应用Delphi法确定妇女孕前生殖健康素养的内容

目的确定妇女孕前生殖健康素养评价的内容。方法通过文献查阅确定妇女孕前健康素养评价的方面和能力维度,采用德尔菲(Delphi)专家咨询法对15位妇女保健领域的专家进行3轮函询确立达成共识的妇女孕前生殖健康素养的内容。结果妇女孕前生殖健康素养的内容包括医疗服务、疾病预防和健康促进3个方面和健康素养的获取、理解、评价和应用4种能力。3轮Delphi专家咨询问卷回收率均为93.3%,专家权威系数是0.80。经过3轮Delphi专家咨询,各核心内容均分≥4.0分,变异系数<0.25,专家意见协调系数是0.324。最终确定14条核心内容,主要涉及婚前保健服务、孕前保健服务、叶酸补充、生活方式、生活/职业环境中的危险因素共5个方面。结论本研究建立的妇女孕前生殖健康素养内容可作为后续编制妇女孕前生殖健康素养量表的基础。     

铜陵市孕前育龄妇女生殖健康素养状况及其影响因素调查

目的了解铜陵市孕前育龄妇女生殖健康素养状况及其影响因素,为开展生殖健康素养促进提供循证依据。方法选取2017年5月-2018年2月到铜陵市妇幼保健机构婚孕门诊参加免费孕前优生优育检查的育龄妇女作为研究对象,实施现场问卷调查。结果 2 556名孕前育龄妇女的生殖健康总体素养的具备率为41. 55%,生殖健康相关知识、生殖健康相关生活方式和行为、生殖健康相关技能素养的具备率分别为27. 19%、86. 97%、8. 02%。多因素Logistic回归模型分析显示:年龄、职业、文化程度、家庭月收入、怀孕情况等是该人群生殖健康素养水平的重要影响因素。结论铜陵市孕前育龄妇女的生殖健康素养总体水平较低,应针对性加强孕前妇女生殖健康教育,提高婚孕人群生殖健康素养相关知识与技能水平。     

国家卫生健康委办公厅关于统筹推进婚前孕前保健工作的通知

为贯彻《基本医疗卫生与健康促进法》《健康中国行动(2019-2030年)》,落实《全民健康信息化为基层减负工作措施》,全面加强婚前孕前保健和出生缺陷一级预防,不断提高出生人口素质和妇女儿童健康水平,现就统筹推进健康教育、婚前医学检查、孕前优生健康检查、增补叶酸等婚前孕前保健服务,提高服务可及性、促进服务均等化,提出如下要求。     

2018—2019年上海市黄浦区产后妇女母婴健康素养水平调查分析

目的本研究通过调查上海市黄浦区"孕期全程化标准化健康教育"工作模式实施后,该区连续两年的产后妇女健康素养水平变化,分析该模式对产后妇女母婴健康素养的干预效果。方法上海市黄浦区街道社区卫生服务中心社区医生在2018年8—10月和2019年同期进行产后家庭访视过程中,随机抽取401名访视对象并进行了《妇女产后生殖健康素养问卷》调查。计算评价调查对象产后相关母婴健康素养水平和素养具备率,并分析各因素可能的影响作用。结果产后妇女母婴健康素养具备率2018年为2.5%,2019年为3.0%,差异无统计学意义(P0.05)。2019年该人群母婴健康素养在医疗服务领域中的理解维度,健康促进中的理解、应用维度得分分别为(8.26±2.45)分、(3.16±1.16)分、(1.77±0.48)分,均高于2018年得分,而医疗服务中的应用维度,疾病预防中的评价维度得分分别为(11.68±1.61)分、(3.49±0.95)分,均低于2018年得分,差异具有统计学意义(P0.05)。结论产后妇女母婴健康素养水平仍然偏低,收入水平、城乡差异都是重要的影响因素。现有健康教育模式可能一定程度上有利于提高产后妇女在疾病治疗和健康促进领域母婴健康素养水平,但对该人群在疾病预防领域的素养水平提升效果较差。     

北京市西城区"健康生育快乐园"项目效果评估

目的 为了探讨适合社区推广的出生缺陷综合干预模式,对北京市西城区开展的"健康生育快乐园"项目进行效果评估.方法 采用类试验设计方法,在西城区7个街道,采用问卷的方法调查参加及未参加"快乐园"并已分娩的妇女1 359人和1 633人.比较两组人群孕前和孕期规避危险因素、采纳健康优生措施及不良妊娠结局发生的情况.结果 参加"快乐园"的妇女孕前规避被动吸烟的比例及其丈夫规避吸烟的比例均显著高于未参加者;孕期规避被动吸烟的比例、孕早期服用叶酸的比例、孕前3个月服用叶酸的比例、孕期上孕妇学校的比例、早孕3个月建档比例和妊娠20周B超或唐氏筛查的比例均显著高于未参加者;未见两组人群不良妊娠结局的差异.结论 "健康生育快乐园"活动有效改善育龄夫妇孕前和孕期健康行为,为预防出生缺陷社区健康促进模式的建立提供依据.     

