产前超声检查及产前指导对妊娠高血压综合征结局的影响分析

目的探讨产前超声检查及产前指导对妊娠高血压综合征患者母婴结局的影响。方法将我中心2016年1月至2017年2月收治的90例妊娠高血压综合征患者随机分成观察组与对照组各45例,对照组只进行产前超声检查,观察组进行产前超声检查联合产前指导,观察比较两组的母婴结局。结果观察组孕妇的并发症总发生率为13.33%,显著低于对照组的33.33%(P <0.05)。观察组的围产儿不良结局总发生率为4.44%,显著低于对照组的20.00%(P <0.05)。结论产前超声检查联合产前指导应用于妊娠高血压综合征患者可以显著改善孕妇及围产儿结局,降低并发症的风险,改善母婴预后。     

The Stability of Pregnancy Intentions and Pregnancy-Related Maternal Behaviors

Objectives: Our objectives were to characterize the stability of pregnancy intention and to examine whether stability is associated with the timing of prenatal care initiation, smoking during pregnancy, and breastfeeding. Methods: We use a sample of women from the National Longitudinal Survey of Youth (NLSY) for whom information on pregnancy intention was collected both during pregnancy and after delivery. In bivariate analyses we compare outcomes and characteristics of women whose pregnancy intention changed between the prenatal and postpartum periods. With multivariate methods, we analyze the correlates of switching pregnancy intention as well as the association between switching and maternal behaviors. Results: Women whose pregnancy intention changes between the two assessments are similar in marital status and socioeconomic background to those who report both during pregnancy and after delivery that the pregnancy is unintended. Disagreement during pregnancy between the parents' pregnancy intentions is the most important predictor of instability in the mother's pregnancy intention. Effects of unintended pregnancy on the timing of initiation of prenatal care, smoking during pregnancy, and breastfeeding based on reports after delivery are smaller than those based on reports during pregnancy, although differences are not statistically significant. Adverse effects of unintended pregnancy are greater when pregnancies reported by the mother to be unintended at either assessment are combined into a single category for unintended pregnancy. Conclusion: Unstable pregnancy intention may be a marker for adverse maternal behaviors related to infant health.     

Fathers' Involvement in Child Health Care: Associations with Prenatal Involvement,Parents' Beliefs,and Maternal Gatekeeping

Using data from 182 dual‐earner couples experiencing the transition to parenthood, this study examined associations between prenatal involvement, gender‐role beliefs, and maternal gatekeeping and new fathers' involvement in child health care. Results indicated that prenatal father involvement was associated with fathers' direct engagement in child health care and perceived influence in child health‐related decision making. Fathers also demonstrated greater direct engagement in child health care when mothers held more nontraditional beliefs about gender roles. Moreover, when mothers were more encouraging of fathers' involvement in childrearing, fathers felt more influential in child health‐related decision making, whereas when mothers engaged in greater gate‐closing behavior, fathers with more traditional gender‐role beliefs felt less influential in child health‐related decision making. This study suggests that fathers' prenatal involvement, mothers' beliefs, and maternal gatekeeping may play a role in the development of new fathers' involvement in child health care at the transition to parenthood.     

Comparison of Centering Pregnancy to Traditional Care in Hispanic Mothers

Objective To compare maternal and infant outcomes in Hispanic women participating in the Centering Pregnancy Model (CPM) to those receiving prenatal care via the traditional model and determine acceptability of the CPM. Methods Forty-nine women (n = 24 CPM; n = 25 traditional) participated in this quasi-experimental prospective comparative design. Participants self selected the model of care delivery. Data were collected via questionnaires at the initial visit, 34–36 weeks gestation, and postpartum. Outcome measures included: satisfaction with care delivery model, health behaviors, prenatal/postnatal care knowledge, self-esteem and depression. Breastfeeding initiation and continuation, infant birth weight, gestational age at delivery, mode of delivery and infant length of stay were also collected. Results Traditional participants had a history of more pregnancies, more living children, and higher levels of postpartum self-esteem compared to centering participants. Knowledge deficits and health behaviors were similar between groups. No differences were found for infant outcomes. Conclusions This study provides information regarding Hispanic mothers’ responses to an alternative care delivery model. Preliminary evidence suggests CPM compares with traditional care and yields a high degree of patient satisfaction. Specific pregnancy-related knowledge deficits were identified in both groups that could focus prenatal education. In light of similar outcomes in both groups; patient and provider satisfaction and economics would therefore be a factor when choosing a model of prenatal care delivery.     

