Pervin Jesmin, Rahman Syed Moshfiqur, Rahman Monjur, Aktar Shaki, Rahman Anisur
Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh.
International Maternal and Child Health, Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden.
BMJ Open. 2020 Jul 23;10(7):e036699. doi: 10.1136/bmjopen-2019-036699.
Strengthening the antenatal care programme is suggested as one of the public health strategies to reduce preterm birth burden at a population level. However, the evidence so far available is inconclusive.
To evaluate the association between antenatal care (ANC) visit and preterm birth; and also to explore to what extent the increased usage of ANC after the initiation of the Maternal, Neonatal and Child Health (MNCH) project in Matlab, Bangladesh, contributed to the reduction of preterm birth.
This population-based cohort study was conducted in Matlab, a subdistrict under Chandpur. The analysis was based on data collected from 2005 to 2009. In 2007, an MNCH project was initiated in the area that strengthened the ongoing ANC services.
In total, 12 980 live births with their mothers during the study period were included in the analysis.
We performed logistic regression with generalised estimating equation models to evaluate the associations.
Preterm birth.
The number of ANC visits was associated with preterm birth in a dose-dependent way (p for linear trend <0.001). The adjusted odds of preterm birth were 2.4-times higher (OR 2.37, 95% CI 2.07 to 2.70) among women who received ≤1 ANC compared with women who received ≥3 ANC. We observed a significant reduction of preterm birth rates (OR 0.69, 95% CI 0.61 to 0.77) in the period after (2008 to 2009) MNCH project initiation in comparison to the period before (2005 to 2006). Controlling for ANC visits substantially attenuated this observed effect of the MNCH project on preterm birth (OR 0.88, 95% CI 0.77 to 0.99) (Sobel test of mediation p<0.001).
ANC visits are associated with decreased occurrences of preterm births. Strengthening the ANC services should be prioritised in countries with high preterm birth rates to reduce the preterm birth burden at the population level.
加强产前保健计划被认为是在人群层面减轻早产负担的公共卫生策略之一。然而，目前可得的证据尚无定论。
评估产前检查（ANC）就诊与早产之间的关联；并探讨在孟加拉国马特莱启动孕产妇、新生儿和儿童健康（MNCH）项目后，ANC使用增加在多大程度上有助于降低早产率。
这项基于人群的队列研究在钱德布尔下属的一个分区马特莱进行。分析基于2005年至2009年收集的数据。2007年，该地区启动了一个MNCH项目，加强了现有的ANC服务。
分析纳入了研究期间12980例活产及其母亲。
我们使用广义估计方程模型进行逻辑回归以评估关联。
早产。
ANC就诊次数与早产呈剂量依赖关系（线性趋势p<0.001）。与接受≥3次ANC的女性相比，接受≤1次ANC的女性早产的校正比值高2.4倍（OR 2.37，95%CI 2.07至2.70）。我们观察到，与之前的时期（2005年至2006年）相比，MNCH项目启动后的时期（2008年至2009年）早产率显著降低（OR 0.69，95%CI 0.61至0.77）。控制ANC就诊次数后，MNCH项目对早产的观察效应大幅减弱（OR 0.88，95%CI 0.77至0.99）（中介效应的索贝尔检验p<0.001）。
ANC就诊与早产发生率降低相关。在早产率高的国家，应优先加强ANC服务，以减轻人群层面的早产负担。
