产后避孕对降低早产的影响：来自加利福尼亚的研究结果
The impact of postpartum contraception on reducing preterm birth: findings from California.
作者信息
Rodriguez Maria I, Chang Richard, Thiel de Bocanegra Heike
机构信息
Department of Obstetrics and Gynecology, Oregon Health and Science University, Portland, OR.
Bixby Center for Global Reproductive Health, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, School of Medicine, San Francisco, CA.
出版信息
Am J Obstet Gynecol. 2015 Nov;213(5):703.e1-6. doi: 10.1016/j.ajog.2015.07.033. Epub 2015 Jul 26.
OBJECTIVE
Family planning is recommended as a strategy to prevent adverse birth outcomes. The potential contribution of postpartum contraceptive coverage to reducing rates of preterm birth is unknown. In this study, we examine the impact of contraceptive coverage and use within 18 months of a birth on preventing preterm birth in a Californian cohort.
STUDY DESIGN
We identified records for second or higher-order births among women from California's 2011 Birth Statistical Master File and their prior births from earlier Birth Statistical Master Files. To identify women who received contraceptive services from publicly funded programs, we applied a probabilistic linking methodology to match birth files with enrollment records for women with Medi-Cal or Family Planning, Access, Care, and Treatment Program (PACT) claims. The length of contraceptive coverage was determined through applying an algorithm based on the specified method and the quantity dispensed. Preterm birth was defined as a birth occurring <37 weeks' gestation, and calculated from the medical record. We further examined differences in preterm birth using subcategories defined by the World Health Organization: extremely preterm (<28 weeks); very preterm (28 to <32 weeks); and moderate to late preterm (32 to <37 weeks). We built a multivariable regression model to examine the effect of contraceptive coverage on the odds of a preterm birth and control for key covariates.
RESULTS
The cohort consisted of 111,948 women who were seen at least once by a Medi-Cal or Family PACT provider within 18 months of delivery. Of the cohort, 9.75% had a preterm birth. Contraceptive coverage was found to be protective against preterm birth. For every month of contraceptive coverage, odds of a preterm birth <37 weeks decrease by 1.1% (odds ratio, 0.989; 95% confidence interval, 0.986-0.993).
CONCLUSION
Improving postpartum contraceptive use has the potential to reduce preterm births.
目的
计划生育被推荐作为预防不良分娩结局的一项策略。产后避孕覆盖率对降低早产率的潜在贡献尚不清楚。在本研究中，我们调查了加利福尼亚队列中分娩后18个月内避孕覆盖率及避孕措施使用情况对预防早产的影响。
研究设计
我们从加利福尼亚2011年出生统计主文件中识别出二次或更高次分娩的女性记录以及她们之前在早期出生统计主文件中的分娩记录。为了识别从公共资助项目接受避孕服务的女性，我们应用概率链接方法将出生文件与有医疗补助或计划生育、准入、护理和治疗项目（PACT）理赔的女性登记记录进行匹配。避孕覆盖时长通过基于指定方法和发放量应用算法来确定。早产定义为妊娠<37周分娩，从病历中计算得出。我们进一步使用世界卫生组织定义的亚类别来检查早产差异：极早早产（<28周）；非常早产（28至<32周）；中度至晚期早产（32至<37周）。我们构建了一个多变量回归模型来研究避孕覆盖率对早产几率的影响并控制关键协变量。
结果
该队列由111,948名在分娩后18个月内至少被医疗补助或家庭PACT提供者诊治过一次的女性组成。该队列中，9.75%的女性早产。发现避孕覆盖对预防早产有保护作用。每增加一个月的避孕覆盖，<37周早产的几率降低1.1%（比值比，0.989；95%置信区间，0.986 - 0.993）。
结论
提高产后避孕措施的使用有可能降低早产率。
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