Improved perinatal health through qualified antenatal care in urban Phnom Penh,Cambodia

Objectives  The aim of this study is to examine the utilities of antenatal care with comprehensive health education qualified in Phnom Penh for the health of mothers and infants during perinatal and postpartum periods. Attention was given to the existing socioeconomic disparties among women in this urban area, and the utilities were discussed irrespective of socioeconomic status. Methods  A total of 436 pregnant women in an urban area in Phnom Penh were selected using a complete survey in randomly sampled villages and were followed up. Participating in antenatal care with comprehensive health education at least three time was regarded as the use of “qualified antenatal care” during pregnancy. In this study, we investigated the independent associations of the use of qualified antenatal care with the following outcome variables after the adjustment for the influence of socieconomic variables: postpartum maternal health knowledge, postpartum maternal anemia, low birth weight, and infant immunization. Results  Of the 314 subjects who completed the follow-up examination, 66.8% used qualified antenatal care during pregnancy. The use of qualified antenatal care was positively associated with postpartum maternal health knowledge (OR=2.38, 95% CI: 1.12–5.05). and reductions in the incidences of postpartum anemia (OR=0.22,95% CI: 0.05–0.95) and low birth weight (OR=0.05,95% CI: 0.01–0.39) after the adjustment of the influence of socioeconomic status. The infants born to mothers who used qualified antenatal care had significantly higher coverage of BCG, DPT₁, and DTP₃ immunizations (P<0.001,P<0.001, andP<0.01, respectively), independent of their socioeconomic conditions. Conclusion  This study shows the solid utilities of qualified antenatal care in Phnom Penh for perinatal health.     

Impact of Maternal Health Behaviours and Social Conditions on Infant Diet at Age 1-Year: Results from a Prospective Indigenous Birth Cohort in Ontario,Canada

Background: Understanding the impact of maternal health behaviours and social conditions on childhood nutrition is important to inform strategies to promote health during childhood. Objective: To describe how maternal health sociodemographic factors (e.g., socioeconomic status, education), health behaviours (e.g., diet), and traditional health care use during pregnancy impact infant diet at age 1-year. Methods: Data were collected from the Indigenous Birth Cohort (ABC) study, a prospective birth cohort formed in partnership with an Indigenous community-based Birthing Centre in southwestern Ontario, Canada. 110 mother-infant dyads are included in the study and were enrolled between 2012 and 2017. Multiple linear regression analyses were performed to understand factors associated with infant diet scores at age 1-year, with a higher score indicating a diet with more healthy foods. Results: The mean age of women enrolled during pregnancy was 27.3 (5.9) years. Eighty percent of mothers had low or moderate social disadvantage, 47.3% completed more than high school education, and 70% were cared for by a midwife during their pregnancy. The pre-pregnancy body mass index (BMI) was <25 in 34.5% of women, 15.5% of mothers smoked during pregnancy, and 14.5% of mothers had gestational diabetes. Being cared for by an Indigenous midwife was associated with a 0.9-point higher infant diet score (p = 0.001) at age 1-year, and lower maternal social disadvantage was associated with a 0.17-point higher infant diet quality score (p = 0.04). Conclusion: This study highlights the positive impact of health care provision by Indigenous midwives and confirms that higher maternal social advantage has a positive impact on child nutrition.     

北京市朝阳区孕产妇母婴健康知识认知情况调查

【目的】 了解孕产妇母婴健康相关知识的认知情况,为完善孕产期健康教育宣传内容及形式提供依据。【方法】 采用问卷调查的方法,选择2011年2-3月份在北京市朝阳区妇儿医院进行孕期检查和住院分娩的孕产妇作为研究对象进行问卷调查。 【结果】 本次调查及格率为31.0%,其中孕产妇保健知识及格率为57.7%,新生儿保健知识及格率为16.6%;产妇的及格率(42.4%)明显高于孕早期妇女(25.3%);涉及孕产妇不同妊娠时期的具体生理指标或婴儿不同月龄的具体生理现象等健康知识问题,正确率均较低。 【结论】 根据孕产期不同阶段的需求,通过适宜的途径、采用恰当的载体,及时地开展适时、有效的健康知识宣传,以更好的提高孕产妇母婴健康知识掌握程度。     

