Wally Meghan K, Huber Larissa R Brunner, Issel L Michele, Thompson Michael E
Department of Public Health Sciences, UNC Charlotte, 9201 University City Blvd, Charlotte, NC, 28223, USA.
Matern Child Health J. 2018 Jan;22(1):41-50. doi: 10.1007/s10995-017-2352-6.
Objectives Prenatal care (PNC) is a critical preventive health service for pregnant women and infants. While timely PNC has been associated with improved birth outcomes, improvements have slowed since the late 1990s. Therefore, focus has shifted to interventions prior to pregnancy. Preconception care is recommended for all women of reproductive age. This study aimed to examine preconception care and its association with timeliness and adequacy of PNC. Methods This retrospective cohort study used data from a large sample of United States first-time mothers (n = 13,509) who participated in the 2009-2011 Pregnancy Risk Assessment Monitoring System in ten states. Timeliness and adequacy of PNC data came from birth certificates, while preconception care receipt was self-reported. Logistic regression provided odds ratios (ORs) and 95% confidence intervals (CIs) to model the association between preconception care receipt and the two PNC outcomes. Results After adjustment, women who received preconception care had statistically significant increased odds of timely (OR 1.30, 95% CI 1.08, 1.57), but not adequate PNC (OR 1.08, 95% CI 0.94, 1.24) as compared to women who did not receive preconception care. Pregnancy intention modified these associations. Associations were strongest among women with intended pregnancies (timely PNC: OR 1.63 and adequate PNC: OR 1.22). Conclusions for Practice Given that untimely PNC is associated with adverse birth outcomes, the observed association warrants increased focus on implementing preconception care. Future studies should investigate how specific components of preconception care are associated with PNC timeliness/adequacy, health behaviors during pregnancy, and birth outcomes.
目标 产前护理（PNC）是一项针对孕妇和婴儿的关键预防性保健服务。虽然及时的产前护理与改善分娩结局相关，但自20世纪90年代末以来，改善速度有所放缓。因此，重点已转向怀孕前的干预措施。建议所有育龄妇女接受孕前保健。本研究旨在探讨孕前保健及其与产前护理及时性和充分性的关联。方法 这项回顾性队列研究使用了来自美国10个州参与2009 - 2011年妊娠风险评估监测系统的大量首次生育母亲样本（n = 13509）的数据。产前护理的及时性和充分性数据来自出生证明，而孕前保健的接受情况是自我报告的。逻辑回归提供比值比（OR）和95%置信区间（CI），以模拟孕前保健接受情况与两种产前护理结果之间的关联。结果 调整后，与未接受孕前保健的女性相比，接受孕前保健的女性及时接受产前护理的几率在统计学上显著增加（OR 1.30，95% CI 1.08，1.57），但产前护理充分性方面无显著差异（OR 1.08，95% CI 0.94，1.24）。妊娠意愿改变了这些关联。在有计划妊娠的女性中关联最强（及时产前护理：OR 1.63；充分产前护理：OR 1.22）。实践结论 鉴于不及时的产前护理与不良分娩结局相关，观察到的这种关联值得更加关注实施孕前保健。未来的研究应调查孕前保健的具体组成部分如何与产前护理的及时性/充分性、孕期健康行为以及分娩结局相关联。