“妇女孕前增补叶酸预防神经管畸形”列为全国计划生育系统推广项目

<正> 国家计生委科技司向全国计划生育系统发出关于推广“妇女孕前增补叶酸预防神经管畸形”科技成果的通知,通知指出:“妇女孕前增补叶酸预防神经管畸形”是我国一项重要科研成果,神经管畸形是一种严重的出生缺陷疾病,是影响出生人口素质的一个主要因素,采用孕前增补叶酸的方法可取得较好的预防效果。做好“妇女孕前增补叶酸预防神经管畸形”的推广工作是提高出生人口素质的一项得力措施,望各级计划生育技术     

北京市郊区育龄妇女叶酸服用现状调查

目的 了解2016年北京市郊区备孕期及妊娠期妇女叶酸的补充现状。方法 2016年10-11月采用整群抽样方法在北京市郊区抽取6家医院，共计722名育龄妇女进行问卷调查。结果 有效样本量为714人，叶酸服用率为63.9%（456/714）；叶酸规律服用率为83.3%（380/456）。在记得叶酸服用天数的450名妇女中，35.5%（159/450）在孕前开始服用叶酸，其中27.3%（123/450）在孕前0~3个月开始服用叶酸，8.0%（36/450）在孕前3个月开始服用叶酸。多因素logistic回归分析发现户口性质、备孕期或妊娠期、产妇类型、吸烟和饮酒情况是服用叶酸产品或复合产品的影响因素。结论 北京市郊区育龄妇女叶酸服用现状不容乐观，需要进一步加大叶酸相关知识的宣传力度，从而提高叶酸服用率和规律服用率、促进母婴健康及降低母婴并发症。     

河南省焦作地区孕前出生缺陷健康教育干预效果分析

目的:对河南省出生缺陷项目试点地区孕前健康教育干预效果进行评估。方法:在焦作市11个县市区抽取38个项目点,采用宣传教育、免费发放叶酸和进行TORCH实验室筛查的方式对育龄妇女进行出生缺陷孕前干预。在干预前和干预后采取多阶段整群抽样方法,分别抽取了9963名和8207名妇女进行相同的孕前出生缺陷相关情况问卷调查。结果:干预后对象的优生优育知识的知晓率由干预前的35.5%提高到82.3%(χ2=3958.40,P<0.01)。项目干预时主要宣传途径为宣传手册的发放,但干预对象最易接受的宣传方式为知识讲座,群众满意度为96.11%;妇女吸烟(χ2=277.50,P=0.01)、饮酒者(χ2=204.00,P=0.01)所占比重较干预前下降,其丈夫吸烟的比重也降低(χ2=25.43,P=0.01)。孕前接触有毒有害物质和乱服药现象有所下降;86.73%的对象进行了孕前优生筛查(TORCH)。干预后服用叶酸或营养素类药物妇女的比例(86.22%)比干预前(15.38%)明显提高(χ2=8957.10,P<0.01),并且64.39%的对象能在孕前3个月连续正规服用。结论:孕前健康教育干预效果显著,但需重视其中薄弱环节。需继续加强基层计划生育技术服务人员的服务能力,向育龄群众宣传孕前连续规范服用叶酸的重要性。     

山西省妊娠20周内妇女血浆叶酸水平及影响因素研究

目的了解妊娠妇女血浆叶酸水平及其影响因素,为育龄及妊娠妇女制定干预措施提供科学依据。方法选取2016年1月-2016年8月在山西省妇幼保健院进行孕期保健的妊娠20周内的724名妇女,静脉血叶酸水平的测定采用改良微生物法。结果 724名孕妇的血浆叶酸平均水平为(38.5±42.9)nmol/L,缺乏率为4.4%(血浆叶酸10.5 nmol/L)。认为是否有必要服用叶酸、本次怀孕是否服用叶酸、末次月经前后一个月食用水果的次数、孕前体质指数、孕妇年龄是孕妇血浆叶酸缺乏的影响因素。结论妊娠20周内妇女血浆叶酸营养状况较好,我们应该针对不同人群开展有针对性的健康教育,提高妇女体内叶酸水平,保证母婴健康。     