Pregnant smokers who quit,pregnant smokers who don't: does history of problem behavior make a difference?

More than half of women who smoke in the USA continue to do so while pregnant. While socioeconomic and demographic factors that distinguish pregnancy quitters from persistent smokers have been identified, less is known about behavioral factors that are associated with persistent smoking. Because smoking during pregnancy is not only an individual, but also a maternal behavior, it may have different behavioral correlates than women's smoking has in general. We propose a conceptual framework in which smoking during pregnancy is viewed as a maternal problem behavior. We explore this conceptualization by examining whether persistent smoking during pregnancy is associated with a pattern of psychosocial risk- and health-compromising behaviors in multiple domains, with pilot data from a small clinic-based sample. Data are presented for 96 predominantly Caucasian, working-class pregnant women recruited from prenatal clinics in the USA. Smoking during pregnancy was measured repeatedly by self-report and biochemical assay. Participants were non-smokers (37%), pregnancy quitters (17%), and persistent smokers (46%). These groups were compared in terms of their history of problem behavior in three domains: interpersonal difficulties, problems in adaptive functioning and problematic health behaviors. With few exceptions, smokers were more likely to have problematic relationships, poorer adaptive functioning and to engage in problematic health behaviors, than both pregnancy quitters and non-smokers. This pattern of problem behavior may interfere with the effectiveness of standard public health prenatal cessation interventions for a sub-group of women. Examining pregnancy smoking as part of a broader matrix of problem behavior may help to identify pregnant women most at risk for persistent smoking and inform the development of targeted interventions.     

Paternal Identity,Maternal Gatekeeping,and Father Involvement*

Abstract: The purpose of this study was to examine whether mothers’ beliefs about the role of the father may contribute to mothers influencing the quantity of father involvement in their children's lives. Participants were 30 two‐parent families with children between the ages of 2 and 3 years. A combination of self‐report and interview data were collected from both mothers and fathers. Results from multiple regression analyses indicated that fathers’ perceived investments in their parental roles and actual levels of paternal involvement are moderated by mothers’ beliefs about the role of the father. Findings are discussed in terms of implications for future research on parenting identity and maternal gatekeeping as well as the development of parenting programs for fathers.     

The Effects of Prenatal Care Utilization on Maternal Health and Health Behaviors

While many economic studies have explored the role of prenatal care in infant health production, the literature is sporadic on the effects of prenatal care on the mother. This research contributes to this understudied but important area using a unique large dataset of sibling newborns delivered by 0.17 million mothers. We apply within‐mother estimators to find robust evidence that poor prenatal care utilization due to late onset of care, low frequency of care visits, or combinations of the two significantly increases the risks of maternal insufficient gestational weight gain, prenatal smoking, premature rupture of membranes, precipitous labor, no breastfeeding, postnatal underweight, and postpartum smoking. The magnitude of the estimates relative to the respective sample means of the outcome variables ranges from 3% to 33%. The results highlight the importance of receiving timely and sufficient prenatal care in improving maternal health and health behaviors during pregnancy as well as after childbirth. Copyright © 2016 John Wiley & Sons, Ltd.     

加强妊娠期ITP产前监护对母婴分娩结局的影响

目的:探讨产前加强监护对妊娠期合并血小板减少性紫癜(ITP)患者母婴妊娠结局的影响.方法:选取该院2010年1月～2013年1月实施产前监护的妊娠期ITP患者32例为观察组,并与2006年1月～2009年12月进行常规产前监护的妊娠期ITP患者30例(对照组)进行对比分析,观察两组产妇转归情况、妊娠合并症发生情况、剖宫产率、胎儿出生情况等方面的差异.结果:观察组监护后血小板计数高于对照组,而产中出血量、产后出血量显著低于对照组,差异有统计学意义(P＜0.05).对照组患者并发症发生率为15.63％,剖宫产率为50.00％,对照组的并发症发生率是43.33％,剖宫产率为76.67％,两组并发症发生率及剖宫产率具有统计学差异(P＜0.05),而两组死亡率无统计学差异(P＞0.05).观察组新生儿Apgar评分为(9.3±1.2)分优于对照组(7.9±1.1)分,差异有统计学意义(P＜0.05).结论:对妊娠合并ITP产妇加强妊娠期监护可有效降低产妇并发症发生率,减少产妇分娩出血量,有利于提高患者血小板水平,有利于母婴预后.     

