Vallgårda S
Department of Social Medicine, University of Copenhagen, Denmark.
Paediatr Perinat Epidemiol. 1995 Apr;9(2):201-18. doi: 10.1111/j.1365-3016.1995.tb00134.x.
Perinatal mortality rate (PMR) is often taken as an indicator of the quality of obstetric care. Its decline started in the early 1940s in Denmark and Sweden, at the same time as in several other European countries, and its development has been strikingly parallel in the two Scandinavian countries. The changes in the mothers' ages and birth order do not coincide with the changes in the PMR. The percentage of children born weighing less than 2500 g has been very stable over time, albeit higher in Denmark. The move towards hospital confinements in obstetric care took place mainly in the 1930s in Sweden, i.e. before the decline started, and in the 1950s and 1960s in Denmark. The factors investigated have contributed very little to explain why the PMR started to decline in the early 1940s. Factors associated with the distribution of perinatal deaths in a population do not seem to be able to explain the changes taking place over time. In the current study it is postulated that factors behind the change in the PMR are improvements in the mothers' health together with the decline in the total period fertility rate from the beginning of this century. With a smaller number of children the risk of infection was reduced and the amount of food available to each child and pregnant woman increased. This better health in early life may be associated with improved reproductive health in the adult years.
围产期死亡率（PMR）常被视为产科护理质量的一项指标。其下降始于20世纪40年代初的丹麦和瑞典，与其他几个欧洲国家同时开始，并且在这两个斯堪的纳维亚国家其发展呈现出显著的平行态势。母亲年龄和生育顺序的变化与围产期死亡率的变化并不一致。出生体重低于2500克的儿童比例长期以来一直非常稳定，尽管在丹麦这一比例更高。产科护理中转向医院分娩的情况在瑞典主要发生在20世纪30年代，即在下降开始之前，而在丹麦则发生在20世纪50年代和60年代。所调查的因素对于解释为何围产期死亡率在20世纪40年代初开始下降贡献甚微。与人群中围产期死亡分布相关的因素似乎无法解释随时间发生的变化。在当前的研究中，推测围产期死亡率变化背后的因素是母亲健康状况的改善以及自本世纪初以来总和生育率的下降。随着孩子数量减少，感染风险降低，每个孩子和孕妇可获得的食物量增加。早年这种更好的健康状况可能与成年期生殖健康的改善有关。
