首次产前检查时高危妊娠与低危妊娠对肯尼亚妊娠和分娩期间并发症发生的影响：双重稳健估计。
Effect of high-risk versus low-risk pregnancy at the first antenatal care visit on the occurrence of complication during pregnancy and labour or delivery in Kenya: a double-robust estimation.
机构信息
Data Science and Evaluation Unit, African Population and Health Research Center, Nairobi, Kenya
Data Science and Evaluation Unit, African Population and Health Research Center, Nairobi, Kenya.
出版信息
BMJ Open. 2023 Oct 29;13(10):e072451. doi: 10.1136/bmjopen-2023-072451.
OBJECTIVES
We evaluated the causal effects of high-risk versus low-risk pregnancy at the first antenatal care (ANC) visit on the occurrence of complications during pregnancy and labour or delivery among women in Kenya.
METHODS
We designed a quasi-experimental study using observational data from a large mobile health wallet programme, with the exposure as pregnancy risk at the first ANC visit, measured on a binary scale (low vs high). Complications during pregnancy and at labour or delivery were the study outcomes on a binary scale (yes vs no). Causal effects of the exposure were examined using a double-robust estimation, reported as an OR with a 95% CI.
RESULTS
We studied 4419 women aged 10-49 years (mean, 25.6±6.27 years), with the majority aged 20-29 years (53.4%) and rural residents (87.4%). Of 3271 women with low-risk pregnancy at the first ANC visit, 833 (25.5%) had complications during pregnancy while 1074 (32.8%) had complications at labour/delivery. Conversely, of 1148 women with high-risk pregnancy at the first ANC visit, 343 (29.9%) had complication during pregnancy while 488 (42.5%) had complications at labour delivery. Multivariable adjusted analysis showed that women with high-risk pregnancy at the time of first ANC attendance had a higher occurrence of pregnancy during pregnancy (adjusted OR (aOR) 1.22, 95% CI 1.02 to 1.46) and labour or delivery (aOR 1.20, 95% CI 1.03 to 1.41). In the double-robust estimation, a high-risk pregnancy at first ANC visit increased the occurrence of complications during pregnancy (OR 1.23, 95% CI 1.04 to 1.46) and labour or delivery (OR 1.24, 95% CI 1.07 to 1.45).
CONCLUSION
Women with a high-risk pregnancy at the first ANC visit have an increased occurrence of complications during pregnancy and labour or delivery. These women should be identified early for close and appropriate obstetric and intrapartum monitoring and care to ensure maternal and neonatal survival.
目的
我们评估了肯尼亚女性首次产前检查（ANC）时高风险与低风险妊娠对妊娠和分娩期间并发症发生的因果影响。
方法
我们使用大型移动健康钱包计划的观察性数据设计了一项准实验研究，将暴露情况作为首次 ANC 检查时的妊娠风险，采用二进制尺度（低 vs 高）进行测量。妊娠和分娩期间的并发症是二进制尺度（是/否）的研究结果。使用双重稳健估计检查暴露的因果效应，报告为比值比（OR）及其 95%置信区间（CI）。
结果
我们研究了 4419 名年龄在 10-49 岁（平均 25.6±6.27 岁）的女性，其中大多数年龄在 20-29 岁（53.4%），且居住在农村地区（87.4%）。在首次 ANC 检查时患有低风险妊娠的 3271 名女性中，有 833 名（25.5%）在妊娠期间出现并发症，而有 1074 名（32.8%）在分娩时出现并发症。相反，在首次 ANC 检查时患有高风险妊娠的 1148 名女性中，有 343 名（29.9%）在妊娠期间出现并发症，而有 488 名（42.5%）在分娩时出现并发症。多变量调整分析表明，首次 ANC 就诊时患有高风险妊娠的女性妊娠期间（调整后的比值比[aOR]1.22，95%CI 1.02 至 1.46）和分娩期间（aOR 1.20，95%CI 1.03 至 1.41）出现并发症的几率更高。在双重稳健估计中，首次 ANC 检查时的高风险妊娠增加了妊娠期间（OR 1.23，95%CI 1.04 至 1.46）和分娩期间（OR 1.24，95%CI 1.07 至 1.45）出现并发症的几率。
结论
首次 ANC 就诊时患有高风险妊娠的女性妊娠和分娩期间出现并发症的几率增加。这些女性应早期识别，以便进行密切和适当的产科和产时监测和护理，以确保母婴生存。
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