Hillemeier Marianne M, Weisman Carol S, Chase Gary A, Dyer Anne-Marie, Shaffer Michele L
Department of Health Policy and Administration, Pennsylvania State University, 116 Henderson, University Park, PA 16802, USA.
Health Serv Res. 2008 Feb;43(1 Pt 1):54-75. doi: 10.1111/j.1475-6773.2007.00741.x.
To improve understanding of women's use of health care before pregnancy, by analyzing how the health status and health risks of pre- and interconceptional women are associated with health services use.
Data are from a cross-sectional random-digit dial telephone survey of a representative sample of 2002 women ages 18-45 years from the Central Pennsylvania Women's Health Study (CePAWHS). A subsample of 1,325 respondents with current reproductive capacity, classified by reproductive life stage (preconceptional or interconceptional), was analyzed.
Bivariate and multiple logistic regression analyses were conducted to determine how health needs (including indices of health status and health risks related to adverse pregnancy outcomes) are associated with five indicators of health services use (receipt of a regular physical exam, obstetrician-gynecologist [ob/gyn] visit, receipt of a set of recommended screening services, receipt of health counseling services on general health topics, and receipt of pregnancy-related counseling), controlling for predisposing and enabling variables.
Only half of women at risk of pregnancy report receiving counseling about pregnancy planning in the past year. One-third of women surveyed did not receive routine physical examinations and screening services, and over half received little or no health counseling. Multivariate analyses showed that all the measures of health needs except for negative health behavior were related to some type of health services use. Psychosocial stress was associated with having a recent ob/gyn visit, with receiving general health counseling, and with receiving pregnancy planning counseling. Cardiovascular risk was positively associated with receiving general health counseling and a regular physical exam, but negatively associated with seeing an ob/gyn. Positive health behaviors were associated with receiving screening services and with receiving general health counseling. Preconceptional reproductive life stage was positively associated with receiving a regular physical exam and negatively associated with having an ob/gyn visit.
Pre- and interconceptional women with specific health care needs may not receive appropriate health care before pregnancy. Improving pregnancy experiences and outcomes requires more comprehensive preconception health care and more preventive care before the first pregnancy.
通过分析孕前及受孕间期女性的健康状况和健康风险与医疗服务利用之间的关联，增进对女性孕前医疗服务利用情况的了解。
数据来自宾夕法尼亚州中部女性健康研究（CePAWHS）对2002名年龄在18 - 45岁的女性进行的横断面随机数字拨号电话调查。对1325名有当前生殖能力的受访者按生殖生命阶段（孕前或受孕间期）进行分类后组成的子样本进行了分析。
进行双变量和多因素逻辑回归分析，以确定健康需求（包括与不良妊娠结局相关的健康状况指标和健康风险）如何与五项医疗服务利用指标（接受定期体检、看妇产科医生[ob/gyn]、接受一套推荐的筛查服务、接受关于一般健康主题的健康咨询服务以及接受与妊娠相关的咨询）相关联，并对 predisposing 和 enabling 变量进行控制。
在有怀孕风险的女性中，只有一半报告在过去一年接受过关于妊娠计划的咨询。三分之一的受访女性未接受常规体检和筛查服务，超过一半的女性接受的健康咨询很少或没有。多因素分析表明，除了负面健康行为外，所有健康需求指标都与某种类型的医疗服务利用相关。心理社会压力与近期看妇产科医生、接受一般健康咨询以及接受妊娠计划咨询相关。心血管风险与接受一般健康咨询和定期体检呈正相关，但与看妇产科医生呈负相关。积极的健康行为与接受筛查服务和接受一般健康咨询相关。孕前生殖生命阶段与接受定期体检呈正相关，与看妇产科医生呈负相关。
有特定医疗需求的孕前及受孕间期女性在孕前可能未获得适当的医疗保健。改善妊娠体验和结局需要更全面的孕前保健以及首次怀孕前更多的预防性保健。
