Department of Epidemiology, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA 70112, USA.
Department of Behavioral Sciences and Social Medicine, College of Medicine, Florida State University, Tallahassee, FL 32306, USA.
Int J Environ Res Public Health. 2021 Jan 6;18(2):390. doi: 10.3390/ijerph18020390.
: Disasters are associated with worse perinatal outcomes, perhaps due to inadequate prenatal care (PNC). : Using 2017-2019 Florida vital statistics, we compared PNC use before and after Hurricane Michael. We categorized counties as most affected (Area A) or less affected (Area B and C). We examined whether Michael's effects on perinatal outcomes varied by maternity care availability and used the Baron and Kenny method to assess whether delayed PNC initiation mediated perinatal outcomes. Log-binomial regression and semi-parametric linear regression were used, controlling for maternal and ZIP code tabulation area characteristics. : Compared to the one-year period pre-Michael, the week of the first PNC was later in all areas in the one-year period post-Michael, with the largest change in Area A (adjusted difference 0.112, 95% CI: 0.055-0.169), where women were less likely to receive PNC overall (aRR = 0.994, 95% CI = 0.990-0.998) and more likely to have inadequate PNC (aRR = 1.193, 95% CI = 1.127-1.264). Michael's effects on perinatal outcomes did not vary significantly by maternity care availability within Area A. Delayed PNC initiation appeared to mediate an increased risk in small for gestational age (SGA) births after Michael. : Women in Area A initiated PNC later and had a higher likelihood of inadequate PNC. Delayed PNC initiation may partially explain increased risk of SGA.
灾害与围产期结局较差有关，这可能是由于产前保健（PNC）不足。我们使用了 2017-2019 年佛罗里达州生命统计数据，比较了飓风迈克尔前后的 PNC 使用情况。我们将县分为受影响最大的（A 区）和受影响较小的（B 区和 C 区）。我们研究了迈克尔对围产期结局的影响是否因产妇保健服务的可用性而有所不同，并使用 Baron 和 Kenny 方法来评估 PNC 启动延迟是否调节了围产期结局。采用对数二项式回归和半参数线性回归，控制了母亲和邮政编码区特征。与迈克尔飓风前一年的同期相比，迈克尔飓风后一年的第一周 PNC 时间较晚，A 区的变化最大（调整后的差异为 0.112，95%置信区间：0.055-0.169），那里的妇女总体上更不可能接受 PNC（调整后的相对危险度[aRR] = 0.994，95%置信区间[CI] = 0.990-0.998），并且更有可能接受不足的 PNC（aRR = 1.193，95%CI = 1.127-1.264）。迈克尔飓风对 A 区产妇保健服务可用性内围产期结局的影响没有显著差异。PNC 启动延迟似乎部分解释了迈克尔飓风后 SGA 出生风险增加的原因。A 区的妇女 PNC 启动较晚，PNC 不足的可能性更高。PNC 启动延迟可能部分解释了 SGA 风险增加的原因。