再生育妇女叶酸服用的依从性及影响因素研究

目的探讨再生育妇女叶酸服用的依从现状及其影响因素,为制定相应的干预措施提供科学依据。方法采用方便抽样的方法,选取在山西省妇幼保健院进行孕期保健的629名怀孕3个月以上的再生育妇女,对其进行问卷调查。结果97.1%的再生育妇女服用过叶酸,其中51.1%从孕前开始服用叶酸,21.3%从末次月经3个月前开始服用叶酸,53.5%服用叶酸90天以上,41.1%能规律性服用叶酸。叶酸服用依从性的影响因素包括孕妇受教育程度、婚龄及孕前BMI。结论再生育妇女的叶酸服用依从性不容乐观,应针对不同人群开展形式多样的健康教育来提高再生育妇女的依从性。     

云南省农村育龄妇女增补叶酸影响因素调查

目的:探讨云南省农村育龄妇女围孕期及妊娠期增补叶酸的现状及影响因素。方法:采用整群随机抽样法抽取泸西县符合条件的共2538位农村孕产妇进行问卷调查。应用单因素分析和多因素非条件logistic逐步回归法寻找围孕期及妊娠期增补叶酸的影响因素。结果:51.7%的调查对象在围孕期或妊娠期补充过叶酸。多因素分析显示影响农村育龄妇女增补叶酸的因素有妻子的受教育年限(OR=0.53)、家庭去年的总收入(OR=2.222)、孕前健康检查状况(OR=3.397)、家中有无优生宣传资料(OR=1.957)、优生知识是否及格(OR=2.380)、是否知道叶酸的作用(OR=88.015)。结论:健康教育应当成为云南广大农村增补叶酸服务的先导,孕前保健服务应当是叶酸推广和其他生殖保健技术服务的结合。在叶酸的推广中,计划生育宣传员发挥着重要作用。     

Undergraduate Student Awareness of Issues Related to Preconception Health and Pregnancy

Objectives To assess undergraduate student awareness of issues related to preconception health and pregnancy and to investigate gender differences. Methods Two-hundred forty-one undergraduate students (137 females, 104 males) completed a questionnaire designed to assess awareness of issues related to preconception health and pregnancy. Results Overall, students demonstrated a low to moderate level of awareness, correctly answering 64% of items. Individual student scores varied a great deal, ranging from 33% to 89% correct. Students who had previously taken a course containing information on pregnancy and/or child development correctly answered a greater percentage of items than those who had not taken such a course. Females had slightly, but statistically significantly, higher awareness scores than males. Students self-reported ratings of awareness of behaviors that are dangerous during pregnancy were associated with their composite scores on the questionnaire. Awareness across individual items varied a great deal. Students demonstrated a high level of awareness for substance use, a moderate level of awareness for sexually transmitted diseases and preconception care, and lower levels of awareness for folic acid, prenatal development, health, and pregnancy spacing. Conclusions Efforts to improve preconception health should include increasing awareness of reproductive issues for both males and females. Existing efforts to provide information on reproductive health to students need to be expanded and new strategies developed. Particular attention should be paid to increasing awareness of the benefits of family planning, the early onset and rapid rate of organogenesis, the benefits of folic acid, and the importance of addressing health-related issues.     

吉林省孕产妇母婴健康素养影响因素调查分析

目的调查并分析吉林省孕产妇母婴健康素养现状及影响因素,为提出妇幼健康工作策略提供参考依据。方法以2018年12月-2019年1月在吉林省助产机构接受助产服务的孕产妇为研究对象,开展问卷调查。结果吉林省孕产妇母婴健康素养具备者比例为15. 8%。年龄23岁及以上、家庭人均月收入1 000~3 000元,参加过孕妇学校是具备健康素养的有利因素(P<0. 05);产后,职业为商业、服务业人员、其他和未就业是具备健康素养的危险因素(P<0. 05)。结论吉林省孕产妇母婴健康素养较低,应进一步提高母婴健康素养水平。     