玉树农牧区藏族妇女孕产期保健服务可及性研究

目的:了解偏远农牧区藏族育龄妇女的孕产期保健服务可及性状况。方法:利用2009年在青海省玉树县及囊谦县大、小苏莽乡的现场调查数据,分析农牧区藏族育龄妇女的孕产期保健服务利用率与经济、教育、医疗卫生服务可及性等因素的关系。结果:仅12.4%的妇女受过孕产期保健知识教育。最近一次生孩子孕产期保健服务利用率低,产前检查率为49.1%,新法接生率为11.2%,住院分娩率为9.5%,产后访视率为6.5%,均低于同类地区;怀孕期间发生紧急情况,60.4%的妇女会求助村医或乡医;生孩子后身体出现不适,68.6%的妇女会求助村医或乡医。受过孕产期保健知识教育者服务利用率高于未受过教育者;家庭年收入较高的妇女,在怀孕期间出现紧急情况和分娩后身体不适时,求医率高于家庭年收入较低的妇女。服务利用率与到医疗机构采用的不同交通方式和所需时间长短没有明显关系。调查地区67.3%的妇女生孩子无医药费用;有费用者,其自付医药费用占家庭年收入的比例在60%～100%者占5.7%,有2.9%的妇女生孩子自付医药费用超过了过去一年的家庭总收入。受访者报告了在过去2年内有4例亲属在孕产期死亡。结论:偏远农牧区藏族妇女在孕产期保健教育、服务等方面可及性不足。应进一步促进偏远农牧区的经济发展,倡导先进的生育文化,普及育龄妇女孕产期保健知识教育,加强乡村医生孕产期保健服务能力。     

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.     

Racial Disparities in Perinatal Outcomes and Pregnancy Spacing Among Women Delaying Initiation of Childbearing

Introduction Reducing racial/ethnic disparities is a key objective of the Healthy People 2010 initiative. Unfortunately, racial disparities among women delaying initiation of childbearing have received limited attention. As more women in the US are delaying initiation of childbearing, it is important to examine racial disparities in reproductive health outcomes for this subgroup of women. Objective To examine racial disparities in perinatal outcomes, interpregnancy interval, and to assess the risk for adverse outcomes in subsequent pregnancy for women delaying initiation of childbearing until age 30 or older compared to those initiating childbearing at age 20–29. Methods We conducted a retrospective cohort study using the Missouri maternally linked cohort files 1978–1997. Final study sample included 239,930 singleton sibling pairs (Whites and African Americans). Outcome variables included first and second pregnancy outcomes (fetal death, low birth weight, preterm delivery and small-for-gestational age) and interpregnancy interval between first and second pregnancy. Independent variables included maternal age at first pregnancy and race. Analysis strategies used involved stratified analyses and multivariable unconditional logistic regression; interactions between maternal race, age and interpregnancy interval were examined in the regression models. Results Compared to Whites, African American mothers initiating childbearing at age 30 or older had significantly higher rates of adverse outcomes in the first and second pregnancy (P < 0.0001). Generally, African Americans had significantly higher rates of second pregnancy following intervals <6 months compared to Whites; however, no significant racial differences were noted in interpregnancy interval distribution pattern after controlling for maternal age at first pregnancy. African Americans delaying initiation of childbearing had significantly higher risk for adverse perinatal outcomes in the second pregnancy compared to Whites after controlling for potential confounders, however there were no significant interactions between maternal age at first pregnancy, race and short interpregnancy interval. Conclusion Although African Americans were less likely to delay initiation of childbearing than were White women, their risk for adverse perinatal outcomes was much greater. As health care providers strive to address racial disparities in birth outcomes, there is need to pay attention to this unique group of women as their population continues to increase. Greg R. Alexander—Deceased.     