Prenatal and Parenting Stress on Adolescent Maternal Adjustment: Identifying a High-Risk Subgroup

OBJECTIVES: Identifying adolescents who are at increased risk for a particularly difficult pregnancy and adjustment into parenthood is important, as the physical and psychological development of their infants rest in the well-being of these new mothers. This study aims to examine the effects of prenatal stress and parenting stress and the association with: (1) adolescent maternal adjustment; and (2) postpartum emotional distress. METHODS: In a prospective longitudinal cohort study, 154 pregnant adolescents (age 14-19) from 10 public clinics were interviewed four times from the third trimester of pregnancy to 16 months postpartum. Planned comparisons of four stress groups were used to compare mean scores for measures of feelings about motherhood, infant care, parenting competency, and emotional distress. RESULTS: Adolescent mothers who experienced high prenatal stress and high parenting stress had lower maternal adjustment (i.e., fewer positive feelings about motherhood, less infant care, and low parenting competency) and high postpartum emotional distress. Even when compared to adolescent mothers who experienced prenatal or parenting stress only, these adolescents were still at a greater disadvantage. CONCLUSIONS: Results suggest that adolescents who experience high stress during and after pregnancy are at increased risk for difficult maternal adjustment and high postpartum emotional distress. Findings support the need for health services targeting this subgroup of adolescent mothers, including both prenatal and parenting support. Early intervention to increase maternal adjustment and decrease emotional distress should remain a priority in facilitating the most optimal maternal and child health outcomes.     

Pregnancy Intentions,Pregnancy Attitudes,and the Use of Prenatal Care in Missouri

Objectives: This study uses data from 2378 mothers of live-born infants from the NICHD/Missouri Maternal and Infant Health Survey to examine the relationship between pregnancy intention and adequacy of prenatal care. Methods: Pregnancy intention was measured using traditional classifications of mistimed and unwanted pregnancies as well as additional measures of women's attitudes about their pregnancies. Odds ratios for inadequate prenatal care and its component parts (initiation of care and receipt of services) were calculated using multiple logistic regression in separate models and in a combined model for the measures of intention and attitude. Results: Women's attitudes about their pregnancies were associated with inadequate prenatal care, including both inadequate initiation of care and inadequate receipt of services. Traditional measures of intendedness were significantly related only to inadequate initiation of care. Women who were unhappy about the pregnancy (OR = 1.44), unsure that they wanted to be pregnant (OR = 2.81), or denied their pregnancies (OR = 4.82) were more likely to have inadequate prenatal care than women who did not have these attitudes. Women who were unhappy about being pregnant (OR = 1.86), unsure that they wanted to be pregnant (OR = 3.44), or who denied the pregnancy (OR = 6.69) were more likely to have inadequate initiation of care. Women who were unsure that they wanted to be pregnant (OR = 1.95) or who denied their pregnancies (OR = 2.47) were more likely to have received inadequate care once they had entered care. Conclusions: This study suggests that attitudes about pregnancy may be a psychosocial barrier to women obtaining early and continuous prenatal care. Pregnancy attitudes should be assessed and appropriate services provided to improve women's utilization of prenatal care. New measures of pregnancy attitude, beyond the traditional intention measures, can be useful in assessing pregnancy wantedness and identifying women to target for these services.     

医院兼职孕期管理师团队的建设与成效

总结了医院兼职孕期管理师团队建设的现实意义、人员设置与工作职责、工作方法等。通过孕期管理师的指导,孕妇产检的依从性、产检工作的满意度与孕期知识的掌握度都得到提高,妊娠期并发症和剖宫产率显著下降,对孕期保健具有重要意义。     

Father Involvement and Early Intervention: Effects of Empowerment and Father Role Identity

The family‐centered service delivery model used in early intervention is meant to empower families of children with disabilities. The present analysis examined the effects of empowerment and father identity on father involvement with children with disabilities. Father involvement was measured using three indices: attachment (i.e., feeling a strong connection to the child), engagement (i.e., participating in activities with the child), and responsibility (i.e., meeting the child's needs). Father empowerment and father identity, measured as salience, satisfaction, and reflected appraisals, consistently predicted higher levels of father involvement in hierarchical regression models. In addition, mediation analyses revealed that father identity partially mediated the relationship between empowerment and father involvement. These findings support the family‐centered service delivery model and suggest that it may be able to improve the lives of children with disabilities by enhancing father role identity and subsequent fathering activities.     

