Division of Epidemiology, Statistics and Prevention Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Rockville, MD, USA.
BJOG. 2013 Oct;120(11):1395-402. doi: 10.1111/1471-0528.12202. Epub 2013 Mar 21.
Screening for psychosocial and behavioural risks, such as depression, intimate partner violence, and smoking, during pregnancy is considered to be state of the art in prenatal care. This prospective longitudinal analysis examines the added benefit of repeated screening, compared with a single screening, in identifying such risks during pregnancy.
Data were collected as part of a randomised controlled trial to address intimate partner violence, depression, smoking, and environmental tobacco smoke exposure in African American women.
Prenatal care sites in the District of Columbia serving mainly women of minority background.
A cohort of 1044 African American pregnant women in the District of Columbia.
Mothers were classified by their initial response (acknowledgement of risks), and these data were updated during pregnancy. Risks were considered new if they were not previously reported. Standard hypothesis tests and logistic regression were used to predict the acknowledgment of any new risk(s) during pregnancy.
New risks: psychosocial variables to understand what factors might help identify the acknowledgement of additional risk(s).
Repeated screening identified more mothers acknowledging risk over time. Reported smoking increased by 11%, environmental tobacco smoke exposure increased by 19%, intimate partner violence increased by 9%, and depression increased by 20%. The psychosocial variables collected at the baseline that were entered into the logistic regression model included relationship status, education, Medicaid, illicit drug use, and alcohol use during pregnancy. Among these, only education less than high school was associated with the acknowledgement of new risk in the bivariate analyses, and significantly predicted the identification of new risks (OR 1.39, 95% CI 1.01-1.90).
It is difficult to predict early on who will acknowledge new risks over the course of pregnancy, and thus all women should be screened repeatedly to allow for the identification of risks and intervention during prenatal care.
在产前护理中，筛查心理社会和行为风险（如抑郁、亲密伴侣暴力和吸烟）被认为是最先进的方法。本前瞻性纵向分析研究了与单次筛查相比，重复筛查在怀孕期间识别此类风险的额外益处。
数据是作为一项针对非裔美国妇女的亲密伴侣暴力、抑郁、吸烟和环境烟草烟雾暴露的随机对照试验的一部分收集的。
在哥伦比亚特区为主要是少数族裔背景的妇女提供服务的产前护理点。
哥伦比亚特区的 1044 名非裔美国孕妇队列。
根据母亲的初始反应（承认风险）对其进行分类，并且这些数据在怀孕期间进行更新。如果以前未报告过，则认为风险是新的。标准假设检验和逻辑回归用于预测怀孕期间任何新风险的承认。
新风险：心理社会变量，以了解哪些因素可能有助于识别额外风险的承认。
重复筛查随着时间的推移发现更多承认风险的母亲。报告的吸烟增加了 11%，环境烟草烟雾暴露增加了 19%，亲密伴侣暴力增加了 9%，抑郁增加了 20%。纳入逻辑回归模型的基线收集的心理社会变量包括关系状况、教育、医疗补助、非法药物使用和怀孕期间饮酒。在这些变量中，只有高中以下教育在双变量分析中与新风险的承认相关，并且显著预测了新风险的识别（比值比 1.39，95%置信区间 1.01-1.90）。
很难预测谁会在整个怀孕期间承认新的风险，因此所有妇女都应接受重复筛查，以便在产前护理中识别风险并进行干预。