Explaining Racial Disparities in Infant Health in Brazil

Objectives. We sought to quantify how socioeconomic, health care, demographic, and geographic effects explain racial disparities in low birth weight (LBW) and preterm birth (PTB) rates in Brazil.Methods. We employed a sample of 8949 infants born between 1995 and 2009 in 15 cities and 7 provinces in Brazil. We focused on disparities in LBW (< 2500 g) and PTB (< 37 gestational weeks) prevalence between infants of African ancestry alone or African mixed with other ancestries, and European ancestry alone. We used a decomposition model to quantify the contributions of conceptually relevant factors to these disparities.Results. The model explained 45% to 94% of LBW and 64% to 94% of PTB disparities between the African ancestry groups and European ancestry. Differences in prenatal care use and geographic location were the most important contributors, followed by socioeconomic differences. The model explained the majority of the disparities for mixed African ancestry and part of the disparity for African ancestry alone.Conclusions. Public policies to improve children’s health should target prenatal care and geographic location differences to reduce health disparities between infants of African and European ancestries in Brazil.Large health disparities exist between Black and White infants in Brazil.1−4 Infant mortality is more than twice as common among Black as White infants in Southern Brazil (30.4 vs 13.9 per 1000).5 Poor birth outcomes including low birth weight (LBW) and preterm birth (PTB) are also more common among Black infants. Racial disparities are also reported in prenatal and postnatal care, with White mothers having more and higher-quality prenatal visits and greater use of postnatal care.6,7Documenting the prevalence and magnitude of racial disparities in infant’s and children’s health is important. However, of more importance is explaining these disparities and identifying the pathways through which they arise to identify contributors that can be targeted by policy interventions. Such effort has lifelong implications because of the importance of children’s health for adult health and human capital attainment.8−12 Because children’s health may have multiplicative effects on health over life, early health disparities may extend into large health and human capital disparities later in life.13,14Studies in the United States have shed light on several pathways that lead to racial disparities in infant’s and children’s health.15−21 Individual-level factors including socioeconomic status (SES),22 maternal age, prenatal care use,22−24 and stressful life events before delivery,17 as well as differences in health care access and quality25−27 and social inequalities because of residential segregation and poverty,15,28,29 are thought to be important contributors to racial disparities in infants’ health in the United States.To our knowledge, there are no studies that simultaneously quantify the contributions of a large number of conceptually relevant factors to racial disparities in infants’ health in Brazil. In this study, we examined the extent to which socioeconomic, health care, demographic, and geographic effects explain disparities in LBW (< 2500 grams) and PTB (< 37 gestational weeks) rates by African ancestry in Brazil. Unlike any previous study for Brazil, we evaluated the contributions of the explanatory factors to the disparities by different degrees of African ancestry. We focused on disparities by African ancestry because they are the most prevalent and affect a large percentage of the Brazilian population.1−5Our study is the first to simultaneously quantify the contributions of several factors both as a group and each on its own (with control for the others) to explaining racial disparities in infant health in Brazil. Such a study is needed not only because Brazil is the largest country in South America but also because there are many historical, demographic, economic, social, cultural, and health care system differences between Brazil and other racially admixed countries such as the United States. These differences limit the generalizability of studies of racial infant health disparities in the United States to the Brazilian population as these differences may modify the underlying factors and the extent of their contributions to the disparities.There is a sharp contrast in perception of race between Brazil and the United States.30 Race for individuals of African and European ancestry in Brazil has been historically and socially defined on a “continuum” of skin color including Black, Brown (mixed between Black and White), or White, instead of the Black or White color line as in the United States. This is in part because of the large racial admixing in Brazil.31 The difference in perceptions of racial identity between Brazil and the United States implies potential differences in cultural and socioeconomic factors related to race and how these may affect health and contribute to racial disparities. Brazil also differs significantly in its economic growth and extent of economic disparities by race from the United States.32 Finally, there are major differences in access to and quality of health care between Brazil and the United States.33,34 For all of these reasons, a study that explains the racial disparities in LBW and PTB in Brazil is needed to draw inferences that can help to inform policymaking and interventions to reduce these disparities in that country.     

