基于健康信念模型探索影响大于胎龄儿发生的社会心理学决定因素

Social psychological determinants predicating for large for gestational age infant based on health belief model

目的本研究旨在运用健康信念模型(HBM)评估膳食相关的社会心理决定因素与大于胎龄儿(LGA发生的相关性。方法对2020年10月至2021年7月在北京市平谷区医院产科门诊常规产检的537名孕妇进行问卷调查。结果537名孕妇中,LGA的分娩率为19.44%。其中LGA组妇女孕前体质量指数(BMI)显著高于非LGA组(P<0.001)。单因素分析显示,LGA孕妇和非LGA孕妇的膳食相关社会心理因素差异无统计学意义。多元统计分析显示,感知风险中的妊娠糖尿病导致医药费增加[OR=1.77,95%CI(1.12~2.81)]、让自己遭受指尖采血的痛苦[OR=0.59,95%CI(0.40~0.87)]、感知益处中的平衡膳食有助于维持适宜体重[OR=0.39,95%CI(0.17~0.89)]、行动线索中的从媒体获得健康饮食信息[OR=0.69,95%CI(0.52~0.91)]四个因素与LGA发生率显著相关,这些相关在矫正了年龄、孕前BMI和产次后,依然显著。结论孕前肥胖的孕妇,大于胎龄儿娩出率较高;孕妇对于平衡膳食相关的感知风险、感知益处、行动线索的认同程度与LGA的分娩率显著相关。依据健康信念模型设计的营养健康教育课程可提高健康教育的针对性和有效性来防止LGA的发生。

Objective To evaluate the correlationship between dietary behavior related social and psychological determinants in health belief model and the occurrence of large for gestational age(LGA)infants.Methods A questionnaire survey was conducted on 537 pregnant women who underwent routine prenatal examinations at the Obstetrics and Gynecology Outpatient Department of Beijing Pinggu Hospital from October 2020 to July 2021.Results Among 537 pregnant women,the delivery rate of LGA was 19.44%.Among them,women in the LGA group had a significantly higher pre-pregnancy body mass index(BMI)than those in the non-LGA group(P<0.001).Univariate analysis showed that there were no statistically significant differences of scores of social and psychological factors between LGA and non LGA pregnant women.Multivariate statistical analysis showed that perceived risk of gestational diabetes related increase of medical costs[OR=1.77,95%CI(1.12-2.81)]and pain of fingertip blood collection[OR=0.59,95%CI(0.40-0.87)]predicted LGA.Perceived benefits of balanced diets helped to maintain an appropriate weight gain[OR=0.39,95%CI(0.17-0.89)].Scores of four items in the action cue to receive healthy diet information from the media[OR=0.69,95%CI(0.52-0.91)]were significantly associated with the incidence of LGA,and these associations remained significant after adjusting for age,preconception BMI,and parity.Conclusion Pregnant women who are obese before pregnancy have a higher change to deliver a LGA baby.Pregnant women's agreement with the perceived risks,perceived benefits,and cues for action associated with a balanced diet was significantly associated with the risk of LGA deliveries.Nutrition and health education curriculum designed according to health belief model improves the pertinence and effectiveness of health education to prevent the occurrence of LGA.