Maternal Sociodemographic Characteristics, Experiences and Health Behaviors Associated with Postpartum Care Utilization: Evidence from Maryland PRAMS Dataset, 2012-2013
Maternal Sociodemographic Characteristics, Experiences and Health Behaviors Associated with Postpartum Care Utilization: Evidence from Maryland PRAMS Dataset, 2012-2013
复制标题
DOI：
10.1007/s10995-018-2428-y
复制
发表时间：
2018-04-01
影响因子：
2.3
通讯作者：
Holmes, Laurens, Jr.
中科院分区：
文献类型：
--
作者：
Morgan, Isabel;Hughes, Mary Elizabeth;Holmes, Laurens, Jr.
目的产后访视日益被认为是卫生保健提供者咨询新妈妈和促进健康行为的机会之窗，包括增加避孕药的使用和产后抑郁症的筛查。在马里兰州，缺乏关于产后探视(PPV)出勤率和与不接受产后护理相关的特定风险因素的研究。在这项研究中，我们估计了马里兰州参加PPV的母亲的比例，并评估了与未参加PPV相关的母亲的社会人口学特征和健康行为。方法对2012年和2013年马里兰州妊娠风险评估监测系统(n=2204)的数据进行分析。采用双变量和多变量Logistic回归分析协变量与PPV缺勤之间的关系。结果总体而言，89.6%的女性报告参加了PPV。母亲社会人口学和健康行为特征与PPV未就诊的双因素分析显示，未婚(OR 3.03，95%CI 2.12~4.31)、失去婴儿(OR 7.17，95%CI 2.57~19.97)、孕期工作(OR 0.44，95%CI 0.31~0.63)和未接受牙科护理(OR 2.03，95%CI 1.43~2.88)是PPV未就诊的显著危险因素。在控制了已知的和理论上的混杂因素后，经历过婴儿死亡(AOR 5.18，95%CI 1.54-17.4)、没有接受牙科护理(AOR 1.54，95%CI 1.06-2.26)和怀孕期间工作(AOR 0.61，95%CI 0.41-0.93)成为PPV缺勤的强烈预测因素。对于最近经历过婴儿死亡的实习母亲来说，没有参加PPV的风险最大，这表明需要建立全面的支持网络，包括悲伤咨询和为经历婴儿死亡的母亲提供额外的服务提醒。
Objectives Postpartum visits are increasingly recognized as a window of opportunity for health care providers to counsel new mothers and promote healthy behaviors, including increasing contraceptive use and screening for postpartum depression. In Maryland, there is a lack of research on postpartum visit (PPV) attendance and the specific risk factors associated with not receiving postpartum care. In this study, we estimated the proportion of mothers in Maryland who attended a PPV and assessed maternal sociodemographic characteristics and health behaviors associated with PPV non-attendance. Methods Data were analyzed from the 2012 and 2013 Maryland Pregnancy Risk Assessment Monitoring System (n = 2204). Bivariate and multivariable logistic regression were performed to examine the association between covariates and PPV non-attendance. Results Overall, 89.6% of women reported PPV attendance. Bivariate analyses between maternal sociodemographic and health behavior characteristics and PPV non-attendance indicated that being unmarried (OR 3.03, 95% CI 2.12-4.31), experiencing infant loss (OR 7.17, 95% CI 2.57-19.97), working during pregnancy (OR 0.44, 95% CI 0.31-0.63) and not receiving dental care (OR 2.03, 95% CI 1.43-2.88) as significant risk factors for PPV non-attendance. After controlling for known and theoretical confounders, experiencing an infant loss (aOR 5.18, 95% CI 1.54-17.4), not receiving dental care (aOR 1.54, 95% CI 1.06-2.26) and working during pregnancy (aOR 0.61, 95% CI 0.41-0.93) emerged as strong predictors of PPV non-attendance. Conclusions for Practice Mothers who recently experienced an infant death were at greatest risk for not attending a PPV, suggesting the need to establish comprehensive support networks, including grief counseling and additional service reminders for mothers who experienced an infant death.