Department of Health Administration and Policy, The College of Health and Human Services, George Mason University, Fairfax, VA 22030, USA.
Womens Health Issues. 2012 Sep;22(5):e455-60. doi: 10.1016/j.whi.2012.06.003. Epub 2012 Jul 28.
To identify the contribution of life stressors and barriers to the untimely initiation of prenatal care for women with high-risk pregnancies living in rural and nonrural areas.
Data collected in 10 U.S. states by the 2006-2008 Pregnancy Risk Assessment Monitoring System (PRAMS) were used (n = 34,161). Data were weighted to reflect the PRAMS complex survey design. Separate logistic regression models derived adjusted odds ratios for untimely prenatal care initiation based on several life stressors and barriers.
Women with high-risk pregnancies living in rural areas were more likely to report late initiation of prenatal care (17.5% vs. 14.6%). The most frequently reported life stressors were the same for both cohorts: Moving, having a very sick family member, arguing more than usual with their partners, and having bills they could not pay. The most frequently cited barriers were also the same for both groups: Not having enough money or insurance for health care visits and not being able to get an appointment when they wanted one. Having two or more barriers increased the risk of late prenatal care initiation by 2.85-fold for rural women and 2.01-fold for nonrural women.
To increase timely prenatal care initiation, preconception interventions are needed that address common life stressors and barriers shared by women living in rural and nonrural areas.
确定生活应激源和障碍对农村和非农村高风险妊娠妇女产前保健开始时间不当的影响。
使用了 2006-2008 年美国 10 个州妊娠风险评估监测系统（PRAMS）收集的数据（n=34161）。数据经过加权处理，以反映 PRAMS 复杂的调查设计。根据几个生活应激源和障碍，分别为及时开始产前保健制定了调整后的优势比的逻辑回归模型。
农村地区高风险妊娠的妇女更有可能报告产前保健开始时间不当（17.5%比 14.6%）。两个队列报告的最常见生活应激源相同：搬家、有非常生病的家庭成员、与伴侣争吵多于平常、有无法支付的账单。两个群体最常提到的障碍也相同：没有足够的钱或保险来支付医疗费用，并且无法在他们想要的时间预约。对于农村妇女和非农村妇女，有两个或更多障碍会使产前保健开始时间不当的风险增加 2.85 倍和 2.01 倍。
为了增加及时的产前保健开始时间，需要在农村和非农村地区的妇女中进行孕前干预，以解决共同的生活应激源和障碍。
