Zhou Qiongjie, Zhang Shikun, Wang Qiaomei, Shen Haiping, Tian Weidong, Chen Jingqi, Acharya Ganesh, Li Xiaotian
Obstetrics and Gynecology Hospital of Fudan University, 419 Fangxie Road, Shanghai, 200011, China.
The Shanghai Key Laboratory of Female Reproductive Endocrine-Related Diseases, Shanghai, China.
BMC Health Serv Res. 2016 Dec 28;16(1):689. doi: 10.1186/s12913-016-1930-4.
Preconception care (PCC) is recommended for optimizing a woman's health prior to pregnancy to minimize the risk of adverse pregnancy and birth outcomes. We aimed to evaluate the impact of strategy and a novel risk classification model of China´s "National Preconception Health Care Project" (NPHCP) in identifying risk factors and stratifying couples' preconception health status.
We performed a secondary analysis of data collected by NPHCP during April 2010 to December 2012 in 220 selected counties in China. All couples enrolled in the project accepted free preconception health examination, risk evaluation, health education and medical advice. Risk factors were categorized into five preconception risk classes based on their amenability to prevention and treatment: A-avoidable risk factors, B- benefiting from targeted medical intervention, C-controllable but requiring close monitoring and treatment during pregnancy, D-diagnosable prenatally but not modifiable preconceptionally, X-pregnancy not advisable. Information on each couple´s socio-demographic and health status was recorded and further analyzed.
Among the 2,142,849 couples who were enrolled to this study, the majority (92.36%) were from rural areas with low education levels (89.2% women and 88.3% men had education below university level). A total of 1463266 (68.29%) couples had one or more preconception risk factors mainly of category A, B and C, among which 46.25% were women and 51.92% were men. Category A risk factors were more common among men compared with women (38.13% versus 11.24%; P = 0.000).
This project provided new insights into preconception health of Chinese couples of reproductive age. More than half of the male partners planning to father a child, were exposed to risk factors during the preconception period, suggesting that an integrated approach to PCC including both women and men is justified. Stratification based on the new risk classification model demonstrated that a majority of the risk factors are avoidable, or preventable by medical intervention. Therefore, universal free PCC can be expected to improve pregnancy outcomes in rural China.
推荐进行孕前保健（PCC），以在怀孕前优化女性健康，将不良妊娠和分娩结局的风险降至最低。我们旨在评估中国“国家孕前保健项目”（NPHCP）的策略和一种新的风险分类模型在识别风险因素以及对夫妇孕前健康状况进行分层方面的影响。
我们对NPHCP在2010年4月至2012年12月期间在中国220个选定县收集的数据进行了二次分析。所有参与该项目的夫妇均接受了免费的孕前健康检查、风险评估、健康教育和医疗建议。根据风险因素对预防和治疗的可及性，将风险因素分为五类孕前风险等级：A类-可避免的风险因素，B类-受益于针对性医疗干预，C类-可控但孕期需要密切监测和治疗，D类-产前可诊断但孕前不可改变，X类-不宜怀孕。记录并进一步分析了每对夫妇的社会人口统计学和健康状况信息。
在纳入本研究的2,142,849对夫妇中，大多数（92.36%）来自农村地区，教育水平较低（89.2%的女性和88.3%的男性教育水平低于大学）。共有1,463,266对（68.29%）夫妇有一个或多个孕前风险因素，主要为A、B和C类，其中46.25%为女性，51.92%为男性。与女性相比，A类风险因素在男性中更为常见（38.13%对11.24%；P = 0.000）。
该项目为中国育龄夫妇的孕前健康提供了新的见解。超过一半计划生育的男性伴侣在孕前期间暴露于风险因素中，这表明包括男性和女性在内的综合孕前保健方法是合理的。基于新的风险分类模型进行分层表明，大多数风险因素是可避免的，或可通过医疗干预预防。因此，普遍免费的孕前保健有望改善中国农村地区的妊娠结局。
