Children's Hospital of Richmond at VCU (ER Wolf and BB Nelson), Richmond, Va; Department of Pediatrics (ER Wolf and BB Nelson), Virginia Commonwealth University, Richmond, Va.
Department of Cancer Biostatistics (E Donahue), Levine Cancer Institute, Charlotte, NC; Department of Biostatistics (E Donahue and RT Sabo), Virginia Commonwealth University, Richmond, Va.
Acad Pediatr. 2021 Aug;21(6):955-960. doi: 10.1016/j.acap.2020.11.025. Epub 2020 Dec 3.
Prenatal care (PNC) and well child visit (WCV) attendance are associated with improved health outcomes. We aimed to determine if the factors affecting maternal and child attendance are similar or different.
We conducted a retrospective case control study at Virginia Commonwealth University Health System. We used the Adequacy of Prenatal Care Utilization Index and the American Academy of Pediatrics recommendations to assess the adequacy of PNC and WCV attendance, respectively. Mothers with less than 50% visit adherence or initiation after 5 months gestation were eligible as cases and those with 80% or more adherence and initiation before 5 months were eligible as controls. Children in the lowest quintile of adherence were eligible as cases and those with 80% or more adherence were eligible as controls. Cases and controls were randomly selected at a 1:2 ratio from the eligible subjects and frequency matched on birth month.
In adjusted analyses, mothers and children who were publicly insured or who were uninsured had higher odds of poor preventive visit attendance. Mothers who experienced intimate partner violence and had more living children were more likely to have poor attendance. Children whose mothers had younger age, greater number of pregnancies and transportation difficulties had poorer attendance.
While lack of insurance and public insurance remained significantly associated with both poor PNC and WCV attendance, other factors varied between groups. Expanding eligibility requirements and streamlining enrollment and renewal processes may improve two generations of preventive visit attendance.
产前保健（PNC）和儿童常规健康检查（WCV）的参与与改善健康结果有关。我们旨在确定影响母婴参与的因素是否相似或不同。
我们在弗吉尼亚联邦大学健康系统进行了回顾性病例对照研究。我们分别使用产前保健利用率充足指数和儿科学会的建议来评估 PNC 和 WCV 参与的充足性。妊娠 5 个月后就诊依从性或起始率低于 50%的母亲有资格作为病例，而 80%或以上依从性和起始率在 5 个月前的母亲有资格作为对照。就诊依从性最低五分位的儿童有资格作为病例，而 80%或以上就诊依从性的儿童有资格作为对照。病例和对照是按照 1:2 的比例从合格的研究对象中随机选择的，并按出生月份进行频率匹配。
在调整后的分析中，有公共保险或没有保险的母亲和儿童更有可能出现预防就诊参与不良的情况。经历过亲密伴侣暴力和有更多孩子的母亲更有可能出现就诊参与不良的情况。母亲年龄较小、怀孕次数较多和交通困难的儿童就诊参与情况较差。
尽管缺乏保险和公共保险仍然与 PNC 和 WCV 参与不良显著相关，但其他因素在两组之间存在差异。扩大资格要求并简化注册和续保流程可能会改善两代人的预防就诊参与度。
