Prenatal health behaviors and stress as contributors to socioeconomic gaps in adverse birth outcomes for Korean women = 여성의 부정적 출산결과에 대한 사회경제적 격차와 산전 건강행동과 스트레스의 영향

국문 초록 (Abstract)

1997년 IMF 이후 사회경제적 지위에 상관없이 여성들의 결혼과 출산 시기는 모두 늦어지기 시작하면서, 미숙아 및 저체중아 출산에 있어 여성들의 사회 경제적･행동적 및 심리적 특성보다는 이들의 연령과 생물학적 특성이 더 중요한 위험요인으로 주목받고 있다. 이에 본 연구는 한국 여성들의 미숙아 및 저체중아 출산에 대한 사회경제적 격차가 산전(임신 전과 임신 중) 시기에 경험한 건강 행동과 스트레스 및 이들의 생물학적 요인과의 연관성을 파악하기 위해, 최근 3년 출산 경험이 있고 그 당시 30세 이상 44세 이하의 여성 951명을 대상으로 면대면 설문조사를 실시하였다. 주요 변수로 고려한 산전 건강행동에는 정기적인 검진, 엽산제 복용, 임신 중 체중증가, 흡연 및 영양섭취 등이, 산전 스트레스에는 주변인의 죽음과 폭력 경험 등과 같은 부정적인 생활사건, 태아의 건강에 관한 걱정과 불안 등으로 구성하였다. 분석결과, 여성들의 생물학적 특성 및 신생아의 특성을 보정한 후에도 여성들의 미숙아 및 저체중아 출산의 위험은 이들의 사회경제적 지위에 따 라 차이를 보였다. 그러나 산전의 건강 행동 및 스트레스 변인을 보정한 경우, 기존의 연관성은 완전히 사라졌다. 즉, 산전의 건강 행동과 스트레스는 여성들의 사회경제적 지위와 미숙아 및 저체중아 출산 사이에 매개요인으로 작용하고 있었다. 따라서 사회경제적 지위가 낮은 여성들의 미숙아 및 저체중아 출산 위험을 예방하기 위해 이들의 산전 건강행동을 증진하고, 스트레스를 관리하는 등의 지원이 요구된다.

다국어 초록 (Multilingual Abstract)

Despite delayed childbearing for women in both high and low socio-economic status(SES) in Korea since the economic crisis in the late 90s, more attention has been drawn to women’s older age and biomedical characteristics than other socioeconomic, behavioral, and psychological factors to predict preterm birth (PTB) or low birth weight (LBW). Thus, this study aims to explore contributing factors in the prenatal period—health care and stress, and psychosocial correlates of stress—to the SES differentials in PTB or LBW among Korean women. We surveyed 951 women aged 30-44 years who had delivered in the last three years. We estimated the odds ratios of PTB or LBW between the SES groups adjusting for the following four categories of variables : (a) prenatal health behaviors (e.g., regular hospital visits, folic acid supplementation, gestational increase in body mass index, smoking, and regular meals) ; (b) prenatal stress (e.g., negative life events, anxiety about fetal health, etc.) ; (c) psychosocial correlates of stress (e.g., anxiety about fetal health, social support, and residential environment) ; (d) maternal medical history and birth characteristics. Among Korea mothers, the SES gaps in preterm birth or LBW were completely explained by the prenatal health behaviors and stress in prenatal period with the biomedical characteristics for mothers and newborns held constant. PTB or LBW births for Korean women in low-SES occupations could be prevented by promoting their health behaviors and building stress-coping skills in the prenatal period.

목차 (Table of Contents)

• I. Introduction
• Ⅱ. Methods
• Ⅲ. Results
• Ⅳ. Discussion

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