计划怀孕对神经管缺陷一级预防措施实施的影响

Effect of pregnancy planning on primary prevention measures for neural tube defects

目的了解育龄妇女计划怀孕现状,分析计划怀孕对育龄妇女孕前-围孕期实施神经管缺陷一级预防措施的影响。方法采用横断面调查方法,在山东省随机选取两县(区)妇幼保健院,于2008年1～2月对医院内的所有育龄妇女进行面访。结果研究对象最近一次妊娠为计划怀孕的占68.7%,其中生育年龄在24～29岁以及30岁以上的妇女计划怀孕率分别为72.2%和73.4%,显著高于23岁及以下妇女(P<0.05);计划怀孕可促使育龄妇女实施优生优育健康教育、遗传优生咨询、孕前健康检查和叶酸服用,较非计划怀孕分别增高了49.9%、65.3%、77.90%和69.0%;调整其他因素的影响后,计划怀孕与健康教育对遗传优生咨询和孕前健康检查的实施存在协同作用,交互效应超额相对危险度分别为4.59和4.26;计划怀孕与遗传咨询对叶酸的服用亦存在协同作用,超额相对危险度为6.71。结论育龄妇女实施计划怀孕可明显促进神经管缺陷各项一级预防措施的实施,且与各项措施间存在协同作用。

Objective To find out the current situation of pregnancy planning of women at childbearing age,and to an-alyze the effects of pregnancy planning on promoting neural tube defects （NTD） primary prevention measures during the pre-conceptual and peri-conceptual periods. Methods From January to February,2008,using cross-sectional survey, we carried out interviews with all women of childbearing age from Maternal and Child Health （MCH） Institutions in two counties randomly selected in Shandong Province about the implementation of the NTD primary prevention meas-ures. Results Among all the subjects,68. 7% had pregnancy planning for the last pregnancy and 31. 3% did not. The pregnancy planning rates of women between 24 and 29 years old and those aged above 30 were 72. 2% and 73. 4% re-spectively,which were much higher than that of women aged 23 and below （P〈 0. 05）. Pregnancy planning allowed women of childbearing age to carry out health education,genetic counseling,pre-concepual health examinations and pe-ri-conceptiual folic acid intake,the rates of which increased by 49. 9% ,65. 3% ,77. 90% and 69. 0% respectively;after adjusting the effects of other factors. Pregnancy planning and health education had synergistic effects on genetic counseling and pre-concepual health examinations,RERI （relative excess risk due to interaction） being 4. 59 and 4. 26 respectively. Pregnancy planning and genetic counseling had synergistic effects on folic acid intake,RERI being 6. 71. Conclusion Pregnancy planning could significantly promote the implementation of NTD primary prevention measures and there exist synergistic effects between pregnancy planning and other primary prevention measures.