Psykosociala riskgraviditeter och deras utfall

• The present study describes a prospective survey of an index-group of78 pregnant women, who during pregnancy met with certain arbitrarily selected, but well defined criteria associated with drug addiction, moderate mental insufficiency or particular social circumstances of possible relevance to the course of pregnancy and early child development. For comparison, a referencegroup of 78 pregnant women who did not meet the present inclusion criteria, were studied in equal detail. The two groups of women were derived out of a total number of 1575 pregnant women who during the year 1983 registered at the public Antenatal Health Care Service in the community of Linköping. The two groups of women were followed and compared until their children were four years old. By means of repeated personal, semistructured interviews with all the women, together with standardized observations of the women and their children and collection of a range of social, economic, medical,obstetrical and neonatal data, the duration and outcome of pregnancy in relation to the need for medical antenatal care and social wellfare was illustrated in some detail. Furthermore, the psychosocial conditions of the pregnant women, apparent during early pregnancy were related to the development of the interaction and relationship between mother and child as observed during the first 18 months as well as to the somatic and psycho-motor development of the child at four years of age.In summary, at least five per cent of all pregnant women in the community of Linköping were found, already during early pregnancy, to be characterized by drug addiction, suffering from modefate mental insufficiency symptoms or being associated with one or more defined social attributes thought to be of relevance to the course of pregnancy and early child development. These women, when compared to the reference group of pregnant women, were eventually found to require a significantly increased amount of medical attention and social wellfare during pregnancy. However, no significant differences were observed between the groups regarding duration and outcome of pregnancy, thestates of the neonates or the somatic wellbeing of mother and child postnatally.With the beginning soon after delivery, the indexchildren appeared to run a considerably increased risk for an unfavourable somatic as well as psycho-motor development during their ftrst four years of life, as compared to the reference children.It is obvious that present efforts and routines with regard to antenatal medical and social care, at least as presendy practised in Linköping, Sweden, are consistent with regular obstetric courses and outcomes of pregnancies in general in women stigmatized by certain impaired psychosocial conditions. However, if we are to prevent and eventually eliminate the significantly increased risks for an unfavourable somatic and psycho-motor development of the children of these women, we mustprobably introduce complementary elements of an educational and socially reassuring type in the Antenatal Health Care Service.

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MEDICINE

MEDICIN

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