Rethinking Preconception Care: A Critical,Women’s Health Perspective

Objectives Preconception care aims to provide care to reproductive aged individuals in order to improve pregnancy and birth outcomes. Given that preconception care is a public health priority, it is important to evaluate the evolution of this health paradigm and the promotion of preconception messages that are obtained by the public. We identified online preconception health messages, which were critically assessed through a women’s health perspective. Methods We searched for “preconception care” on three major search engines. Websites were included if they were U.S.-based, provided content in English, and mentioned preconception care. Blogs and journal articles were excluded. The final sample included 52 websites. Using a content analysis approach, we assessed the presence of gender bias and identified other emergent themes. Results The majority of websites focused on preconception care for women only (67%). The recommendations centered on: (1) health behaviors for women (e.g., folic acid, drinking, smoking); (2) visiting healthcare providers; and (3) evaluating medical risks. Moreover, most content implied that women desired, or should desire, pregnancy. Overall, the messages used biomedical language and rarely mentioned other important health topics, such as social support and violence. Conclusions The primary messages presented on preconception care websites emphasized biomedical aspects of women’s health. The current context of preconception care medicalizes this pre-pregnancy period by defining it as a biomedical condition requiring lifestyle changes and interventions. Additionally, the biases presented in these messages assumed women want and are capable of pregnancies and excluded an integral factor for heteronormative reproduction—men.

     

家人及专业人员对育龄妇女孕期叶酸服用行为的影响分析

目的分析家人及专业人员对育龄妇女孕期叶酸服用行为的影响,为提高叶酸干预效果提供基础数据。方法采用医院及入户调查方法,抽取甘肃省两个县内2094名孕后三个月至产后一年的妇女进行面对面匿名问卷调查。结果 2094名调查对象叶酸知晓率为62.2%,叶酸服用率为25.4%。家人对叶酸较高的认知水平(OR=0.268,95%CI 0.208～0.346)、家人对叶酸服用持赞成态度(OR=0.103,95%CI 0.031～0.338)、家人的督促行为(OR=0.147,95%CI 0.115～0.190)、专业人员宣传(OR=0.252,95%CI 0.197～0.323)及督导行为(OR=0.168,95%CI 0.096～0.296)是妇女孕期叶酸服用行为的影响因素。结论家人及专业人员对妇女孕期叶酸服用行为具有影响,应将孕妇家人及专业人员纳入干预对象开展叶酸干预宣教,以提高叶酸服用率。     

四川省农村孕妇对优生知识的认知现状调查

目的:了解四川省农村孕妇对出生缺陷一级预防知识的掌握情况,为出生缺陷干预工作中宣传教育的服务方式和内容提供科学依据。方法:利用因子分析方法从4个维度分析研究对象的孕前保健知识水平,通过广义估计方程分析获取知识的途径,并研究知识获取途径、知识掌握水平和教育经历的关系。结果:共选取了四川省8个地区的917例孕妇,优生知识问卷的正确率为65.49%,其中风险预防知识正确率为87.37%,疾病预防知识正确率为58.32%,生育史知识正确率为49.84%,叶酸增补知识正确率为42.02%。没有主动学习优生知识的孕妇中有53.5%认为自己健康,有37.5%是意外怀孕。结论:孕妇的保健知识掌握情况较好,特别是文化水平较高的地区。其中,风险预防知识维度掌握情况较好,在某些方面认识不足(如生育史和叶酸增补方面);选择宣传手册、培训讲座或咨询医生途径获取知识的人群其优生知识水平较高;本科及以上高学历人群与初中及以下低学历人群相比,前者更容易选择这3种途径获取知识。没有主动学习保健知识的最主要原因是认为自己健康。     

Surveillance of preconception health indicators among women delivering live-born infants--Oklahoma, 2000-2003

