Schrag Stephanie J, Arnold Kathryn E, Mohle-Boetani Janet C, Lynfield Ruth, Zell Elizabeth R, Stefonek Karen, Noga Heather, Craig Allen S, Thomson Sanza Laurie, Smith Glenda, Schuchat Anne
Centers for Disease Control and Prevention, Atlanta, Georgia 30333, USA.
Obstet Gynecol. 2003 Oct;102(4):753-60. doi: 10.1016/s0029-7844(03)00671-9.
To characterize adherence with recommendations for prenatal infectious disease screening and missed opportunities for prevention of congenital and perinatal infections.
Demographic, prenatal, and peripartum information was abstracted from labor and delivery records of a random, stratified sample of live births in 1998 and 1999 to residents of eight active surveillance areas. Adherence with prenatal screening recommendations was evaluated for hepatitis B, syphilis, rubella, human immunodeficiency virus (HIV), and group B streptococcus (GBS). Characteristics of missed opportunities for disease prevention were assessed by univariate and multivariable analysis to account for survey design.
Prenatal screening rates for hepatitis B surface antigen (HBsAg) (96.5%), syphilis (98.2%), and rubella (97.3%) were high. Areas of excess syphilis morbidity did not adhere to recommendations for third-trimester retesting. Testing rates for HIV (57.2%) and GBS (52.0%) were lower and had wide geographic variation. Postpartum rubella vaccination was documented for only 65.7% of rubella-susceptible women. Inadequate prenatal care was the single strongest predictor of missed opportunities for prenatal testing (relative risk 14.6; 95% confidence interval 6.3, 33.7). Blacks were less likely than whites to receive adequate prenatal care and prenatal tests, more likely to test positive for HBsAg and syphilis, and less likely to receive recommended prevention interventions such as postpartum rubella vaccination for susceptible women.
Adherence to both long-standing and more recent recommendations for congenital and perinatal disease prevention can be improved, thus perhaps reducing racial disparities in the use of prenatal screening and appropriate prevention interventions.
描述对产前传染病筛查建议的依从性以及预防先天性和围产期感染的错失机会。
从1998年和1999年八个主动监测地区居民的活产随机分层样本的分娩记录中提取人口统计学、产前和围产期信息。评估对乙型肝炎、梅毒、风疹、人类免疫缺陷病毒（HIV）和B族链球菌（GBS）的产前筛查建议的依从性。通过单变量和多变量分析评估疾病预防错失机会的特征，以考虑调查设计。
乙型肝炎表面抗原（HBsAg）（96.5%）、梅毒（98.2%）和风疹（97.3%）的产前筛查率很高。梅毒发病率较高的地区未遵循孕晚期重新检测的建议。HIV（57.2%）和GBS（52.0%）的检测率较低，且存在广泛的地理差异。仅65.7%的风疹易感女性有产后风疹疫苗接种记录。产前护理不足是产前检测错失机会的最强单一预测因素（相对风险14.6；95%置信区间6.3，33.7）。黑人比白人接受充分产前护理和产前检测的可能性更小，HBsAg和梅毒检测呈阳性的可能性更大，且接受针对易感女性的产后风疹疫苗接种等推荐预防干预措施的可能性更小。
可以提高对先天性和围产期疾病预防的长期及最新建议的依从性，从而可能减少产前筛查和适当预防干预措施使用方面的种族差异。