The Influence of Site of Care on the Content of Prenatal Care for Low-Income Women

Objective: To assess whether site of prenatal care influences the content of prenatal care for low-income women. Design: Bivariate and logistic analyses of prenatal care content for low-income women provided at five different types of care sites (private offices, HMOs, publicly funded clinics, hospital clinics, and other sites of care), controlling for sociodemographic, behavioral, and maternal health characteristics. Participants: A sample of 3405 low-income women selected from a nationally representative sample of 9953 women surveyed by the National Maternal and Infant Health Survey, who had singleton live births in 1988, had some prenatal care (PNC), Medicaid participation, or a family income less than $12,000/year. Outcome Measures: Maternal report of seven initial PNC procedures (individually and combined), six areas of PNC advice (individually and combined), and participation in the Women Infant Children (WIC) nutrition program. Results: The content of PNC provided for low-income women does not meet the recommendations of the U.S. Public Health Service, and varies by site of delivery. Low-income women in publicly funded clinics (health departments and community health centers) report receiving more total initial PNC procedures and total PNC advice and have greater participation in the WIC program than similar women receiving PNC in private offices. Conclusions: Publicly funded sites of care appear to provide more comprehensive prenatal care services than private office settings. Health care systems reforms which assume equality of care across all sites, or which limit services to restricted sites, may foster unequal access to comprehensive PNC.     

The Effect of Medicaid Managed Care on Prenatal Care: The Case of Puerto Rico

Objectives From 1994 to the year 2000 the government of Puerto Rico implemented a health care reform which included the mandatory enrollment of the entire Medicaid eligible population under Medicaid managed care (MMC) plans. This study assessed the effect of MMC on the use, initiation, utilization, and adequacy of prenatal care services over the reform period. Methods Using the vital records of all infants born alive in Puerto Rico from the year 1995–2000, a series of bivariate and multivariate analyses were conducted to assess the effect of insurance status (traditional Medicaid, MMC, private insurance and uninsured) on prenatal care utilization patterns. In order to assess the potential influence of selection bias in generating the health insurance assignments, propensity scores (PS) were estimated and entered into the multivariate regressions. Results MMC had a generally positive effect on the frequency and adequacy of prenatal care when compared with the experience of women covered by traditional Medicaid. However, the PS analyses suggested that self-selection may have generated part of the observed beneficial effects. Also, MMC reduced but did not eliminate the gap in the amount and adequacy of prenatal care received by pregnant women covered by Medicaid when compared to their counterparts covered by private insurance. Conclusions The Puerto Rico Health Reform to implement MMC for pregnant women was associated with a general improvement in prenatal care utilization. However, continued progress will be necessary for women covered by Medicaid to reach prenatal care utilization levels experienced by privately insured women.     

对孕期保健的影响因素调查

摘要l目的探讨不同因素对孕期保健的影响,为社区干预提出相关对策。方法采用回顾性分析的方法对2012年1月-12月在东莞市企石镇医院住院分娩的1021例孕产妇的保健情况进行统计分析。结果孕产妇实施孕期保健者893例,覆盖率为87．4％,保健次数以4～8次最多。不同年龄、户籍、婚姻状况、孕产史的孕期保健次数比较,差异均有统计学意义（P〈0．01）。年龄21～35岁、本市户籍、已婚、怀孕次数2～3次、流产次数少的孕妇,产前检查覆盖率较高。结论年龄、户籍、婚姻状况及孕产史对孕期保健有显著影响。加强对未参加孕期保健孕妇的指导工作,对提高孕妇的自我保健意识、避免不良妊娠、有效降低孕产妇死亡率和新生儿出生缺陷发生率有重要意义。     

