Lejeune C, Fontaine A, Crenn-Hebert C, Paolotti V, Foureau V, Lebert A
Service de Néonatologie, Hôpital Louis-Mourier, Colombes.
J Gynecol Obstet Biol Reprod (Paris). 1998 Dec;27(8):772-81.
Perinatal morbidity is increased among women without health insurance and/or receiving poor antenatal care. The objectives of this study were to estimate the prevalence of such situations, to analyze underlying social conditions, to identify possible means to secure health insurance and to assess the impact of the absence of health insurance on antenatal care and pregnancy outcomes.
All pregnant women without health insurance during one calendar year were included. Those who delivered a live child were compared with a control group of women with health insurance who delivered a live child until the date of the last delivery for uninsured women. Statistical analyses were conducted to describe the characteristics of uninsured women and to identify risk factors for poor antenatal care and pregnancy outcomes.
A total of 259 uninsured women were enrolled, including 201 (78%) foreigners the majority of whom had resided in France for more than one year; 205 were followed-up and delivered in our hospital, including 192 live births. The social context of uninsured French women was worse than that of foreign uninsured women. Health insurance was obtained for 85% (173/205). Overall, the absence of health insurance was associated with increased risks for poor antenatal care. Being uninsured and receiving poor antenatal care was associated with an increase in the incidence of intra-uterine growth failure. Post-term deliveries were more frequent among women with poor antenatal care.
Improving antenatal care and health insurance coverage could help decrease perinatal morbidity, given the current increase in the number of women with social risk factors. It seems essential that all women obtain access to public maternity wards, and that these wards develop effective social services working in concert with ambulatory health and social workers.
未参保及/或接受不良产前护理的女性围产期发病率会升高。本研究的目的是估计此类情况的发生率，分析潜在社会状况，确定获得医疗保险的可能途径，并评估未参保对产前护理及妊娠结局的影响。
纳入一自然年内所有未参保的孕妇。将分娩活产儿的未参保孕妇与分娩活产儿的参保孕妇对照组进行比较，直至未参保女性的最后一次分娩日期。进行统计分析以描述未参保女性的特征，并确定不良产前护理及妊娠结局的危险因素。
共纳入259名未参保女性，其中201名（78%）为外国人，她们中的大多数已在法国居住一年以上；205名在我院接受随访并分娩，其中包括192例活产。未参保法国女性的社会背景比未参保外国女性更差。85%（173/205）的人获得了医疗保险。总体而言，未参保与不良产前护理风险增加相关。未参保且接受不良产前护理与宫内生长受限发生率增加相关。产前护理差的女性过期产更常见。
鉴于目前社会风险因素女性数量增加，改善产前护理和医疗保险覆盖范围有助于降低围产期发病率。所有女性都能进入公共产科病房，且这些病房与门诊医疗和社会工作者协同开展有效的社会服务似乎至关重要。
