Department of Obstetrics and Gynecology, McMaster University, Hamilton, Ontario, Canada.
Department of Obstetrics and Gynecology, University of British Columbia, Vancouver, British Columbia, Canada.
JAMA Netw Open. 2020 Aug 3;3(8):e2012576. doi: 10.1001/jamanetworkopen.2020.12576.
Women who experience imprisonment have high morbidity and an increased risk of adverse pregnancy outcomes. Antenatal care could modify pregnancy-related risks, but there is a lack of evidence regarding antenatal care in this population.
To examine antenatal care quality indicators for women who experience imprisonment and to compare these data with data for the general population.
DESIGN, SETTING, AND PARTICIPANTS: This population-based, retrospective cohort study used linked correctional and health administrative data from women released from provincial prison in Ontario, Canada, in 2010 and women in the general population with deliveries at 20 weeks' gestation or greater from January 1, 2005, to December 31, 2015. Data analysis was performed from January 1, 2017, to May 4, 2020.
Pregnancies in women with time in prison during pregnancy (prison pregnancies), pregnancies in women with time in prison but not while pregnant (prison control pregnancies), and pregnancies in women in the general population (general population pregnancies).
Antenatal care quality indicators: first-trimester visit, first-trimester ultrasonography, and 8 or more antenatal care visits.
A total of 626 prison pregnancies in 529 women (mean [SD] age, 26.6 [5.4] years), 2327 prison control pregnancies in 1570 women (mean [SD] age, 26.2 [5.4] years), and 1 308 879 general population pregnancies in 884 063 women (mean [SD] age, 30.3 [5.3] years) were studied. Of 626 prison pregnancies, 193 women (30.8%; 95% CI, 27.1%-34.6%) had a first-trimester visit, 272 (48.4%; 95% CI, 44.4%-52.4%) had at least 8 antenatal care visits, and 209 (34.6%; 95% CI, 31.0%-38.4%) received first-trimester ultrasonography. In 2327 prison control pregnancies, 1106 women (47.5%; 95% CI, 45.3%-49.8%) had a first-trimester visit, 1356 (59.2%; 95% CI, 56.9%-61.4%) had 8 or more antenatal care visits, and 893 (38.5%; 95% CI, 36.4%-40.6%) received first-trimester ultrasonography. Compared with 1 308 879 general population pregnancies, the odds of antenatal care were lower for the first-trimester visit (odds ratios [ORs], 0.11 [95% CI, 0.09-0.13] in prison pregnancies and 0.23 [95% CI, 0.21-0.25] in prison control pregnancies), 8 or more antenatal care visits (ORs, 0.16 [95% CI, 0.14-0.19] in prison pregnancies and 0.25 [95% CI, 0.23-0.28] in prison control pregnancies), and first-trimester ultrasonography (ORs, 0.43 [95% CI, 0.36-0.50] in prison pregnancies and 0.51 [95% CI, 0.46-0.55] in prison control pregnancies).
This study found that women who experienced imprisonment were substantially less likely to receive adequate antenatal care than were women in the general population whether or not they were in prison during pregnancy. Efforts are needed to improve antenatal care for this population both in prison and in the community.
经历过监禁的女性发病率较高，不良妊娠结局的风险增加。产前护理可以改变与妊娠相关的风险，但关于这一人群的产前护理，证据不足。
检查经历监禁的女性的产前护理质量指标，并将这些数据与一般人群的数据进行比较。
设计、地点和参与者：这是一项基于人群的回顾性队列研究，使用了加拿大安大略省 2010 年从省级监狱获释的妇女和 2005 年 1 月 1 日至 2015 年 12 月 31 日妊娠 20 周或以上分娩的一般人群的校正和健康行政数据。数据分析于 2017 年 1 月 1 日至 2020 年 5 月 4 日进行。
怀孕期间入狱的女性（监狱妊娠）、怀孕期间未入狱但有入狱史的女性（监狱对照妊娠）和一般人群中的女性（一般人群妊娠）。
产前护理质量指标：孕早期检查、孕早期超声检查和 8 次以上产前护理检查。
共研究了 626 例监狱妊娠中的 529 名妇女（平均[标准差]年龄，26.6[5.4]岁）、2327 例监狱对照妊娠中的 1570 名妇女（平均[标准差]年龄，26.2[5.4]岁）和 1308879 例一般人群妊娠中的 884063 名妇女（平均[标准差]年龄，30.3[5.3]岁）。在 626 例监狱妊娠中，193 名妇女（30.8%；95%CI，27.1%-34.6%）接受了孕早期检查，272 名妇女（48.4%；95%CI，44.4%-52.4%）接受了至少 8 次产前护理检查，209 名妇女（34.6%；95%CI，31.0%-38.4%）接受了孕早期超声检查。在 2327 例监狱对照妊娠中，1106 名妇女（47.5%；95%CI，45.3%-49.8%）接受了孕早期检查，1356 名妇女（59.2%；95%CI，56.9%-61.4%）接受了 8 次或更多次产前护理检查，893 名妇女（38.5%；95%CI，36.4%-40.6%）接受了孕早期超声检查。与 1308879 例一般人群妊娠相比，监狱妊娠和监狱对照妊娠的孕早期检查（比值比[ORs]，0.11[95%CI，0.09-0.13]和 0.23[95%CI，0.21-0.25]）、8 次或更多次产前护理检查（ORs，0.16[95%CI，0.14-0.19]和 0.25[95%CI，0.23-0.28]）和孕早期超声检查（ORs，0.43[95%CI，0.36-0.50]和 0.51[95%CI，0.46-0.55]）的可能性均较低。
这项研究发现，经历监禁的女性接受充分产前护理的可能性明显低于一般人群中的女性，无论她们是否在怀孕期间入狱。需要努力改善这一人群在监狱中和社区中的产前护理。
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