Associations Among Food Security,Diet Quality,and Dietary Intake During Pregnancy in a Predominantly African American Group of Women from North Carolina

BackgroundLow food security during pregnancy can negatively affect women’s physical and mental health. Although many women make a greater effort to eat a healthy diet during pregnancy, the influence of low food security during pregnancy on maternal diet is not well understood.ObjectiveThis study aimed to assess the association between adult food security and maternal diet during pregnancy in a sample from North Carolina.DesignThis was a cross-sectional, secondary data analysis of food security (marginal, low, and very low vs high) and maternal diet during pregnancy.Participants and settingThis study included 468 predominantly Black/African American women during pregnancy from the Nurture cohort, enrolled through prenatal clinics in central North Carolina between 2013 and 2016.Main outcome measureDiet quality was assessed using the Alternate Healthy Eating Index-Pregnancy and the Mediterranean Diet Score. Dietary intake from seven food groups included in the Alternate Healthy Eating Index-Pregnancy and/or Mediterranean Diet Score was assessed as well.Statistical analysis performedMultiple linear regression models were used to examine the association between food security and diet quality and dietary intake during pregnancy, adjusting for race/ethnicity; participation in the Special Supplemental Nutrition Program for Women, Infants, and Children; education; prepregnancy body mass index; age; parity; and mean daily energy intake.ResultsIn this study, there was no association between maternal food security status and diet quality during pregnancy. However, researchers observed an association between low and marginal food security and greater intake of red and processed meats (marginal: β = 2.20 [P = 0.03]; low: β = 2.28 [P = 0.04]), as well as an association between very low food security and decreased vegetable consumption (β = –.43; P = 0.03).ConclusionsVery low food security was associated with reduced vegetable intake. In addition, low and marginal food security were associated with greater red and processed meat intake. Future research should focus on nationally representative populations and include longitudinal assessments to allow for the study of the influence of food security on health during pregnancy.     

上海市松江区《全覆盖孕产期系统保健管理》项目效果评估

目的:探讨《全覆盖孕产期系统保健管理》对孕产妇死亡、围产儿死亡、孕产妇系统管理的影响。方法:开展全社会孕情排摸提高早孕建册率、评估孕期妊娠风险加强重点孕妇管理、设立危重抢救中心提高抢救技能与设立抢救"绿色"通道积极应对危重抢救、政府经济支持设立外来孕产妇住院分娩点及免费产后访视、开展孕产期全程健康教育等方法。结果:评估项目前后(2008年、2011年)非本市孕产妇的系统管理率、早孕建册率、产前检查(产检)≥5次率、产后访视率、围产儿死亡率均有明显改变,经χ2检验,差异都具有统计学意义(P<0.05)。结论:项目对降低孕产妇死亡率、围产儿死亡率效果明显,对提高孕产妇系统管理率有一定的作用。     

Dental Cleaning Before and During Pregnancy Among Maryland Mothers

Despite increasing recognition of the importance of oral health to overall health, dental care utilization remains low in the US. Given the established link between maternal oral health and child oral health, this study examined factors related to preventive dental care utilization at two critical time points, before and during pregnancy. Data were obtained from a sample of 6,171 women who delivered a live birth during 2004–2008 and completed the Maryland Pregnancy Risk Assessment Monitoring System postpartum survey. Multinomial logistic analyses examined associations between predisposing and enabling factors with dental cleaning before and during pregnancy. Women with less than a high school education or a history of physical abuse and non-Hispanic black and Hispanic women were less likely to report teeth cleaning before and during pregnancy. Having no insurance at the start of pregnancy was associated with significantly lower risk of teeth cleaning before pregnancy and both before and during pregnancy. Receipt of oral health counseling during pregnancy was positively related to teeth cleaning during pregnancy. Dental cleaning is associated with insurance, oral health counseling and maternal factors such as race, ethnicity, education and history of physical abuse. Better integration of oral health into prenatal health care, particularly among ethnic and racial minority groups, may be beneficial to maternal and infant well-being. Oral health promotion, disease prevention and health care should be a part of the local, state and national health policy agendas.     

