Servan-Mori Edson, Sosa-Rubí Sandra G, Najera-Leon Esmeralda, Darney Blair G
National Institute of Public Health, Mexico, Center for Health System Research.
National Institute of Public Health, Mexico, Center for Health System Research,
Health Policy Plan. 2016 May;31(4):444-53. doi: 10.1093/heapol/czv082. Epub 2015 Sep 1.
This article examines the role of components of adequate antenatal care (ANC) in disparities in birth weight between indigenous and non-indigenous women in Mexico. We estimate the potential for added weight gain among indigenous infants if their mothers received timely, frequent ( ≥4 visits) and complete ANC (≥75% of recommended processes of care). We used population-based survey data (2012;N= 6612 women 12-49). We applied quantile regression to examine heterogeneity of the association between adequate ANC, indigenous ethnicity and birth weight across quantiles of the birth weight distribution. A greater proportion of indigenous women reported a low-birth weight infant (<2.5 kg) at last delivery (14 vs 8% among non-indigenous women). Coverage of adequate ANC (timely, frequent and complete care) is lower among indigenous (59%, CI:53;65) than non-indigenous (68%, CI:66;70) women. Indigenous ethnicity is associated with a lower birth weight across quantiles of the observed birth weight distribution: between 300 g in the 0.05, 0.10 and 0.25 quantiles. Among indigenous women, greater newborn weight gains are achieved in the lowest quantiles if they have access to ≥75% of the content of ANC compared with those that did not have access: ∼180 and 260 g are gained in both quantiles 0.05 and 0.10, respectively. This means that the smallest indigenous newborns could potentially reach 2.36 kg (from 1.86 kg), close to the normal weight threshold. The frequency of ANC was positively associated with birth weight for all women but complete ANC appears to differentially affect indigenous women at the bottom of the birth weight distribution. The marginal gains obtained among indigenous newborns that received complete ANC compared with indigenous/non-indigenous newborns did not receive it, is particularly important in low-birth weight quantiles. Delivering basic processes of ANC may therefore have the potential to impact the highest risk women and help them to overcome the low-birth weight threshold.
本文探讨了充分的产前护理（ANC）各组成部分在墨西哥土著和非土著妇女出生体重差异中所起的作用。我们估计，如果土著婴儿的母亲接受了及时、频繁（≥4次就诊）且完整的ANC（≥75%的推荐护理流程），其体重增加的潜力。我们使用了基于人群的调查数据（2012年；N = 6612名12 - 49岁的妇女）。我们应用分位数回归来检验在出生体重分布的各个分位数上，充分的ANC、土著种族与出生体重之间关联的异质性。更大比例的土著妇女报告称上次分娩时婴儿出生体重低（<2.5千克）（非土著妇女中这一比例为8%，而土著妇女中为14%）。土著妇女中充分的ANC（及时、频繁且完整的护理）覆盖率（59%，置信区间：53；65）低于非土著妇女（68%，置信区间：66；70）。在观察到的出生体重分布的各个分位数上，土著种族与较低的出生体重相关：在0.05、0.10和0.25分位数上相差约300克。在土著妇女中，如果能够获得≥75%的ANC内容，与无法获得的妇女相比，在最低分位数上新生儿体重增加更多：在0.05和0.10分位数上分别增加约180克和260克。这意味着最小的土著新生儿有可能达到2.36千克（从1.86千克开始），接近正常体重阈值。对于所有妇女而言，ANC的就诊频率与出生体重呈正相关，但完整的ANC似乎对出生体重分布底部的土著妇女有不同影响。与未接受完整ANC的土著/非土著新生儿相比，接受完整ANC的土著新生儿所获得的边际收益在低出生体重分位数上尤为重要。因此，提供基本的ANC护理流程可能有潜力影响风险最高的妇女，并帮助她们跨越低出生体重阈值。