Promoting preconception health of women is a key public health strategy in the United States to decrease morbidity and mortality associated with adverse maternal and infant outcomes. In 2006, CDC published 10 recommendations for improving the health of women before pregnancy; one recommendation proposed maximizing public health surveillance to monitor preconception health. Toward this end, data collected in Oklahoma (the only state to develop a detailed survey question on preconception health) during 2000-2003 from the Pregnancy Risk Assessment Monitoring System (PRAMS) were analyzed to 1) estimate the prevalence of women who did not report three selected preconception health indicators, (i.e., pre-pregnancy awareness of folic acid benefits, multivitamin consumption, and receipt of health-care counseling) and 2) identify those subpopulations of women who were more likely not to report these indicators. Results of this analysis indicated that 21.5% of Oklahoma women with a recent live birth were not aware of folic acid benefits before they became pregnant, 73.5% did not consume multivitamins at least four times per week during the month before pregnancy, and 84.8% did not receive preconception counseling from a health-care provider. Subpopulations of women with characteristics (at the time of conception) significantly associated (p<0.05) with not reporting at least two of the three indicators included those who were younger, were unmarried, had < or =12 years of education, had no health insurance, had an unintended pregnancy, or had a previous live birth. Other states might use this analysis to help develop preconception health questions to be included in their own PRAMS surveys; Oklahoma state and local health officials can use the results to help prioritize preconception health objectives and identify subpopulations of women in need of targeted programs.     

The relationship between pregnancy intention and preconception health behaviors

ObjectiveTo describe smoking, heavy drinking, and folic acid supplementation in preconception women and determine if the likelihood of healthy preconception behaviors differs by whether and when women intend future pregnancy.MethodsAnalysis was based on 35,351 nonpregnant women who participated in the 2004 Behavioral Risk Factor Surveillance System who were of reproductive age (18–44 years), sexually active, and capable of future pregnancy. The association between future pregnancy intention and preconception behaviors was determined adjusting for diabetes, weight category, age group, race/ethnicity, marital status, education, income, and children living in household.ResultsEighty percent of women were non-smokers, 94.3% were non-heavy drinkers, and 42.6% were daily folic acid users. In adjusted analysis, only the odds of folic acid supplementation remained higher in women intending pregnancy in the next 12 months (adjusted odds ratio, 1.57; 95% confidence interval, 1.21–2.04) compared with women not intending future pregnancy. Women intending pregnancy later or ambivalent about future pregnancy were no more likely to be engaging in healthy preconception behaviors than women not intending future pregnancy.ConclusionWomen intending pregnancy within 12 months were more likely to use folic acid, but pregnancy intention was not associated with preconception smoking or heavy drinking.     

Effectiveness of Folic Acid Supplementation Recommendations among Polish Female Students from the Podkarpackie Region

Adequate folic acid supplementation during the preconception period is an important element in the primary prevention of neural tube defects (NTDs). This study aims to study the effectiveness of folic acid supplementation recommendations among women of childbearing age, and to assess and characterise their awareness about this public health measure. The cross-sectional study included women (N = 1285) aged 22.27 ± 4.6 years old on average. Some of the results were obtained on a subgroup of women (N = 1127) aged 21.0 ± 2.1. This study was performed using a questionnaire. The analysis was performed with the use of a logistic regression model, chi-square test for independence and odds ratio (OR). According to the results, only 13.9% of women supplement folic acid, and 65.3% of them do so daily. A total of 91.1% of the respondents were not aware of its recommended dose and 43% did not know the role it plays in the human body. Among women who do not currently supplement folic acid (N = 1052), 52.4% declared doing so while planning their pregnancy. Women’s awareness about the role of folic acid in NTD prevention (OR = 4.58) and the information they got from physicians (OR = 1.68) are key factors that increased the odds of the women taking folic acid before pregnancy. There is therefore a need for more information and education campaigns to raise awareness about folic acid.     

Pregnancy Intention and Health Behaviors: Results from the Central Pennsylvania Women’s Health Study Cohort

Objective Our objective was to determine whether intention for future pregnancy affects selected preconception health behaviors that may impact pregnancy outcomes. Methods Analyses are based on data from a population-based cohort study of women ages 18–45 residing in Central Pennsylvania. A subsample of 847 non-pregnant women with reproductive capacity comprise the analytic sample. We determined the associations between intention for future pregnancy and the pattern in the following health behaviors over a 2-year period: nutrition (fruit and vegetable consumption), folic acid supplementation, physical activity, binge drinking, smoking, and vaginal douching. Multivariable analyses controlled for pregnancy-related variables, health status, health care utilization, and sociodemographic variables. Results At baseline, 9% of women were considering pregnancy in the next year, 37% of women were considering pregnancy some other time in the future, and 53% of women were not considering future pregnancy. In multivariable analyses, there were no associations between intention for future pregnancy and maintaining healthy behavior or improving behavior for any of the seven longitudinal health behaviors studied. Conclusions The importance of nutrition, folic acid supplementation, physical activity, avoiding binge drinking, not smoking, and avoiding vaginal douching in the preconception period needs to be emphasized by health care providers and policy makers.