上海市某区早孕女性孕前检查率及相关因素分析

Factors associated with preconception health examination rate among females of early pregnancy in a district of Shanghai

目的了解上海市某区早孕女性孕前检查参与情况,并探讨其相关因素,为提高孕前检查率,做好孕前保健工作提供建议和参考。方法采用等比例抽样方法,选取2022年上海市某区13个街道的808名早孕建册女性为研究对象,采用回顾性问卷调查方式,了解其孕前健康检查的参与情况。结果上海市某区早孕建册女性的自报孕前健康检查率为34.90%,其中自费孕前检查率为26.48%,免费孕前检查率为8.42%。孕前检查的认知偏差(39.35%)和意外怀孕(37.07%)是早孕女性未参检的主要原因。多因素分析显示,在人口学特征方面,高年龄组(>35岁)妇女(OR=2.097,95%CI:1.080~4.072)、计划怀孕者(OR=12.894,95%CI:6.801~24.448)、首胎生育者(OR=3.080,95%CI:1.846~5.137)孕前检查率更高;在备孕知识方面,充分了解免费孕前健康检查政策(OR=1.893,95%CI:1.138~3.148),怀孕前了解(OR=2.152,95%CI:1.254~3.693)或非常了解(OR=2.886,95%CI:1.261~6.606)备孕保健知识,了解(OR=2.840,95%CI:1.201~6.714)或非常了解(OR=3.022,95%CI:1.113~8.209)叶酸服用知识的调查对象孕前检查率也更高;在态度方面,对“计划怀孕前双方都应该先做孕前检查”观念持赞同(OR=10.521,95%CI:4.433~24.973)和非常赞同(OR=16.086,95%CI:6.908~37.460)态度,对“每年参加常规体检,孕前检查就不必要”观念持不赞同态度的调查对象孕前检查率相对更高(OR=3.980,95%CI:1.721~9.208)。结论上海市某区育龄女性孕前健康检查率有待提高,需加强免费孕前检查政策和孕前保健知识的深入宣传,提高育龄女性对计划妊娠和孕前保健的认识。强调孕前检查和常规体检的区别可能有助于提高孕前健康检查率,保障孕前保健服务的实施。

Objective To investigate the current status of and factors associated with preconception health examination among females of early pregnancy in a district of Shanghai,so as to increase the participation rate and provide suggestions and evidences for improving preconception care.Methods An equal proportional sampling method was used to recruited 808 females who registered for early pregnancy in 2022 from 13 communities in a district as study subjects.A retrospective questionnaire survey was conducted to investigate their participation in preconception health examinations.Results The self-reported preconception health examination rate for females of early pregnancy registration in a district of Shanghai was 34.90%,of which 26.48%were self-paid and 8.42%were free.Cognitive bias in preconception examination(39.35%)and unplanned pregnancy(37.07%)were primary reasons for not participating preconception examination.Multivariate analysis showed that among demographic characteristics,females with older age(>35 years)(OR=2.097,95%CI:1.080−4.072),planned pregnancies(OR=12.894,95%CI:6.801−24.448),and first-time pregnancies(OR=3.080,95%CI:1.846−5.137)had higher rates of preconception health examinations.In terms of pre-pregnancy preparation,women who had overall understanding of the National Free Preconception Health Examination Project(OR=1.893,95%CI:1.138−3.148),who were familiar(OR=2.152,95%CI:1.254−3.693)or highly familiar(OR=2.886,95%CI:1.261−6.606)with preconception care,and who were familiar(OR=2.840,95%CI:1.201−6.714)or highly familiar(OR=3.022,95%CI:1.113−8.209)with folic acid also had higher rates of preconception examination.With regard to attitudes,women who agreed(OR=10.521,95%CI:4.433−24.973)or strongly agreed(OR=16.086,95%CI:6.908−37.460)with the perception that“Couples should have preconception examination before planning a pregnancy”,and who disagreed with the perception that“Preconception examination is not necessary if you attend routine health check every year”(OR=3.980,95%CI:1.721−9.208)had higher participation rates.Conclusion The rate of preconception health examination among females of reproductive age in a district of Shanghai needs to be improved.It is necessary to strengthen in-depth advocacy of the National Free Preconception Health Examination Project and preconception care,improve understanding of planned pregnancy and preconception care,and emphasize the difference between preconception health examination and regular health check,which might be helpful to increase the participation rate of preconception health examination and ensure the implementation of preconception care services.