Petersson Kerstin, Lindkvist Marie, Persson Margareta, Conner Peter, Åhman Annika, Mogren Ingrid
Department of Clinical Sciences, Obstetrics and Gynecology, Umeå University, Umeå, Sweden.
Department of Statistics, USBE; Department of Public Health and Clinical Medicine, Epidemiology and Global Health, Umeå University, Umeå, Sweden.
BMC Pregnancy Childbirth. 2016 Nov 22;16(1):365. doi: 10.1186/s12884-016-1165-8.
Prenatal diagnosis involves methods used in early pregnancy as either screening tests or diagnostic methods. The aims of the study were to i) investigate guidelines on prenatal diagnosis in the counties of Sweden, ii) investigate uptake of prenatal diagnosis, and iii) background characteristics and pregnancy outcomes in relation to different prenatal diagnostic methods.
A retrospective cross-sectional study using data from the Swedish Pregnancy Register 2011 to 2013 (284,789 pregnancies) was performed. Additionally, guidelines on prenatal diagnosis were collected. Biostatistical and epidemiological analyses were performed including calculation of odds ratios (OR) and their 95% confidence intervals in univariate and multivariate logistic regression analyses.
The national uptake of routine ultrasound examination, Combined Ultrasound and Biochemical test (CUB), Amniocentesis (AC) and Chorionic Villus Sampling (CVS) were 97.6, 33.0, 2.6 and 1.1%, respectively. From 2012, 6/21 counties offered CUB test to all pregnant women, nine counties at specific indications, and five counties did not offer CUB at all. Advanced maternal age demonstrated the highest impact on uptake of prenatal diagnosis. Further, university educational level in relation to lower educational level was associated with an increased likelihood of undergoing CUB (OR 2.30, 95% CI 2.26-2.35), AC (OR 1.54, 95% CI 1.46-1.63) and CVS (OR 2.68, 95% CI 2.44-2.93).
Offers of prenatal diagnosis varied considerably between counties resulting in unequal access to prenatal diagnosis for pregnant women. The intentions of the Swedish Health and Medical Services Act stating equal care for all, was thus not fulfilled.
产前诊断涉及在妊娠早期使用的筛查试验或诊断方法。本研究的目的是：i）调查瑞典各县的产前诊断指南；ii）调查产前诊断的接受情况；iii）与不同产前诊断方法相关的背景特征和妊娠结局。
采用瑞典妊娠登记处2011年至2013年（284,789例妊娠）的数据进行回顾性横断面研究。此外，收集了产前诊断指南。进行了生物统计学和流行病学分析，包括在单变量和多变量逻辑回归分析中计算比值比（OR）及其95%置信区间。
常规超声检查、超声与生化联合检测（CUB）、羊膜穿刺术（AC）和绒毛取样（CVS）的全国接受率分别为97.6%、33.0%、2.6%和1.1%。从2012年起，21个县中有6个县为所有孕妇提供CUB检测，9个县在特定指征下提供，5个县根本不提供CUB检测。高龄产妇对产前诊断接受率的影响最大。此外，与低教育水平相比，大学教育水平与接受CUB检测（OR 2.30，95%CI 2.26-2.35）、AC检测（OR 1.54，95%CI 1.46-1.63）和CVS检测（OR 2.68，95%CI 2.44-2.93）的可能性增加相关。
各县之间产前诊断的提供情况差异很大，导致孕妇获得产前诊断的机会不平等。因此，瑞典《健康和医疗服务法》规定的对所有人平等护理的意图没有实现。
