Swan L L, Apgar B S
Department of Family Practice, University of Michigan Medical School, Ann Arbor, USA.
Am Fam Physician. 1995 Jun;51(8):1875-85, 1888-90.
Preconceptual risk assessment is an increasingly important part of obstetric care in the era of fetal therapeutics, invasive diagnostic techniques and "premium" pregnancies. The constant rates of the two greatest contributors to infant morbidity and mortality--congenital malformations and low birth weight--suggest that our basic approach to obstetric care is not sufficiently preventive. Preconceptual obstetric risk assessment, along with health promotion, education and therapeutic intervention, can reduce risk and improve outcome. A medical and psychosocial emphasis on preconceptual and early pregnancy care, along with promotion of the health of the pregnant woman, the fetus, the infant and the family up to one year after birth, may prove to be a way of decreasing infant morbidity and mortality. The identification of important risks associated with demographics, systemic disease, infection, environment, genetics and lifestyle will assist the family physician in promoting health strategies in obstetric care.
在胎儿治疗学、侵入性诊断技术和“优质”妊娠的时代，孕前风险评估在产科护理中变得越来越重要。婴儿发病和死亡的两大主要原因——先天性畸形和低出生体重——的发生率持续不变，这表明我们基本的产科护理方法预防措施不足。孕前产科风险评估，连同健康促进、教育和治疗干预，可以降低风险并改善结局。从医学和社会心理层面重视孕前及孕早期护理，同时促进孕妇、胎儿、婴儿以及出生后长达一年的家庭健康，可能是降低婴儿发病和死亡率的一种方法。识别与人口统计学、全身性疾病、感染、环境、遗传学和生活方式相关的重要风险，将有助于家庭医生在产科护理中推广健康策略。
