بررسی ارتباط تعیین‌کننده‌های اجتماعی سلامت و اضافه وزن باقی‌مانده پس از زایمان در ایران بر اساس مدل سازمان جهانی بهداشت: یک مطالعه مروری سیستماتیک

نوع مقاله : مروری

نویسندگان

1 دانشجوی دکترای بهداشت باروری، کمیته پژوهشی دانشجویان، دانشکده پرستاری و مامایی، دانشگاه علوم پزشکی شهید بهشتی، تهران، ایران.

2 دانشیار گروه مامایی و بهداشت باروری، دانشکده پرستاری و مامایی، دانشگاه علوم پزشکی شهید بهشتی، تهران، ایران.

3 دانشیار گروه مامایی، مرکز تحقیقات عوامل اجتماعی مؤثر بر سلامت، دانشگاه علوم پزشکی البرز، کرج، ایران.

4 دانشجوی دکترای بهداشت باروری، دانشکده پرستاری و مامایی، دانشگاه علوم پزشکی کاشان، کاشان، ایران.

5 دانشیار گروه مامایی و بهداشت باروری، مرکز تحقیقات مامایی و بهداشت باروری، دانشکده پرستاری و مامایی، دانشگاه علوم پزشکی شهید بهشتی، تهران، ایران.

چکیده

مقدمه: اضافه وزن باقی‌مانده پس از زایمان، نقش مهمی در چاقی، بیماری‌های مزمن و پیامدهای ناگوار مادری، جنینی و نوزادی دارد. امروزه، عوامل اجتماعی از علل پایه‌گذار سلامتی و بیماری محسوب می‌شوند. مرور سیستماتیک حاضر، با هدف بررسی ارتباط تعیین‌کننده‌های اجتماعی سلامت و اضافه وزن باقی‌مانده پس از زایمان در مطالعات ایرانی انجام شد.
روش‌کار: در این مطالعه مروری مقالات فارسی و انگلیسی از نوع مشاهده‌ای (کوهورت، مورد شاهدی، مقطعی) در پایگاه‌های Irandoc، Magiran، SID، Web of Science، Embase، Scopus‌‌، Google Scholar ‌و PubMed با ترکیبات مختلف کلمات کلیدی مرتبط با "تعیین کننده‌های اجتماعی سلامت" (Social determinants of health) و "اضافه وزن باقی‌مانده پس از زایمان" (postpartum weight retention) به‌دست آمده از MESH در سال‌های 2019-2000 جستجو شدند. انتخاب مقالات بر اساس معیارهای ورود و خروج و ارزیابی کیفیت مقالات با مقیاس نیوکاسل اوتاوا انجام شد.
یافته‌ها: از 485 مقاله بررسی شده، 8 مقاله مناسب بود. بر اساس مدل WHO، تعیین‌کننده‌های اجتماعی سلامت در دو گروه ساختاری و بینابینی قرار گرفت. تعیین‌کننده‌های ساختاری شامل تحصیلات، شغل، درآمد و محل سکونت و تعیین‌کننده‌های بینابینی بر اساس مدل مذکور، در سه حیطه عوامل رفتاری، عوامل بیولوژیکی و عوامل روانی اجتماعی قرار گرفت. بر اساس نتایج مطالعات مرور شده، تحصیلات مادر، ورزش، وضعیت عملکردی پس از زایمان، شیردهی انحصاری، تغذیه با شیر خشک، وزن پیش از بارداری، وزن‌گیری بارداری، پاریتی، نحوه زایمان، سن، افسردگی و اضطراب، ارتباط آماری معنی‌داری با اضافه وزن باقی‌مانده پس از زایمان نشان دادند.
نتیجه‌گیری: نتایج مرور سیستماتیک حاضر بیانگر تأثیر تعیین‌کننده‌های اجتماعی ساختاری و بینابینی سلامت - از جمله تحصیلات زنان و عواملی در حیطه‌های رفتاری، بیولوژیکی و روانی اجتماعی- بر باقی‌ماندن اضافه وزن پس از زایمان بود. این امر مؤید نیاز به توجه بیشتر مسئولان و پرسنل بهداشتی به این عوامل تأثیر‌گذار در کنار سایر عوامل پزشکی می‌باشد تا بتوان به پیشگیری یا کاهش میزان این معضل و عوارض ناشی از آن کمک نمود.
 

کلیدواژه‌ها

عنوان مقاله [English]

Relationship between Social Determinants of Health and Postpartum weight retention in Iran Based on the WHO Model: A Systematic Review

نویسندگان [English]

  • Shahin Bazzazian 1
  • Hedyeh Riazi 2
  • Zohreh Mahmoodi 3
  • Saeideh Nasiri 4
  • Giti Ozgoli 5
1 PhD Candidate of Reproductive Health, Student Research Committee, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
2 Associate Professor, Department of Midwifery and Reproductive Health, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
3 Associate Professor, Department of Midwifery, Social Determinants of Health Research Center, Alborz University of Medical Sciences, Karaj, Iran.
4 PhD Candidate of Reproductive Health, School of Nursing and Midwifery, Kashan University of Medical Sciences, Kashan, Iran.
5 Associate Professor, Department of Midwifery and Reproductive Health, Midwifery and Reproductive Health Research Center, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
چکیده [English]

Introduction: Postpartum weight retention has a significant effect on obesity, chronic disease, and adverse maternal, fetal, and neonatal outcomes. Nowadays, social factors are of the basic causes of health and disease. The present systematic review was conducted with aim to investigate the relationship between social determinants of health and postpartum weight retention in Iranian studies.
Methods:In this systematic review, Persian and English observational articles (cohort, case-control, cross-sectional) were searched in databases of PubMed, Google Scholar, Scopus, Embase, Web of Science, SID, Magiran, Irandoc using the different combination of keywords related to “Social determinants of health” And “postpartum weight retention” obtained from Medical Subject Headings (MeSH) from 2000 to 2019. The articles were selected based on the inclusion and exclusion criteria. The quality of selected studies was evaluated using the Newcastle–Ottawa Scale.
Results: From 485 reviewed articles, eight studies were selected. Social determinants of health were classified into structural and intermediate groups based on the WHO model. The structural determinants included education, occupation, income, and residence area. Intermediate determinants were classified into three domains of behavioral factors, biological factors, and psychosocial factors based on this model. According to the results of the reviewed studies, a statistically significant relationship was observed between postpartum weight retention with mother's education, exercise, postpartum functional status, exclusive breastfeeding, formula feeding, pre-pregnancy weight, gestational weight gain, parity, mode of delivery, age, depression, and anxiety.
Conclusion: The results of the current systematic review illustrated the impact of structural and intermediate social determinants of health- including women's education and factors in behavioral, biological, and psychosocial domains- on postpartum weight retention. This result confirms the need for health authorities and staff to pay more attention to these influencing factors along with other medical factors to help prevent or reduce the extent of this problem and its complications.

کلیدواژه‌ها [English]

  • Gestational weight gain
  • Iran
  • Postpartum weight retention
  • Social determinants of health

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مجله زنان، مامایی و نازایی ایران
دوره 23، شماره 8
آبان 1399
صفحه 87-106

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