Amini S B, Catalano P M, Mann L I
Department of Obstetrics and Gynecology, MetroHealth Medical Center, Cleveland, Ohio, USA.
J Matern Fetal Med. 1996 May-Jun;5(3):142-50. doi: 10.1002/(SICI)1520-6661(199605/06)5:3<142::AID-MFM9>3.0.CO;2-M.
The purpose of this study was to examine the demographic and obstetrical outcomes of women with poor prenatal care. A 7-year (1987-1993) computerized perinatal database with 29,225 consecutive deliveries was collected prospectively from a single inner city tertiary medical center. Data from 23,181 women who had documented prenatal visits during their pregnancies were used in the analysis. Overall, 21,004 (90.6%) of the mothers had at least 3 prenatal visits (C), while 2,177 (9.4%) had 2 or fewer visits (NC). The proportion of NC did not change significantly over the years (P = 0.47, by trend test). The NC group was 2.3 times more likely to be unmarried (79.8% vs. 59.4%; P < 0.001), have greater parity (mean +/- SD 2.1 +/- 1.9 vs. 1.2 +/- 1.2; P < 0.001), 6.3 times more likely to be staff patients (have no private insurance), and 1.5 times more likely to be black. The average maternal age was 24 years for both groups (P = 0.65). NC mothers delivered at an earlier gestational age (37.3 +/- 3.3 vs. 39.0 +/- 2.6 weeks; P < 0.001), had lower birth weights (BW) (2,810 +/- 743 vs. 3,203 +/- 607 g for singleton births; P < 0.001), and their infants had longer neonatal hospital stays (8.4 +/- 17.3 vs. 4.8 +/- 10.4 days; P < 0.001) compared with C mothers. Moreover, after adjusting for various confounding factors known to effect BW, C mothers delivered infants which were on the average 550 g heavier than the NC mothers. The neonates of NC had consistently lower Apgar scores and were more likely be delivered in breech presentation (5.7% vs. 3.1%) and to be transferred to the neonatal intensive care unit (11.6% vs. 5.2%; P < 0.001). However, the NC group had fewer cesarean deliveries (9.4% vs. 14.2%; P < 0.001) but more thick meconium fluid (12.4% vs. 8.9%; P < 0.001). In conclusion, the women not seeking adequate prenatal care are more likely to be unmarried, black, and staff patients having several children at home. NC mothers tend to have poor obstetrical outcomes and on the average their neonatal stay in the hospital is twice as long as women obtaining adequate prenatal care.
本研究的目的是调查产前护理不足的女性的人口统计学和产科结局。前瞻性地收集了一家市中心三级医疗中心7年（1987 - 1993年）的计算机化围产期数据库，其中包含29,225例连续分娩病例。分析使用了23,181名在孕期有产前检查记录的女性的数据。总体而言，21,004名（90.6%）母亲至少进行了3次产前检查（C组），而2,177名（9.4%）母亲进行了2次或更少的产前检查（NC组）。多年来，NC组的比例没有显著变化（趋势检验P = 0.47）。NC组未婚的可能性高2.3倍（79.8%对59.4%；P < 0.001），多胎妊娠的比例更高（平均±标准差2.1±1.9对1.2±1.2；P < 0.001），是职工患者（无私人保险）的可能性高6.3倍，是黑人的可能性高1.5倍。两组母亲的平均年龄均为24岁（P = 0.65）。与C组母亲相比，NC组母亲的分娩孕周更早（37.3±3.3对39.0±2.6周；P < 0.001），出生体重更低（单胎出生时为2,810±743对3,203±607克；P < 0.001），其婴儿的新生儿住院时间更长（8.4±17.3对4.8±10.4天；P < 0.001）。此外，在调整了各种已知影响出生体重的混杂因素后，C组母亲所生婴儿的平均体重比NC组母亲所生婴儿重550克。NC组新生儿的阿氏评分一直较低，更有可能以臀位分娩（5.7%对3.1%），并被转入新生儿重症监护病房（11.6%对5.2%；P < 0.001）。然而，NC组的剖宫产率较低（9.4%对14.2%；P < 0.001），但胎粪黏稠的比例更高（12.4%对8.9%；P < 0.001）。总之，未寻求充分产前护理的女性更有可能未婚、是黑人且为职工患者，家中有多个孩子。NC组母亲的产科结局往往较差，其新生儿平均住院时间是获得充分产前护理女性的两倍。
