上海市嘉定区再生育妇女孕前保健服务利用及影响因素分析

Analysis of utilization and influencing factors of preconception healthcare services among women expecting additional childbirth in Jiading District,Shanghai

【目的】了解上海市嘉定区再生育妇女孕前保健服务的利用情况及影响因素,为促进新人口政策形势下孕前保健服务利用提供参考。【方法】对上海市嘉定区6个街镇的682名再生育孕妇开展孕期保健服务利用和影响因素的问卷调查,并对结果进行统计学分析。【结果】再生育妇女平均年龄为(31.7±4.5)岁,30.2%的再生育妇女年龄≥35岁;生育三孩及以上占比较低,为16.4%;92.4%的再生育妇女伴有各种妊娠初筛风险因素。再生育妇女对孕前保健服务利用率较低,为26.7%;对嘉定区免费孕前检查项目的知晓率也低,为28.6%;对嘉定区免费孕前保健服务利用率更低,为7.69%。意外妊娠仍然是再生育妇女未能及时接受孕前保健服务的主要原因,占63.6%。多因素二元logistic回归分析显示,相对于年龄≤29岁的再生育妇女,年龄在35~39岁的再生育妇女本次妊娠前孕前保健服务利用率更高(OR=1.789,95%CI:1.033~3.099);本次妊娠为计划妊娠的再生育妇女妊娠前孕前保健服务利用率更高(OR=4.164,95%CI:2.627~6.602);首次生育前接受过孕前保健服务的再生育妇女本次妊娠前孕期保健服务利用率更高(OR=7.534,95%CI:4.954~11.456);无慢性病家族史的再生育妇女本次妊娠前孕前保健服务利用率更高(OR=1.903,95%CI:1.083~3.345)。【结论】三孩政策下,嘉定区再生育妇女中,三孩及以上生育率占比较低;大多数再生育妇女合并有妊娠初筛风险因素。再生育妇女对孕前保健服务利用率及对嘉定区免费孕前检查项目的知晓率均较低。意外妊娠仍然是再生育妇女未能及时接受孕前保健服务的主要原因。年龄、是否计划妊娠、首次生育前是否接受过孕前保健以及是否有慢性病家族史是影响再生育妇女利用孕前保健服务的主要因素。相关部门应进一步加强对孕前保健服务项目的宣传,尤其是针对尚未生育的育龄妇女,以提高孕前保健服务的利用率。

[Objective]To understand the utilization of preconception healthcare services and the influencing factors among the women expecting additional childbirth in Jiading District,Shanghai,and to provide references for promoting the utilization of preconception healthcare services under the new population policy.[Methods]A questionnaire survey on the utilization of preconception healthcare services and related influencing factors was carried out among 682 women expecting additional childbirth across six subdistricts in Jiading District,Shanghai.The results were statistically analyzed.[Results]The average age of the women was(31.7±4.5)years,30.2%of whom were≥35 years old.The proportion of women having their third or subsequent children was low,at 16.4%.A significant majority,92.4%,were found to have various risk factors during initial pregnancy screening.The utilization rate of preconception healthcare services among women seeking additional childbirth was relatively low at 26.7%.Awareness of the free preconception check-up program in Jiading District was also low at 28.6%,and the utilization rate for these services was even lower at 7.69%.Unplanned pregnancies were the primary reason for not utilizing preconception healthcare services,accounting for 63.6%.The results of multifactorial binary logistic regression analysis showed that the utilization rate of preconception healthcare services before the current pregnancy was higher for women aged between 35 and 39 compared to women aged≤29 years old(OR=1.789,95%CI:1.033‒3.099).Women with planned pregnancies had a higher utilization of preconception healthcare services prior to this pregnancy(OR=4.164,95%CI:2.627‒6.602).Women who had received preconception care prior to their first birth had a higher utilization rate of preconception care prior to the current pregnancy(OR=7.534,95%CI:4.954‒11.456).Women without a family history of chronic diseases had a higher utilization rate of preconception healthcare services(OR=1.903,95%CI:1.083‒3.345).[Conclusion]Under the context of three-child policy,the proportion of women seeking three or more children in Jiading District is low.Most of these women have risk factors identified during initial pregnancy screenings.The utilization rate of preconception healthcare services and the awareness of the free preconception screening program in Jiading District are both low.Unplanned pregnancies remain the primary reason for failing to receive timely preconception healthcare services.Age,whether the pregnancy was planned,whether the women had received preconception healthcare services before their first baby and family history of chronic diseases are the main factors affecting the utilization of preconception healthcare services.Relevant departments should enhance the promotion of preconception healthcare service programs,especially for women of childbearing age who have not yet given birth,so as to improve the utilization rate of preconception health care services.