Assessing the socio-economic and demographic impact on health-related quality of life: evidence from Greece

Objectives:  The impact of socioeconomic status on health has been extensively studied and studies have shown that low socio-economic status is related to lower values of various health and quality-of-health measures. The aim of this study was to assess the influence of demographic and socio-economic factors on health- related quality of life (HRQoL). Methods:  A cross-sectional study was carried out in 2003 using a representative sample of a Greek general population (n = 1007, 18+ years old), living in Athens area. Multivariate stepwise linear regression analyses were performed to investigate the influence of socio-demographic and economic variables on HRQoL, measured by eight scales of the SF-36. Interaction effects between socioeconomic status (SES) and demographic variables were also performed Results:  Females and elderly people were associated with impaired HRQoL in all SF-36 scales. Disadvantaged SES i. e. primary education and low total household income was related to important decline in HRQoL and a similar relation was identified among men and women. Only the interaction effects between age and SES was statistically significant for some SF-36 scales. Multiple regression analyses produced models explaining significant portions of the variance in SF-36 scales, especially physical functioning. Conclusions:  The analysis presented here gives evidence of a relationship existing between SES and HRQoL similar to what has been found elsewhere. In order to protect people from the damaging effects of poverty in health it is important to formulate health promotion educational programs or to direct policies to empower the disposable income etc. Helping people in disadvantaged SES to achieve the good health that people in more advantaged SES attained would help to prevent the widening of health inequalities. Submitted: 05 May 2008; revised: 13 November 2008, 23 March 2009; accepted: 26 March 2009     

Associations Between Preconception Counseling and Maternal Behaviors Before and During Pregnancy

Preconception counseling (PCC) is a vital component of preconception care. Through counseling, providers educate and recommend strategies to improve health and birth outcomes for women of reproductive age. The objective of our analysis was to assess the associations between receipt of PCC and positive maternal behaviors before and during pregnancy. We analyzed 2004?C2008 Pregnancy Risk Assessment Monitoring System data from Maine, New Jersey, Utah, and Vermont. Multivariable logistic regression was used to investigate the associations between receipt of PCC and prepregnancy daily multivitamin consumption, first-trimester entry into prenatal care, and cessation of smoking and drinking before pregnancy among women who smoked/drank in the 2?years preceding the survey, adjusting for a wide range of maternal characteristics. Overall, 32% of women reported receipt of PCC, with particularly low rates reported among women with an unintended pregnancy (14%) and no health insurance prior to pregnancy (14%). Receipt of PCC was associated with daily prepregnancy multivitamin consumption (adjusted odds ratio [AOR]?=?4.4; 95% confidence interval [CI]?=?4.0, 4.7), first-trimester entry into prenatal care for women with an intended pregnancy (AOR?=?2.1; 95% CI?=?1.8, 2.4), and drinking cessation before pregnancy among women who drank in the 2?years preceding the survey (AOR?=?1.3; 95% CI?=?1.2, 1.5). PCC was associated with positive maternal behaviors that increase the likelihood of a healthy woman, pregnancy, and infant. Unfortunately, less than one-third of women with a recent live birth reported receiving PCC. These data provide population-based evidence suggesting the value of PCC in the promotion of healthy maternal behaviors for women with intended or unintended pregnancies.     

Socioeconomic,health, and dietary determinants of multivitamin supplements use in Belgium

Objective  

This study aimed at investigating the use of multivitamin supplements in relationship to dietary pattern, socio-economic conditions and some health indicators.     

