Parto prematuro e saúde mental da mulher: fatores associados

Abstract

Introduction: A woman's emotional health is essential both during pregnancy and after childbirth. It is related to the outcome of the pregnancy, the development of the baby, and the well-being of the mother-baby dyad. Thus, one of the main focuses of attention regarding women's mental health is its association with premature birth. There are several factors associated with premature birth, such as biological, emotional, environmental, and demographic, among others. Although studies addressing the theme in question are found in the literature, there is still a gap that addresses the association of post-traumatic stress disorder (PTSD) and depressive and anxiety symptoms with premature birth in Brazilian women. Objective: To investigate the association of PTSD, depressive and anxious symptoms, as well as the various characteristics of women, with the outcome of preterm birth in women evaluated in the immediate postpartum period in a Brazilian public maternity hospital. Methods: This observational case-control study was conducted with 140 women - 70 with preterm delivery and 70 with full-term delivery, in a public maternity hospital in Minas Gerais. The study was done between May 2022 and March 2023. The International Trauma Questionnaire (ITQ), the Edinburgh Postpartum Depression Scale (EPDS), and the Beck Anxiety Inventory (BAI), respectively, were used to assess PTSD, depression symptoms, and anxiety. Sociodemographic data, women's environmental and reproductive characteristics, data on current pregnancy, lifestyle habits, prenatal care, clinical and obstetric complications in pregnancy, and data on women's mental health were evaluated as exposures. The outcome variable presented in this study was preterm birth. A total of 23 variables were selected for the regression analysis stage (backward) with statistical significance at a significance level of 0.20. Data were analyzed using the chi-square test, Fisher's exact test, Mann-Whitney test, and logistic regression using the International Business Machine (IBM) Statistical Package for Social Sciences (SPSS) Statistics® version 23. Results: Of the characteristics related to women's mental health, PTSD (p=0.02) had a statistically significant association with preterm birth in women evaluated in the immediate postpartum period. Regarding the dimensional component that measures PTSD symptoms, there is a significant association between the increase in the score of reexperience of the traumatic event (p=0.010) and the probability of premature birth. Other women's characteristics associated with preterm birth, age greater than 35 years (p=0.030), previous preterm birth (p=0.004), preeclampsia (p=0.010), and IUGR (p=0.031) were significantly associated with preterm birth. Other factors, such as smoking during pregnancy, high blood pressure, diabetes, anxiety, diagnosis of depression, and symptoms of current depression, did not show a statistically significant association with preterm birth. Conclusion: Women's emotional health during pregnancy should receive appropriate attention and support. The results can provide valuable information on the importance of listening in prenatal care and guide clinical interventions and public health policies to implement more targeted prevention strategies.