THE ASSOCIATION BETWEEN HAVING A PRETERM INFANT AND LATER MENTAL AND PHYSICAL HEALTH OUTCOMES AMONG PARENTS
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Abstract
In 2017, 10% of babies were born preterm, accounting for one out of every ten infants born in the US. Previous research suggests that the birth of a preterm infant may lead to substantial challenges among parents, and may eventually lead to psychological distress and ill mental health. In addition, the psychological stress of having a preterm infant may lead to a decline in physical health, including sleep disturbances, fatigue, and poor overall well-being compared to parents of full term infants. Thus, the purpose of this study was to examine the association between having a preterm infant and physical health among US parents. Ebaugh’s Role Exit Theory guided this study; the researcher argues that the process of role exit may place many new parents in the "vacuum experience," causing them to be unable to swiftly move from one identity into the next, leading to ill mental health. Various data sets were needed to examine the research aims. Specifically, the US Pregnancy Risk Assessment Monitoring System (PRAMS), the North Carolina Behavioral Risk Factor Surveillance Survey (BRFSS), and primary data collection were used to examine the potential relationship. The primary data collection was a web-based survey of women in two Facebook support groups for mothers in the Charlotte, NC area, as well as mothers in the University of North Carolina at Charlotte community. Summary statistics of demographic and lifestyle factors were calculated. Logistic regression and multivariate logistic regression were used to calculate unadjusted and adjusted odds ratios and 95% confidence intervals. SAS-callable SUDAAN were used in BRFSS and PRAMS analyses and SAS was used to analyze the web-based survey data. Although not all results were statistically significant, these studies consistently revealed increased odds of adverse health outcomes for parents who had preterm infants compared to those who had full term infants. Findings of the population-based study of North Carolina mothers and fathers using BRFSS data revealed that parents of preterm infants have increased odds of several chronic diseases (diabetes OR=1.83; 95% CI: 0.54, 6.23; hypertension OR=1.12; 95% CI: 0.43, 2.92; cholesterol OR=1.30; 95% CI: 0.61, 3.23) A population-based study of US women using PRAMS data posited that preterm birth was associated with a statistically significant increased odds of feeling hopeless, but not loss of interest (OR=1.24; 95% CI: 1.08, 1.43; OR=0.96; 95% CI: 0.85, 1.09, respectively). In addition, findings of the cross-sectional, web-based survey of maternal health among North Carolina mothers revealed increased odds of postpartum depression (OR=1.27; 95% CI: 0.28, 5.80), anxiety (OR=2.04; 95% CI: 0.49, 8.56), and poor physical health (OR=1.60; 95% CI: 0.29, 8.82) among women who had a preterm birth. Findings of this dissertation add significant information to the current body of literature on preterm birth and later maternal health outcomes. This dissertation was the first to examine parent health outcomes among those individuals who have experienced a preterm birth using large, population-based datasets. In addition, the dissertation partially focused on health outcomes among fathers who have a child who was born preterm, an issue that has rarely been addressed in the scientific literature. Since the current dissertation suggests a relationship between preterm birth and parent health, there are important public health implications. Health care providers may need additional training regarding how to identify health problems for parents following preterm birth. In addition, comprehensive screening of physical and mental health problems following the birth of a preterm infant may be warranted if the preterm birth-parent health association is confirmed in future studies.