Institute of Health & Society, Newcastle University, Baddiley-Clark Building, Richardson Road, Newcastle upon Tyne, NE2 4AX, UK.
BMC Pregnancy Childbirth. 2017 Sep 6;17(1):290. doi: 10.1186/s12884-017-1475-5.
Late access to antenatal care increases risks of adverse outcomes including maternal and perinatal mortality. There is evidence that BMI influences patient engagement with health services, such as cancer screening services and delayed access to treatment; this association has not been fully explored in the context of antenatal care. This study investigated the association between the stage of pregnancy women access antenatal care, BMI, and other socio-demographic factors.
Retrospective analysis of routine hospital data from 34 NHS maternity units in England, UK, including 619,502 singleton births between 1989 and 2007. Analyses used logistic regression to investigate the association between maternal BMI categories and stage of pregnancy women accessed antenatal care. Adjusted odds ratios (aORs) and 95% confidence intervals (CIs) were used to estimate associations, adjusting for maternal age, ethnic group, parity, Index of Multiple Deprivation score and employment status. The primary outcome was late access to antenatal care (>13 weeks). Secondary outcomes were trimester of access, and the association between late access and other socio-demographic variables.
Women with an overweight or obese BMI accessed antenatal care later than women with a recommended BMI (aOR 1.11, 95%CI 1.09-1.12; aOR 1.04, 95%CI 1.02-1.06 respectively), and underweight women accessed care earlier (aOR 0.77, 95%CI 0.74-0.81). Women with obesity were 42% more likely to access care in the third trimester compared with women with a recommended BMI. Additional significant socio-demographic associations with late access included women from minority ethnic groups, teenagers, unemployment and deprivation. The greatest association was observed among Black/Black British women accessing care in the third trimester (aOR 5.07, 95% CI 4.76, 5.40).
There are significant and complex socio-demographic inequalities associated with the stage of pregnancy women access maternity care, particularly for women with obesity accessing care very late in their pregnancy, and among BME groups, teenagers, deprived and unemployed women. These populations are at increased risk of adverse maternal and fetal outcomes and require support to address inequalities in access to antenatal care. Interventions to facilitate earlier access to care should address the complex and inter-related nature of these inequalities to improve pregnancy outcomes among high-risk groups.
晚期获得产前护理会增加不良母婴结局的风险，包括产妇和围产期死亡率。有证据表明，BMI 会影响患者对健康服务的参与度，例如癌症筛查服务和治疗的延迟；但在产前护理方面，这种关联尚未得到充分探讨。本研究调查了女性接受产前护理的妊娠阶段、BMI 以及其他社会人口因素之间的关联。
对英国 34 家 NHS 产科单位的常规医院数据进行回顾性分析，包括 1989 年至 2007 年间的 619502 例单胎分娩。分析使用逻辑回归来调查孕产妇 BMI 类别与接受产前护理的妊娠阶段之间的关联。使用调整后的优势比（aOR）和 95%置信区间（CI）来估计关联，同时调整了孕产妇年龄、族裔、产次、多重剥夺指数评分和就业状况。主要结局为晚期获得产前护理（>13 周）。次要结局为获得产前护理的妊娠阶段，以及晚期获得与其他社会人口变量之间的关联。
超重或肥胖的女性比 BMI 正常的女性更晚接受产前护理（aOR 1.11，95%CI 1.09-1.12；aOR 1.04，95%CI 1.02-1.06），而体重不足的女性更早接受护理（aOR 0.77，95%CI 0.74-0.81）。与 BMI 正常的女性相比，肥胖女性在第三个孕期接受护理的可能性高出 42%。与晚期获得护理相关的其他重要社会人口因素包括少数族裔、青少年、失业和贫困。黑人/英裔黑人女性在第三个孕期接受护理的关联最大（aOR 5.07，95%CI 4.76，5.40）。
与女性接受产科护理的妊娠阶段相关的社会人口不平等现象显著且复杂，尤其是肥胖女性在妊娠晚期接受护理，以及少数族裔、青少年、贫困和失业女性的情况。这些人群面临不良母婴结局的风险增加，需要采取措施解决产前护理机会不平等问题。为促进更早获得护理而采取的干预措施应解决这些不平等现象的复杂和相互关联的性质，以改善高风险群体的妊娠结局。
