Department of Medical Sociology and Health Sciences, Vrije Universiteit Brussel, Brussels, Belgium.
Eur J Public Health. 2013 Jun;23(3):366-71. doi: 10.1093/eurpub/cks123. Epub 2012 Sep 12.
Antenatal care can play an important role in the prevention of preterm birth. Evaluation of antenatal care is usually based on the number of visits rather than the content of care, using tools such as the Adequacy of Prenatal Care Use index. This article presents an analysis of the relation between specific elements of antenatal care and the risk of preterm birth compared with considering the number of visits only.
A prospective cohort study was conducted in the Brussels Metropolitan Region. In all, 333 women were consecutively recruited at the beginning of their antenatal care trajectory and followed until birth. Information on timing and content for every visit was recorded by structured interview. A new tool was developed to measure the antenatal care trajectory, which included Content and Timing of care in Pregnancy (CTP). Odds ratios (OR) (adjusted and unadjusted) for preterm birth were calculated for the Adequacy of Prenatal Care Use and CTP model.
The number of visits alone was not associated with preterm birth. In contrast, a significant association was found between the content and timing of care and preterm birth. Compared with the CTP lowest ('inadequate') category, women in the CTP 'sufficient' (OR 0.30; 95% CI 0.09-0.94) and CTP 'appropriate' (OR 0.21; 95% CI 0.06-0.68) category had a lower risk.
This study suggests that measurement of the content and timing of care of antenatal care using the new CTP tool is a better assessment of the risk of preterm birth than assessment of the number of antenatal visits alone.
产前护理在预防早产方面可以发挥重要作用。产前护理的评估通常基于就诊次数，而不是护理内容，使用 Adequacy of Prenatal Care Use 指数等工具。本文提出了一种分析特定产前护理要素与早产风险之间关系的方法，与仅考虑就诊次数相比。
在布鲁塞尔大都市区进行了一项前瞻性队列研究。总共连续招募了 333 名女性，在其产前护理轨迹开始时进行随访，并持续到分娩。通过结构化访谈记录每次就诊的时间和内容信息。开发了一种新工具来衡量产前护理轨迹，包括妊娠期间的护理内容和时间（CTP）。使用 Adequacy of Prenatal Care Use 和 CTP 模型计算早产的优势比（OR）（调整和未调整）。
就诊次数与早产无关。相比之下，护理的内容和时间与早产之间存在显著关联。与 CTP 最低（“不足”）类别相比，处于 CTP“充足”（OR 0.30；95%CI 0.09-0.94）和 CTP“适当”（OR 0.21；95%CI 0.06-0.68）类别的女性早产风险较低。
本研究表明，使用新的 CTP 工具测量产前护理的内容和时间，比单独评估产前就诊次数更能评估早产风险。
