免费孕前健康检查夫妇1年内累积受孕率和影响因素的队列研究

A Cohort study on cumulative pregnancy rate and influencing factors of couples who accepted free preconception health examination

目的：调查接受免费孕前健康检查对象1年累积受孕率并探讨相关影响因素。方法：选择2012～2013年上海市静安区参加免费孕前检查的对象进行随访，调查妊娠情况及相关影响因素，用寿命表法估计1年内逐月累积受孕率，用COX回归分析受孕率影响因素。结果：827对夫妇完成随访，接受孕前健康检查后第3、6、12月的累积受孕率分别为15．9％，26．9％和41．3％，单因素分析中发现孕前检查异常人群的累积受孕率低于正常人群（6个月受孕率分别为20％、32％，12个月分别为38％、45％）（P〈O．05）。用COX回归控制潜在混杂因素后，上述差异无统计学意义。未见其他因素与累积受孕率相关。结论：参加免费孕产健康检查人群1年内累积受孕率较低，有必要改进免费孕前健康检查服务策略，以提高其卫生经济学效益。

Objective： To survey 12 month cumulative pregnancy rate and influencing factors of couples who had accept- ed free preconception health examination in JinKan district of Shanghai. Method： Couples who accepted free preconcep- tion health examination in Jingan district from 2012 to 2013 were recruited and were followed up.Their pregnant situa- tion and influencing factors related to pregnancy were investigated. Life table was used to estimate cumulative pregnan- cy rate.COX regression model was used to explore risk factors associated to low pregnancy rate. Result： A total of 827 couples were followed up 12 month after their preconception health examination. The rate of cumulative pregnancy at 3, 6, and 12 month was 15.9%, 26.9% and 41.3%, respectively. Log-rank test showed that couples with abnormal examination results had statistically significant lower cumulative pregnancy rate than those of normal couples （rate of cumulative pregnancy at 6 month was 20% VS. 32M, and rate of cumulative pregnancy at 12 month was 380//oo VS.45% （P〈0.05）. But after controlling potential confounding by using COX regression model, outcomes of preconception health examination had no association with rate of cumulative pregnancy. No other risk factors associated with rate of cumulative pregnancy were identified in this study. Conclusion： Rate of cumulative pregnancy of couples who had ac eepted preconception health examination is low within one year, so service strategy of free preconception health exami- nation should be improved for increasing its cost-effeteness.