Misra Dawn P, Guyer Bernard, Allston Adam
Women's and Children's Health Policy Center, Department of Population and Family Health Sciences, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA.
Am J Prev Med. 2003 Jul;25(1):65-75. doi: 10.1016/s0749-3797(03)00090-4.
Despite great strides in improving prenatal care utilization among American women, key perinatal indicators have remained stagnant or worsened in the past decade, and the United States continues to rank near the bottom compared to other developed countries. A new approach is needed if we are to achieve improvements in perinatal health.
To propose a new framework that integrates a "life span" approach with a multiple determinants model.
We recognize that (1) powerful influences on outcome occur long before pregnancy begins; (2) pregnancy outcome is shaped by social, psychological, behavioral, environmental, and biological forces; and (3) the demography of pregnancy has changed dramatically in the last few decades with more women delaying their first birth. Approaches that simultaneously consider the entire life span as well as multiple determinants may need to be adopted. We propose a framework that integrates these approaches and is supported by the research literature. The life span perspective focuses attention toward the preconceptional and interconceptional periods as targets for intervention in improving perinatal health. The multiple determinants model distinguishes among concepts of disease, health and functioning, and well-being for both women and their offspring.
Our intent is to influence how policymakers, public health professionals, clinicians, and researchers approach perinatal health.
尽管美国女性在提高产前护理利用率方面取得了巨大进展，但关键围产期指标在过去十年中一直停滞不前或有所恶化，与其他发达国家相比，美国仍排名靠后。如果我们要改善围产期健康状况，就需要一种新方法。
提出一个将“生命周期”方法与多因素模型相结合的新框架。
我们认识到：（1）对结果的强大影响在怀孕开始前很久就已出现；（2）妊娠结局受社会、心理、行为、环境和生物学因素影响；（3）在过去几十年中，随着越来越多的女性推迟首次生育，妊娠人口统计学发生了巨大变化。可能需要采用同时考虑整个生命周期以及多种决定因素的方法。我们提出了一个整合这些方法并得到研究文献支持的框架。生命周期视角将注意力集中在孕前和孕间期，将其作为改善围产期健康的干预目标。多因素模型区分了女性及其后代的疾病、健康与功能以及幸福的概念。
我们的目的是影响政策制定者、公共卫生专业人员、临床医生和研究人员处理围产期健康问题的方式。
