北京市通州区产前检查依从性研究

An epidemiological study on compliance of antenatal care in Tongzhou District of Beijing, China

目的分析北京市通州区住院分娩产妇接受产前检查的次数和检查时间的依从性及其影响因素,提出提高产前保健质量的建议。方法利用北京市通州区2013年7月—2017年12月间分娩的产妇保健数据进行回顾性研究,计算全区11个分娩医院54 239名产妇的平均产前检查次数和按时间规范的检查率,分析产前检查率的时间变化趋势,利用Logistic多因素模型分析产前检查依从性的影响因素。结果产前检查次数中位数从2013—2015年的9次上升到2016和2017年的10次和11次;完全按照时间规范完成产前检查的产妇比例较低,从2013年的12.9%逐渐上升到2017年的45.2%;2013年在孕13周内的规范产前检查率只有18.4%,2016年和2017年上升到70%左右。从产妇特征来看,25岁以下、初中及以下文化程度、失业和农林牧渔业、丈夫和妻子均为外省户籍的规范产前检查率最低。Logistics回归分析发现,2017年和2013年相比,影响第1次产前检查的因素基本一致,年龄、文化程度、职业、户籍、自然流产史等因素均明显影响产前检查率;第5次产前检查的影响因素较少,但2017年时年龄、户籍和孕次等仍然存在影响。结论为进一步提高产前检查依从性,进而提高母儿健康,需要对低龄、低文化程度、流动人口等弱势人群采取更有针对性的管理措施。

Objective This study investigated the number of women who received the antenatal care(ANC)and analyzed the factors of ANC compliance in Tongzhou district of Beijing,in order to improve ANC there.Methods We conducted a retrospective study including 54239 women with singleton delivery from 11 hospitals in Tongzhou,from July,2013 to December,2017.We calculated the average numbers of ANC and proportions of women who regularly received ANC,and analyzed trend of the proportions during 2013-2017.We utilized a Logistic regression model to find out the factors that influenced the ANC compliance.Results Median of number of ANC increased from 9 per year during 2013-2015 to 10 in 2016,and to 11 in 2017.Proportions of women who regularly received ANC were increased from 12.9%in 2013 to 45.2%in 2017.The proportion of the first ANC(women who received ANC before 13 pregnancy weeks)rapidly increased from 18.4%in 2013 to^70%in 2016 and 2017.Among different social-economic subgroups,lower proportion of ANC women was found for the mothers under 25 years old,the mothers with education level equal or below junior high school,the unemployed,the farmers,and the families without Beijing Hukou.The results of logistic regression indicated that the factors influencing the first ANC included maternal age,education level,occupation,Hukou,natural abortion history,and were unchanged during 2013-2017.While,few factors except maternal age,Hukou and number of pregnancies in 2017,significantly affected the fifth ANC(women who received ANC during 37-40 pregnancy weeks).Conclusion Our findings suggest that specific healthcare managements should be applied to more vulnerable subgroups including the young,the lower educated,and the migrant,in order to improve ANC service and to protect maternal and child health.