Covington M T, Rice R J
Center for Public Health Practice, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA.
Matern Child Health J. 1997 Sep;1(3):157-64. doi: 10.1023/a:1026269328695.
While the importance of exploring and better measuring elements of prenatal care have been noted in the public health literature, the components and timing of such services have been poorly examined for the overall pregnant population and specifically for African-Americans, who traditionally have had higher rates of low birth weight and premature delivery. This study explores the association between patient receipt of selected recommended prenatal care interventions and infant birth weight in a nationally representative sample of African-American women, while controlling for the influence of low birth weight risk indicators.
This is a retrospective case-control analysis using survey data of women who delivered normal birth weight, moderate low birth weight, and very low birth weight newborns in 1988. A sample of 3905 African-American women who responded to the 1988 National Maternal and Infant Health Survey is examined based on maternal recall of receipt of six clinical screening procedures and seven health-promotion recommendations. Birth weight measures were obtained from linked 1988 birth certificate data.
The initial results indicated that women who do not receive all of the recommended health-promotion advice are more likely to deliver very low birth weight infants than women who receive all of the advice in the content of their prenatal care, after controlling for low birth weight risks (OR = 1.28; 95% CI = 1.01, 1.7). However, when breast-feeding advice is removed from the aggregation of health-promotion advice, the significant effect of advice on very low birth weight is negated. No other significant group variations in the receipt of clinical screening procedures or health-promotion advice for women who gave birth in the remaining birth weight categories are observed.
Nationally recommended initial clinical screening procedures and health-promotion advice in prenatal care content do not appear to be associated with a reduction in low birth weight for African-American women. More research is needed to better assess the impact of other antenatal interventions, particularly those given to women with a higher prevalence of poor birth outcomes.
虽然公共卫生文献中已指出探索并更好地衡量产前护理要素的重要性，但针对全体孕妇人群，尤其是非裔美国人（他们传统上低出生体重和早产发生率较高），此类服务的组成部分和时间安排却鲜有研究。本研究在一个具有全国代表性的非裔美国女性样本中，探讨患者接受选定的推荐产前护理干预措施与婴儿出生体重之间的关联，同时控制低出生体重风险指标的影响。
这是一项回顾性病例对照分析，使用了1988年分娩出正常出生体重、中度低出生体重和极低出生体重新生儿的女性的调查数据。基于对1988年全国母婴健康调查做出回应的3905名非裔美国女性样本，根据母亲对接受六种临床筛查程序和七条健康促进建议的回忆进行研究。出生体重数据来自1988年相关的出生证明。
初步结果表明，在控制低出生体重风险后，未接受所有推荐健康促进建议的女性比在产前护理中接受所有建议的女性更有可能分娩出极低出生体重婴儿（OR = 1.28；95% CI = 1.01，1.7）。然而，当将母乳喂养建议从健康促进建议汇总中去除后，建议对极低出生体重的显著影响就消失了。对于其余出生体重类别的分娩女性，在接受临床筛查程序或健康促进建议方面未观察到其他显著的群体差异。
全国推荐的产前护理内容中的初始临床筛查程序和健康促进建议似乎与非裔美国女性低出生体重的降低无关。需要更多研究来更好地评估其他产前干预措施的影响，特别是针对出生结局较差患病率较高的女性的干预措施。