Mother-Infant Interaction, Life Events and Prenatal and Postpartum Depressive Symptoms Among Urban Minority Women in Primary Care

Objectives: Prenatal and postpartum depression are significant mental health problems that can have negative effects on mother-infant interactions. We examined the relationships among mother-infant interactions, depressive symptoms, life events, and breastfeeding of low-income urban African American and Hispanic women in primary care settings. Methods: Participants were 89 African American and Hispanic women who were part of a larger mental health intervention study conducted in community health centers. Questionnaire data on depression, as well as negative and positive life events, were collected during pregnancy and at three-months postpartum, while mother-infant interaction observations and breastfeeding practice were only collected at three-months postpartum. Results: The ratings of maternal behavior for ‘depressed’ mothers did not differ from ‘nondepressed’ mothers. Except for gaze aversion behavior, infants' behavior while interacting with their mothers did not differ by maternal depression level. Hierarchical regression analyses revealed that maternal positive life events positively predicted infant interactional summary ratings, while maternal negative life events were inversely associated with maternal interactional summary ratings. Conclusions: To improve services in primary care, perinatal screenings for depression can help identify those women most at risk. When follow-up use of structured diagnostic instruments is not possible or cost-effective, clinician assessment of severity of depression will determine women with clinical levels of depression. Reducing negative life events is beyond the control of women or clinicians but cognitive interventions to help women focus on positive life events can reduce the deleterious effects of depression on mothers and their infants.     

Work-life imbalance and mental health among male and female employees in Switzerland

Objectives  To investigate the prevalence and mental health effects of an unequal work-life balance (WLB) including potential gender differences. Methods  A cross-sectional study based on a representative sample of the Swiss employed population aged 20 to 64 (women: n = 1661; men: n = 1591). Results  Based on a single-item measure, more than every seventh employee in Switzerland indicated major difficulties combining work and private life. In certain socio-demographic categories, up to 30% showed such work-life conflict (WLC). For both genders, work-life imbalance turned out to be a risk factor affecting mental health. Employees with self-reported WLC presented a significantly higher relative risk for poor self-rated health (women: aOR = 2.6/men: aOR = 2.0), negative emotions and depression (aOR = 3.0/3.1), low energy and optimism (aOR = 2.1/1.6), fatigue (aOR = 2.4/2.6), and sleep disorders (aOR = 1.8/1.5) compared to employees with no WLC. Conclusions  Internationally, few data on the prevalence of WLC exist. In Switzerland, work-life imbalance is not a marginal phenomenon among the workforce and needs to be addressed as a notable public and mental health issue. Submitted: 01 March 2008; revised: 30 July 2008, 06 November 2008; accepted: 01 December 2008     

Socioeconomic status, working conditions and self-rated health in Switzerland: explaining the gradient in men and women

Objectives:  Epidemiological research has confirmed the association between socioeconomic status (SES) and health, but only a few studies considered working conditions in this relationship. This study examined the contribution of physical and psychosocial working conditions in explaining the social gradient in self-rated health. Methods:  A representative sample of 10 101 employees, 5003 women and 5098 men, from the Swiss national health survey 2002 was used. SES was assessed according to the EGP-scheme. Working conditions included exposure to physical disturbances, physical strain, job insecurity, monotonous work and handling simultaneous tasks. For data analysis logistic regression analyses were performed. Results:  Data show a social gradient for self-rated health (SRH) as well as for physical and psychosocial working conditions. Logistic regression analysis controlling for age, gender and level of employment showed both physical and psychosocial working conditions to be significant predictors of SRH. Physical and psychosocial working conditions such as physical disturbances from work environment, physical strains in doing the job, monotony at work, job insecurity etc. could explain most of the social gradient of SRH in men and women. Conclusion:  The study confirmed the relevance of modifiable physical and psychosocial working conditions for reducing social inequality in health. Gender differences need to be considered in epidemiological and intervention studies. Submitted: 24 August 2007; revised: 06 May 2008, 11 August 2008; accepted: 19 October 2008     

Association Between Maternal Multivitamin Use and Preterm Birth in 24 States,Pregnancy Risk Assessment Monitoring System, 2009–2010

