Suppl 4):69-75.
[29]	Dias FMV, Oliveira AS, Júnior CSD, et al. Social vulnerability:the connection between psychiatric disorders and thiamine deficiency in pregnant women[J]. Psychiatry Res, 2020, 293:113362.
[30]	Li Y, Hassett AL, Seng JS. Exploring the mutual regulation between oxytocin and cortisol as a marker of resilience[J]. Arch Psychiatr Nurs, 2019, 33(2):164-173.
[31]	Peng XQ, Yang N, Zhang C, et al. Cognitive factors of weight management during pregnancy among Chinese women:a study applying protective motivation theory[J]. Am J Health Promot, 2022, 36(4):612-622.
[32]	Songco A, Minihan S, Fox E, et al. Social and cognitive vul-nerability to COVID-19-related stress in pregnancy:a case-matched-control study of antenatal mental health[J]. J Affect Disord, 2023, 325:739-746.
[33]	Brygger Venø L, Jarbøl DE, Ertmann RK, et al. Barriers to assessing vulnerability in pregnant women. A cross-sectional survey in Danish general practice[J]. Fam Pract, 2022:134.
[34]	Ginn C, Benzies KM. Struggling with reciprocity and compas-sion:mentoring pregnant and parenting mothers experiencing vulnerability[J]. Qual Health Res, 2020, 30(4):504-517.
[35]	Ortiz Collado MA, Saez M, Favrod J, et al. Antenatal psychoso-matic programming to reduce postpartum depression risk and improve childbirth outcomes:a randomized controlled trial in Spain and France[J]. BMC Pregnancy Childbirth, 2014, 14:22.
[36]	Bertens LCM, Mohabier KSC, van der Hulst M, et al. Comple-xity and interplay of faced adversities and perceived health and well-being in highly vulnerable pregnant women-the mothers of Rotterdam program[J]. BMC Public Health, 2023, 23(1):43. DOI PMID
[37]	Paterson SK, Godsmark CN. Heat-health vulnerability in tem-perate climates:lessons and response options from Ireland[J]. Global Health, 2020, 16(1):29.
[38]	Furumoto-Dawson A, Gehlert S, Sohmer D, et al. Early-life con-ditions and mechanisms of population health vulnerabilities[J]. Health Aff, 2007, 26(5):1238-1248.
[39]	Skovbjerg S, Sumbundu A, Kolls M, et al. The effect of an adapted mindfulness-based stress reduction program on mental health,maternal bonding and birth outcomes in psychosocially vulnerable pregnant women:a study protocol for a randomized controlled trial in a Danish hospital-based out-patient setting[J]. BMC Complement Med Ther, 2023, 23(1):364. DOI PMID
[40]	Ian Bennett JU. Maternal infant dyad-implementation(MInD-I) project:implementing collaborative care for vulnerable perina-tal populations[EB/OL][2023-10-09]. https://psychiatry.uw.edu/who-we-are/news-events/news/maternal-infant-dyad-implementation-mind-i-pro-ject-implementing-collaborative-care-for-vulnerable-perinatal-po-pulations/.