Liu Xiaoying, Behrman Jere R, Stein Aryeh D, Adair Linda S, Bhargava Santosh K, Borja Judith B, da Silveira Mariangela Freitas, Horta Bernardo L, Martorell Reynaldo, Norris Shane A, Richter Linda M, Sachdev Harshpal S
Population Studies Center, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America.
Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, United States of America.
PLoS One. 2017 Feb 3;12(2):e0171299. doi: 10.1371/journal.pone.0171299. eCollection 2017.
The effectiveness of prenatal care for improving birth and subsequent child outcomes in low-income countries remains controversial, with much of the evidence to date coming from high-income countries and focused on early-life outcomes. We examined associations between prenatal care visits and birth weight, height-for-age at 24 months and attained schooling in four low- and middle-income countries.
We pooled data from prospective birth-cohort studies from Brazil, Guatemala, Philippines and South Africa. We created a prenatal care utilization index based on the number and timing of prenatal visits. Associations were examined between this index and birth weight, height-for-age at 24 months, and highest attained schooling grade until adulthood.
Among 7203 individuals in the analysis, 68.9% (Philippines) to 96.7% (South Africa) had at least one prenatal care visit, with most having at least four visits. Over 40% of Brazilians and Guatemalans had their first prenatal visit in the first trimester, but fewer Filipinos (13.9%) and South Africans (19.8%) did so. Prenatal care utilization was not significantly associated with birth weight (p>0.05 in pooled data). Each unit increase in the prenatal care utilization index was associated with 0.09 (95% CI 0.04 to 0.15) higher height-for-age z-score at 24 months and with 0.26 (95% CI 0.17 to 0.35) higher schooling grades attained. Although there was some heterogeneity and greater imprecision across sites, the results were qualitatively similar among the four different populations.
While not related to birth weight, prenatal care utilization was associated with important outcomes later in life, specifically higher height-for-age at 24 months and higher attained school grades. These results suggest the relevance of prenatal care visits for human capital outcomes important over the lifecycle.
在低收入国家，产前保健对改善分娩及后续儿童健康状况的有效性仍存在争议，目前的大部分证据来自高收入国家，且主要关注生命早期的结果。我们在四个低收入和中等收入国家研究了产前检查次数与出生体重、24个月龄时的年龄别身高以及受教育程度之间的关联。
我们汇总了来自巴西、危地马拉、菲律宾和南非的前瞻性出生队列研究数据。我们根据产前检查的次数和时间创建了一个产前保健利用指数。研究了该指数与出生体重、24个月龄时的年龄别身高以及成年前最高受教育年级之间的关联。
在分析的7203名个体中，68.9%（菲律宾）至96.7%（南非）至少进行了一次产前检查，大多数人至少进行了四次检查。超过40%的巴西人和危地马拉人在孕早期进行了首次产前检查，但菲律宾人（13.9%）和南非人（19.8%）中这样做的较少。产前保健利用与出生体重无显著关联（汇总数据中p>0.05）。产前保健利用指数每增加一个单位，与24个月龄时年龄别身高z评分高0.09（95%CI 0.04至0.15）以及受教育年级高0.26（95%CI 0.17至0.35）相关。尽管各研究地点存在一些异质性和更大的不精确性，但在四个不同人群中结果在定性上相似。
虽然产前保健利用与出生体重无关，但与生命后期的重要结果相关，特别是24个月龄时更高的年龄别身高和更高的受教育年级。这些结果表明产前检查对整个生命周期中重要的人力资本结果具有相关性。
