摘要：Objectives. This study examined the persistence and comorbidity of women’s physical and mental health conditions after pregnancy and the association of these conditions with child outcomes. Methods. A national cohort of women who recently gave birth were surveyed in 1988 and again in 1991. We examined longitudinal data on maternal poor physical health, depressive symptoms, and smoking, and maternal report of child outcomes (at age ∼3 years). Results. Women’s poor physical health and smoking had strong, graded associations with children’s physical health and behavior problems, whereas women’s depressive symptoms were associated with children’s delayed language and behavior problems. Conclusions. Substantial persistence and comorbidity of women’s health conditions exist after pregnancy with adverse effects on early child outcomes. Child health professionals should support services and policies that promote women’s health outside the context of pregnancy. Research on the relation between the health of women and that of their children has traditionally focused on health conditions that arise in pregnancy and the early perinatal period. This emphasis has profoundly shaped the nature of maternal and child health services and policy in the United States. 1– 3 Emerging research, however, highlights the additional role of women’s health both before and after pregnancy as a determinant of child health and well-being. For example, the presence of chronic illnesses, poor nutritional status, and health risk behaviors in women before pregnancy appears to strongly influence neonatal morbidity and mortality. 4, 5 This research has led to an increasing focus on health services for women before pregnancy. 6– 8 Significant gaps exist in research linking women’s health after pregnancy and early child outcomes. First, most studies have sought to isolate the effects of single maternal risk factors, such as smoking. 9, 10 There has been little effort to assess more comprehensively the interrelated conditions women experience after delivery and the scope of their influence on child outcomes. For example, despite the well-documented association between adult smoking and depression, 11 little is known about their joint effect on child health. Furthermore, most studies have relied on cross-sectional assessments of the maternal and child health relationship. More longitudinal approaches are needed to clarify the continuity or persistence of conditions over time and to provide accurate estimates of effects. 12 For example, longitudinal models have better delineated the effect of prolonged exposure to poverty on both birth outcomes and child development. 13, 14 The disadvantage of a focus on isolated maternal risk factors, assessed at a single point in time, is evident in the multiple distinct and unrelated calls for action on the part of child health professionals. 15– 20 Little coherent support among pediatricians has been generated for more comprehensive and continuous health care for women after they deliver. 21– 24 The goal of this study was to offer a broader perspective on the scope and persistence of the maternal and child health relationship after pregnancy as an empirical first step in reconsidering current health programs and policies for women and their children. Specifically, we used a longitudinal cohort to examine maternal poor physical health, depressive symptoms, and smoking at 2 points in time after delivery and their association with child health and development at age 3 years. We also examined social and economic factors that may frame the distribution of maternal conditions.
