An investigation of the effects of stress on maternal and infant morbidity outcomes: focusing on prevention of carcinogenic risk
Centre for Health Policy & Practice, School of Health, Stafford University, Stafford, United Kingdom
Rationale: Substantive literary evidence supports the case concerning adverse effects of smoking on birth weight (Conter et al 1995, Peacock et al 1995), fetal respiratory function, (Cook and Strachan 1999, Hoo et al 1998), and carcinogenic risk in relation to smoking (Bo-Qi Liu, et al 1998, Hackshaw et al 1997, Rantakallio et al 1995), alcohol consumption (La Vecchia et al 1999, Grǿnbæk et al 1998), and poor diet (Zureik et al 1998, Thorogood et al 1994). It appears pertinent, therefore, to concentrate on strategies to reduce carcinogenic risk at the beginning of life, during pregnancy and the neo-natal period. Aim: 1) identify area/s with significant infant morbidity in a geographical area in North Wales UK. 2) Investigate relationships between the morbidity indicator (LBW), with selected measures of deprivation 3) Investigate risk factors found to impact on maternal, fetal and infant health in a selected area 3) investigate relationships between risk factors and morbidity outcomes 4) Consider relevant health promotion strategies. Methods; Phase 1,an epidemiological study, (n=3586 [n=2778] with attributable post [zip] code) utilised spatial analysis and multiple correlation tests to investigate relationships between morbidity indicator [LBW] and selected deprivation measures [Jarman UPA and Townsend Scores]. Phase 2, utilised interpretive study [Barnard 1994] to investigate perceptions of GPs, health visitors, community paediatricians and midwives [n=35] in relation to infant health risk and morbidity outcomes. Phase 3, of this study utilised an emancipatory approach to further seek professional opinion in the design of appropriate health promotion programmes that focus on improvement of maternal and child health. Results: Phase 1, found correlations between selected indicator of infant morbidity [LBW] and Townsend score, Pearson’s product moment correlation co-efficient significant, P> 0.01 r = .613, Jarman UPA Score P >0.01 level r = .620, following removal of outliers. Phase 2, Results indicated high inter-rater reliability between respondent opinion in relation to carcinogenic risk factors, such as smoking in pregnancy, poor diet, fetal undernutrition, alcohol and drug abuse, with multiple stress factors, such as lack of maternal role model, depression, domestic violence, adverse living environments, financial problems, and frequent change of address. Conclusions: Future work in prevention should focus on health promotion models that encompass the reduction of stress in pregnancy as key, in enabling smoking cessation, reduction of alcohol intake and improved nutrition in pregnancy in order to reduce carcinogenic risk.
Paper presented at the International Symposium on Predictive Oncology and Intervention Strategies; Nice, France; February 7 - 10, 2004; in oral session 891 (Risk factors).