Chen Xi-Kuan, Wen Shi Wu, Yang Qiuying, Walker Mark C
OMNI Research Group, Department of Obstetrics and Gynecology, University of Ottawa, Ottawa, Ontario, Canada.
Aust N Z J Obstet Gynaecol. 2007 Apr;47(2):122-7. doi: 10.1111/j.1479-828X.2007.00697.x.
Previous studies have found that inadequate prenatal care was associated with increased neonatal mortality in the general pregnant women.
To examine the association between adequacy of prenatal care and neonatal mortality in the presence and absence of antenatal high-risk conditions.
We conducted a retrospective cohort study of infants based on 1995-2000 vital statistics data in the USA. The relative risk for neonatal death associated with adequacy of prenatal care was estimated by multivariate logistic regressions with adjustment of confounding factors.
Inadequate prenatal care was associated with increased neonatal mortality when pregnancies were complicated by anaemia, cardiac disease, lung disease, chronic hypertension, diabetes, renal disease, pregnancy-induced hypertension, and previous preterm/small-for-gestational-age birth. The observed association also existed in the absence of these antenatal high-risk conditions. Overutilisation of prenatal care was associated with increased risk of neonatal deaths in both the presence and the absence of antenatal high-risk conditions. When gestational age at delivery and birthweight were further adjusted, the observed association between inadequate prenatal care and neonatal mortality was not significant in pregnancies with various high-risk conditions.
Inadequate prenatal care is associated with increased neonatal death in both the presence and the absence of antenatal high-risk conditions. The observed association between inadequate prenatal care and neonatal mortality may be mediated by increased risk of preterm delivery and low birthweight in these pregnancies. Overutilisation of prenatal care is associated with potential risks for fetal and neonatal development, leading to increased neonatal mortality.
先前的研究发现，产前护理不足与普通孕妇的新生儿死亡率增加有关。
研究在有无产前高危情况时，产前护理充足程度与新生儿死亡率之间的关联。
我们基于美国1995 - 2000年生命统计数据对婴儿进行了一项回顾性队列研究。通过多变量逻辑回归并调整混杂因素来估计与产前护理充足程度相关的新生儿死亡相对风险。
当妊娠合并贫血、心脏病、肺病、慢性高血压、糖尿病、肾病、妊娠高血压以及既往有早产/小于胎龄儿出生史时，产前护理不足与新生儿死亡率增加有关。在无这些产前高危情况时，所观察到的关联也存在。无论有无产前高危情况，产前护理过度使用均与新生儿死亡风险增加有关。当进一步调整分娩孕周和出生体重后，在各种高危妊娠中，所观察到的产前护理不足与新生儿死亡率之间的关联并不显著。
无论有无产前高危情况，产前护理不足均与新生儿死亡增加有关。产前护理不足与新生儿死亡率之间所观察到的关联可能是由这些妊娠中早产和低出生体重风险增加所介导的。产前护理过度使用与胎儿和新生儿发育的潜在风险有关，导致新生儿死亡率增加。