Objectives The study objective was to examine the prevalence of maternal multivitamin use and associations with preterm birth (<37 weeks gestation) in the United States. We additionally examined whether associations differed by race/ethnicity. Methods Using the Pregnancy Risk Assessment Monitoring System, we analyzed 2009–2010 data among women aged ≥18 years with a singleton live birth who completed questions on multivitamin use 1 month prior to pregnancy (24 states; n = 57,348) or in the last 3 months of pregnancy (3 states, n = 5095). Results In the month prior to pregnancy, multivitamin use ≥4 times/week continued to remain low (36.8 %). In the last 3 months of pregnancy, 79.6 % of women reported using multivitamins ≥4 times/week. Adjusting for confounders, multivitamin use 1–3 times/week or ≥4 times/week prior to pregnancy was not associated with preterm birth overall. Though there was no evidence of dose response, any multivitamin use in the last 3 months of pregnancy was associated with a significant reduction in preterm birth among non-Hispanic black women. Conclusions for Practice Multivitamin use during pregnancy may help reduce preterm birth, particularly among populations with the highest burden, though further investigations are warranted.     

孕妇产前健康教育与妊娠结局关系的探讨

目的:探讨孕妇产前健康教育与妊娠结局的关系。方法:选择住院分娩且自愿接受产前健康教育的116例初产妇为实验组,选择同期住院分娩未接受产前健康教育的100例初产妇为对照组,比较两组产妇分娩方式、高危妊娠发生率、围产儿死亡率。结果:实验组剖宫产率、高危妊娠发生率显著低于对照组(P<0.05);实验组围产儿死亡率低于对照组,两组差异无统计学意义(P>0.05)。结论:孕妇产前健康教育可有效提高孕妇对孕期保健知识的掌握,降低剖宫产率、高危妊娠发生率,防止并发症的发生,保障母婴健康。     

孕产妇计划妊娠影响因素分析

目的:探讨影响计划妊娠的相关因素。方法:利用无锡市2002～2004年孕产妇回顾性调查资料,采用入户面对面调查方式,运用logistic回归分析进行影响因素分析。结果:共调查1 628例孕产妇,计划妊娠比例为73.2%。多因素分析结果显示,生育年龄≥30岁、与丈夫文化程度相同、孕前家庭人口数少、人均家庭收入较高,以及除享有基本医疗保险以外还享有其他医疗保险的孕产妇计划妊娠的比例高;孕前去过咨询机构、孕前补充过叶酸和孕前进行TORCH或染色体检查的孕产妇计划妊娠的比例高。结论:计划妊娠受到多种因素影响,为提高计划妊娠比例,应建立政府、社区、家庭、个人共同参与的综合干预模式。     

Physical Abuse Around the Time of Pregnancy Among Women With Disabilities

Women with disabilities are at greater risk for physical abuse than women without disabilities. However, no previous population-based studies have examined physical abuse against women with disabilities around the time of pregnancy, a critical period for mother and child. The objective of this study was to describe the prevalence of physical abuse before and during pregnancy among a representative sample of Massachusetts women with and without disabilities. Data from the 2007–2008 Massachusetts Pregnancy Risk Assessment Monitoring System (PRAMS) were analyzed in 2010. Disability prevalence was 4.9% (95% CI = 3.9–6.2) among Massachusetts women giving birth during 2007–2008. The prevalence of physical abuse during the 12-months before pregnancy among women with disabilities was 13.6% (95% CI = 7.2–24.0) compared to 2.8% for women without disabilities (95% CI = 2.1–3.7). Similarly, 8.1% (95% CI = 4.0–15.7) of women with disabilities compared to 2.3% (95% CI = 1.7–3.1) of women without disabilities experienced physical abuse during pregnancy. Multivariate analyses indicated that women with disabilities were more likely to report physical abuse before pregnancy (OR = 4.3, 95% CI = 1.9–9.7), during pregnancy (OR = 2.8, 95% CI = 1.1–7.1), or during either time period (OR = 3.2, 95% CI = 1.4–7.1) than women without disabilities while controlling for maternal age, education, race/Hispanic ethnicity, marital status and household poverty status. No difference was observed by disability status in the likelihood of prenatal-care providers talking to women about physical abuse. These analyses reveal disproportionate prevalence of physical abuse before and during pregnancy among women with disabilities. Screening for physical abuse and timely referral of women in need of assistance are critical to optimize health outcomes for both mother and child.