Herrera生物社会心理模型预测低出生体重

Application of Herrera biopsychosocial model in predicting low birth weight

目的：评价Herrera产前生物社会心理模型预测低出生体重的效果及其在上海地区的适用性。方法：前瞻性队列研究。对前来医院接受产前检查的孕13周及以上的孕妇进行调查、随访，利用Herrera产前生物社会心理模型分别在13～27孕周、28～32孕周和33孕周～分娩三个时期对孕妇的妊娠情况进行评分。记录研究对象的围产期结局。结果：Herrera模型判定的高危妊娠者分娩低出生体重儿的危险性增大（OR：32．1，95％CI：4．3～238．9），模型的阳性预测值和阴性预测值分别为19．0％和99．3％。ROC曲线分析发现，33孕周～分娩时期模型评分预测效果优于其他两个时期，取域值为3和4分之间时灵敏度和特异度分别为88．0％和77．3％。结论：Herrera模型可以有效预测低出生体重，但该模型部分指标尤其是社会心理因素指标，不太适宜上海孕产妇妊娠期危险因素评价，该模型在上海推广尚需进一步的改进和验证。

Objective： To assess the predictive effect of Herrera blopsyehosoeial model on low birth weight and to assess its applicability in Shanghai. Methods： A prospeetive cohort study was conducted in the Obstetries and Gynecology Hospital of Fudan University. Eligible pregnant women whose initial prenatal visit occurred at 13th week of gestation or later were invited to participate in the follow - up study. The blopsyehosoeial risk assessments were carried out in three different gestatlonal periods （ 13 - 27 weeks, 28 - 32 weeks, 33 weeks to delivery） for each patient and risk scores were recorded at each follow - up. Complications of pregnancy and labor were recorded in pregnancy outcome form. Results： High risk pregnancy of Herrera model had a significantly higher risk （ OR： 32. 1, 95% CI： 4. 3 - 238.9） to give birth with low birth weight compared with low risk pregnancy. The positive predletive value of the model was 19. 0% and the negative predictive value was 99.3%. ROC analysis indicated that the predictive effect of the scoring system during 33 weeks of gestation to delivery was better than the others, and a threshold between 3 and 4 , the sensitivity was 88% and the specificity was 77.3%. Conclusion： Herrera model is clinically valid to predict low birth weight. However, some specific factors of Herrera model are not fully applicable to the predietlon of low birth weight in Shanghai. This model need further revision and evaluation before being put to use in Shanghai.