Korenbrot C C, Simpson L, Phibbs C S
University of California, School of Medicine, San Francisco 94109.
Public Health Rep. 1994 Jan-Feb;109(1):68-76.
The authors performed a prenatal care needs assessment for Fresno County, CA, using data from a sample of 11,878 birth certificates for the county for 1989. Birth records, patterns of prenatal care utilization, and low birth weight outcomes in the county were compared with those in a random sample of 11,826 certificates derived from births in the remainder of the State. Bivariate techniques were used in calculating care utilization rates. Multivariate logistic regression analysis was used in associating rates of prenatal care visits and gestational month of initiation of prenatal care with low weight birth outcomes. County women entered prenatal care as early as women in the remainder of the State, but did not return as often for prenatal care visits. Their rate of return for followup visits was 29.9 percent, compared with 24.8 percent for women in all other counties (P < 0.001). County women with the lowest rates of visits had 1.4 to 1.9 times the risk of having a low weight birth than other county women with higher rates of visits, and a significantly higher risk than for women of all other counties. An intensive visit schedule for high-risk care was provided 28.9 percent of county women, compared with 33.0 percent of women in all other counties (P < 0.001). County women who received a high-risk intensive visit schedule were 2.5 times more likely to have a low weight birth than county women who did not receive the schedule. For all other women in the State, the comparable risk was 2.1 times. Improvements in the number and content of prenatal care visits were shown to have a high likelihood of substantially improving birth weight outcomes for pregnancies among Fresno County women.
作者利用加利福尼亚州弗雷斯诺县1989年11,878份出生证明样本数据，对该县的产前护理需求进行了评估。将该县的出生记录、产前护理利用模式和低体重儿出生情况与从该州其他地区随机抽取的11,826份出生证明样本进行了比较。采用双变量技术计算护理利用率。使用多变量逻辑回归分析将产前护理就诊率和开始产前护理的孕周与低体重儿出生情况联系起来。该县的妇女与该州其他地区的妇女一样早开始接受产前护理，但后续产前护理就诊的频率较低。她们的随访就诊率为29.9%，而其他所有县的妇女为24.8%（P<0.001）。就诊率最低的该县妇女生出低体重儿的风险是就诊率较高的其他县妇女的1.4至1.9倍，且风险显著高于其他所有县的妇女。28.9%的该县高危护理妇女接受了密集就诊安排，而其他所有县的这一比例为33.0%（P<0.001）。接受高危密集就诊安排的该县妇女生出低体重儿的可能性是未接受该安排的该县妇女的2.5倍。对于该州的所有其他妇女，相应风险为2.1倍。研究表明，增加产前护理就诊次数和改善就诊内容很有可能大幅改善弗雷斯诺县妇女怀孕后的出生体重情况。
