Rowe R E, Magee H, Quigley M A, Heron P, Askham J, Brocklehurst P
National Perinatal Epidemiology Unit, University of Oxford, Old Road Campus, Headington, Oxford OX3 7LF, UK.
Public Health. 2008 Dec;122(12):1363-72. doi: 10.1016/j.puhe.2008.05.011. Epub 2008 Jul 21.
Evidence about sociodemographic factors associated with late attendance for antenatal care in the UK is of poor quality. This study aimed to identify any social or ethnic differences in access to antenatal care, and to quantify the effect of any such differences using data collected in a survey of women's experiences of antenatal screening.
Cross-sectional survey using a postal questionnaire.
A stratified clustered random sampling strategy was used. Hospitals in England were stratified according to ethnic mix. In order to ensure inclusion of an adequate number of women from Black and Minority Ethnic (BME) backgrounds, hospitals with >or= 15% of women of BME origin were oversampled. Pregnant women aged >or= 16 years, receiving care in 15 participating hospitals, were sent a postal questionnaire at 27-31 weeks of gestation. Logistic regression was used to estimate odds ratios (ORs) comparing social and ethnic groups for attendance for antenatal care, adjusting for sociodemographic and clinical factors.
In total, 839 women (57%) returned completed questionnaires. Compared with all women giving birth in 2005 in England and Wales, the survey sample contained fewer women aged <20 years (5.8% vs 6.9%), more women aged >35 years (24.1% vs 19.6%) and fewer women who were born outside the UK (14.8% vs 20.8%). Five percent of responders were late attenders for their first antenatal appointment. The odds of late initiation of antenatal care were higher for women born outside the UK [OR 4.37, 95% confidence interval (CI) 2.25-8.52; P=0.0004] and for women living without a husband/partner (OR 2.74, 95% CI 1.81-4.16; P=0.0002). In total, 2.5% of women were late attenders for their booking appointment. The odds of late booking were higher for Black women (OR 5.92, 95% CI 2.97-11.83) and women living without a husband/partner (OR 1.95, 95% CI 0.97-3.93; P=0.06).
A small proportion of women initiate and/or book late for antenatal care. This study provides recent, good-quality evidence that women born outside the UK and those living without a husband/partner may be at particular risk of late attendance for antenatal care.
关于英国与产前护理延迟就诊相关的社会人口学因素的证据质量较差。本研究旨在确定在获得产前护理方面是否存在任何社会或种族差异，并利用在一项关于女性产前筛查经历的调查中收集的数据，量化任何此类差异的影响。
采用邮政问卷进行横断面调查。
使用分层整群随机抽样策略。英格兰的医院根据种族构成进行分层。为了确保纳入足够数量来自黑人和少数族裔（BME）背景的女性，对BME族裔女性占比≥15%的医院进行了过度抽样。年龄≥16岁、在15家参与研究的医院接受护理的孕妇，在妊娠27 - 31周时收到一份邮政问卷。采用逻辑回归估计比较社会和种族群体产前护理就诊情况的比值比（OR），并对社会人口学和临床因素进行调整。
总共839名女性（57%）返回了完整的问卷。与2005年在英格兰和威尔士分娩的所有女性相比，调查样本中年龄＜20岁的女性较少（5.8%对6.9%），年龄＞35岁的女性较多（24.1%对19.6%），在英国境外出生的女性较少（14.8%对20.8%）。5%的受访者首次产前预约就诊延迟。在英国境外出生的女性产前护理开始延迟的几率更高[比值比4.37，95%置信区间（CI）2.25 - 8.52；P = 0.0004]，以及没有丈夫/伴侣共同生活的女性（比值比2.74，95% CI 1.81 - 4.16；P = 0.0002）。总共2.5%的女性预约就诊延迟。黑人女性预约延迟的几率更高（比值比5.92，95% CI 2.97 - 11.83），以及没有丈夫/伴侣共同生活的女性（比值比1.95，95% CI 0.97 - 3.93；P = 0.06）。
一小部分女性开始产前护理和/或预约就诊延迟。本研究提供了近期的高质量证据，表明在英国境外出生的女性以及没有丈夫/伴侣共同生活的女性可能特别容易出现产前护理延迟就诊的情况。
