意外怀孕和母婴健康并发症：印度北方邦农村地区的横断面数据分析。
Unintended pregnancy and maternal health complications: cross-sectional analysis of data from rural Uttar Pradesh, India.
机构信息
Center on Gender Equity and Health, Division of Global Public Health, University of California, San Diego School of Medicine, La Jolla, CA, USA.
Joint Doctoral Program in Public Health (Global Health track), University of California San Diego/San Diego State University, San Diego, USA.
出版信息
BMC Pregnancy Childbirth. 2020 Mar 30;20(1):188. doi: 10.1186/s12884-020-2848-8.
BACKGROUND
This study aims to explore the potential association between unintended pregnancy and maternal health complications. Secondarily, we test whether antenatal care (ANC) and community health worker (CHW) visits moderate the observed association between unintended pregnancy and maternal health complications.
METHODS
Cross sectional data were collected using a multistage sampling design to identify women who had a live birth in the last 12 months across 25 highest risk districts of Uttar Pradesh (N = 3659). Participants were surveyed on demographics, unintendedness of last pregnancy, receipt of ANC clinical visits and community outreach during pregnancy, and maternal complications. Regression models described the relations between unintended pregnancy and maternal complications. To determine if receipt of ANC and CHW visits in pregnancy moderated associations between unintended pregnancy and maternal complications, we used the Mantel-Haenzel risk estimation test and stratified logistic models testing interactions of unintended pregnancy and receipt of health services to predict maternal complications.
RESULTS
Around one-fifth of the women (16.9%) reported that their previous pregnancy was unintended. Logistic regression analyses revealed that unintended pregnancy was significantly associated with maternal complications- pre-eclampsia (AOR:2.06; 95% CI:1.57-2.72), postpartum hemorrhage (AOR:1.46; 95% CI: 1.01-2.13) and postpartum pre-eclampsia (AOR:2.34; 95% CI:1.47-3.72). Results from the Mantel Haenszel test indicated that both ANC and CHW home visit in pregnancy significantly affect the association between unintended pregnancy and postpartum hemorrhage (p < 0.001).
CONCLUSION
Unintended pregnancy is associated with increased risk for maternal health complications, but provision of ANC clinical visits and CHW home visits in pregnancy may be able to reduce potential effects of unintended pregnancy on maternal health.
背景
本研究旨在探讨意外怀孕与产妇健康并发症之间的潜在关联。其次，我们测试产前护理 (ANC) 和社区卫生工作者 (CHW) 访视是否可以缓和意外怀孕与产妇健康并发症之间的观察到的关联。
方法
使用多阶段抽样设计收集横断面数据，以确定过去 12 个月内在北方邦 25 个高风险地区活产的妇女（N=3659）。对参与者进行人口统计学、上次妊娠的意外性、怀孕期间接受 ANC 临床访视和社区外展服务以及产妇并发症的调查。回归模型描述了意外怀孕与产妇并发症之间的关系。为了确定怀孕期间接受 ANC 和 CHW 访视是否缓和了意外怀孕与产妇并发症之间的关联，我们使用 Mantel-Haenzel 风险估计检验和分层逻辑模型检验了意外怀孕和接受卫生服务之间的交互作用，以预测产妇并发症。
结果
约五分之一的妇女（16.9%）报告说她们之前的怀孕是意外的。逻辑回归分析显示，意外怀孕与产妇并发症——子痫前期（AOR：2.06；95%CI：1.57-2.72）、产后出血（AOR：1.46；95%CI：1.01-2.13）和产后子痫前期（AOR：2.34；95%CI：1.47-3.72）显著相关。Mantel Haenszel 检验的结果表明，怀孕期间的 ANC 和 CHW 家访都显著影响意外怀孕与产后出血之间的关联（p<0.001）。
结论
意外怀孕与产妇健康并发症的风险增加有关，但怀孕期间提供 ANC 临床访视和 CHW 家访可能能够减轻意外怀孕对产妇健康的潜在影响。
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