Impact of Financial Incentives for Prenatal Care on Birth Outcomes and Spending

Objective. To evaluate the impact of offering US$100 each to patients and their obstetricians or midwives for timely and comprehensive prenatal care on low birth weight, neonatal intensive care admissions, and total pediatric health care spending in the first year of life.
Data Sources/Study Setting. Claims and enrollment profiles of the predominantly low-income and Hispanic participants of a union-sponsored, health insurance plan from 1998 to 2001.
Study Design. Panel data analysis of outcomes and spending for participants and nonparticipants using instrumental variables to account for selection bias.
Data Collection/Abstraction Methods. Data provided were analyzed using t -tests and chi-squared tests to compare maternal characteristics and birth outcomes for incentive program participants and nonparticipants, with and without instrumental variables to address selection bias. Adjusted variables were analyzed using logistic regression models.
Principle Findings. Participation in the incentive program was significantly associated with lower odds of neonatal intensive care unit admission (0.45; 95 percent CI, 0.23–0.88) and spending in the first year of life (estimated elasticity of −0.07; 95 percent CI, −0.12 to −0.01), but not low birth weight (0.53; 95 percent CI, 0.23–1.18).
Conclusion. The use of patient and physician incentives may be an effective mechanism for improving use of recommended prenatal care and associated outcomes, particularly among low-income women.     

西藏昌都地区农牧区妇女孕产期保健现状调查分析

目的:了解昌都地区农牧区妇女孕产期保健现状,并分析其影响因素。方法:运用定量调查和定性研究相结合的方法进行调查分析。结果:妇女产前检查率和产后访视率都极低,住院分娩率<20%,新法接生率<50%。影响妇女孕产期保健行为的因素包括经济、交通、文化和传统习俗以及医疗机构提供卫生服务的能力等。结论:该地区孕产期保健状况亟需改善,建议调整政策,加大政府对妇幼保健的投入和支持;加强健康教育,普及孕产期卫生保健知识,促进产前保健和住院分娩;加强服务系统的能力建设,特别是调整服务方向和改善服务方式。     

新疆生产建设兵团已婚育龄妇女孕产期保健状况调查

目的：了解新疆生产建设兵团1971-2006年间孕产期保健状况。方法：采取分层整群、四阶段、概率比例随机抽样方法,调查员入户面对面问卷调查。结果：共调查有活产已婚育龄妇女6624人,2001年以来,产前检查率、孕早期（妊娠≤12周）检查率、师直≥8次产前检查率、团场≥5次产前检查率、住院分娩率分别达到了86.60％、66.64％、58.70％、65.19％、82.01％,在家分娩率降到14.10％,而产后访视率仅为32.01％。育龄妇女的分娩时期、民族、受教育程度、生育史、家庭年收入、职业与是否参加产前检查有关。结论：近几年孕产期保健状况有明显改善,但产前检查率、孕早期检查率和产后访视率偏低,应特别加强对文化程度低、从事农业、少数民族孕妇的健康教育,普及孕产期卫生保健知识,规范产后访视,提高孕产期保健服务质量和服务利用率。     

Impact of Prenatal Care on Infant Survival in Bangladesh

Despite improvements in public health in recent decades, levels of infant and child mortality remain unacceptably high, particularly in developing countries where primary healthcare services including prenatal care services are not universally available. Using information on 7,001 childbirths in five years preceding the 2004 Bangladesh Demographic and Health Survey, this study examined the relationship between receiving prenatal care during pregnancy and infant mortality using multivariate survival analysis. The results are presented in hazard ratios (HR) with 95% confidence intervals (95% CI). Results indicate that children of mothers who did not receive prenatal care during pregnancy were more than twice as likely to die during infancy as children whose mothers received prenatal care during pregnancy (HR=2.40, 95% CI: 1.74, 3.31) independent of child's sex, delivery assistance, birth order; mother's age at child birth, nutritional status, education level; household living conditions, and other factors. Children born to older mothers living in households without safe drinking water were at an increased risk. The study concludes that prenatal care is strongly negatively associated with infant mortality in Bangladesh independent of other risk factors. The results suggest that improving prenatal care services at the community level is key to improving child survival in Bangladesh. Informed consent : This study is based on an analysis of existing survey data with all identifier information removed. The survey acquired informed consent from mothers of the children included in this study before asking any questions and before obtaining anthropometric measurements.