Jack B W, Culpepper L, Babcock J, Kogan M D, Weismiller D
Department of Family Medicine, Boston University School of Medicine, MA 02118, USA.
J Fam Pract. 1998 Jul;47(1):33-8.
A preconception care program has the potential to assist women who want to become pregnant by advising these women about risk factors, healthy lifestyles, and assessing readiness for pregnancy. We conducted a randomized controlled trial to determine whether comprehensive preconception risk assessment at the time of a negative pregnancy test followed by referral to primary care services is effective in initiating treatment for women with preconception risk factors.
One hundred seventy women were offered preconception risk assessment following a negative pregnancy test. Women were assigned randomly either to a usual care group or an intervention group. Women in the latter group were informed about the risks identified and received an appointment with a primary care clinician who was also informed. Women in the usual care group and their clinicians received no feedback. All charts were reviewed and the women were contacted by telephone to determine if interventions to reduce risk were offered by clinicians during the year following the assessment.
An average of 8.96 risks were identified per woman. The proportion of women having risks in each of 12 risk categories studied ranged from 19% to 71%. One hundred women (59%) made at least one visit during the subsequent year, thus allowing the opportunity for preconception care. The proportion of these women who had a risk addressed ranged from 18% for psychosocial risks to 48% for those with fetal exposures (smoking, alcohol, and drug use). There was no difference between groups in the percentage of risks addressed.
The notification of women and their clinicians of identified preconception risks did not improve intervention rates. A more organized intervention system including office-based protocols is needed.
孕前保健计划有潜力通过向想要怀孕的女性提供风险因素、健康生活方式方面的建议以及评估怀孕准备情况来帮助她们。我们进行了一项随机对照试验，以确定在妊娠试验呈阴性时进行全面的孕前风险评估，随后转诊至初级保健服务机构，对于有孕前风险因素的女性启动治疗是否有效。
170名女性在妊娠试验呈阴性后接受了孕前风险评估。这些女性被随机分配到常规护理组或干预组。后一组的女性被告知所发现的风险，并预约了一位也被告知情况的初级保健临床医生。常规护理组的女性及其临床医生未得到反馈。审查了所有病历，并通过电话联系这些女性，以确定在评估后的一年中临床医生是否提供了降低风险的干预措施。
每位女性平均被识别出8.96项风险。在所研究的12个风险类别中，每个类别有风险的女性比例在19%至71%之间。100名女性（59%）在随后的一年中至少就诊了一次，从而有机会接受孕前保健。这些女性中风险得到处理的比例，从心理社会风险的18%到胎儿暴露（吸烟、饮酒和吸毒）风险的48%不等。两组在风险得到处理的百分比方面没有差异。
向女性及其临床医生通报已识别的孕前风险并不能提高干预率。需要一个更有组织的干预系统，包括基于办公室的方案。
