Postpartum Contraceptive Use and Other Reproductive Health Outcomes Among CenteringPregnancy Group Prenatal Care Participants.
Postpartum Contraceptive Use and Other Reproductive Health Outcomes Among CenteringPregnancy Group Prenatal Care Participants.
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CenteringPregnancy 小组产前护理参与者的产后避孕药具使用情况和其他生殖健康结果。
DOI：
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发表时间：
2020
期刊：
影响因子：
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通讯作者：
L. Haddad
中科院分区：
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作者：
Elizabeth T. Patberg;M. Young;S. Archer;G. Duininck;Jessica Li;C. Blackwell;E. Lathrop;L. Haddad
背景：CenteringPregnancy® 是一种团体产前护理 (PNC) 模式，可减少早产并提高患者满意度。人们对产后结果知之甚少。方法：本研究旨在评估 CenteringPregnancy 参与者与传统 PNC 参与者相比是否具有更有利的产后生殖健康结果。我们的主要结果是长效可逆避孕药（LARC）的使用。作为次要结局，我们检查了产后访视时的母乳喂养、产后访视的随访以及快速重复妊娠。我们对 2011 年至 2015 年间在佐治亚州亚特兰大三级护理医院接受 PNC 并分娩的 422 名妇女进行了一项回顾性队列研究。如果参与者参加了医疗补助计划，并且在 CenteringPregnancy (n = 248) 或传统 PNC (n = 174) 中接受过至少 3 次由认证助产士就诊的 PNC，则有资格参加。人口统计和临床数据是从电子病历中提取的。使用多变量对数二项式回归来比较 CenteringPregnancy 参与者和接受传统 PNC 的女性。结果：四分之一的女性 (26%) 选择 LARC 进行产后避孕。 CenteringPregnancy 组和传统 PNC 组之间的总体避孕药具使用率没有差异。与接受传统 PNC 的女性相比，CenteringPregnancy 参与者在产后使用 LARC 的可能性高出 70%（调整后相对风险 [aRR] 1.76；p<0.01）。 CenteringPregnancy 参与者更有可能在出院前开始母乳喂养（aRR 1.14，p = 0.01），并在产后就诊时报告纯母乳喂养（相对风险 [RR] 2.54；p < 0.01）。 CenteringPregnancy 组中的女性在产后访视时报告母乳喂养并参加产后访视的可能性稍高（分别为 RR 1.31，p = 0.05 和 RR 1.17，p = 0.05），但快速重复妊娠的可能性也同样较高（RR 0.90，p = 0.57）。结论：与传统 PNC 中的类似女性群体相比，CenteringPregnancy 组中的女性对 LARC 的摄取有所增加。 CenteringPregnancy 的其他潜在好处，包括母乳喂养和参加产后检查，需要进一步研究。
Background: CenteringPregnancy® is a model of group prenatal care (PNC) that reduces preterm birth and increases patient satisfaction. Less is known about postpartum outcomes. Methods: This study aimed to evaluate whether CenteringPregnancy participants have more favorable postpartum reproductive health outcomes compared with traditional PNC participants. Our primary outcome was utilization of long-acting reversible contraception (LARC). As secondary outcomes, we examined breastfeeding at the postpartum visit, follow-up at the postpartum visit, and rapid repeat pregnancy. We conducted a retrospective cohort study of 422 women who received PNC and delivered at tertiary care hospital in Atlanta, Georgia between 2011 and 2015. Participants were eligible to participate if they were enrolled in Medicaid and received at least three PNC visits with a Certified Nurse Midwife in either CenteringPregnancy (n = 248) or traditional PNC (n = 174). Demographic and clinical data were abstracted from the electronic medical record. Multivariable log binomial regression was used to compare CenteringPregnancy participants and women who received traditional PNC. Results: One quarter of women (26%) chose LARC for postpartum contraception. There was no difference in overall contraceptive uptake between CenteringPregnancy and traditional PNC groups. CenteringPregnancy participants were 70% more likely to use LARC postpartum compared with women receiving traditional PNC (adjusted relative risk [aRR] 1.76; p < 0.01). CenteringPregnancy participants were significantly more likely to initiate breastfeeding before hospital discharge (aRR 1.14, p = 0.01) and to report exclusive breastfeeding at the postpartum visit (relative risk [RR] 2.54; p < 0.01). Women in the CenteringPregnancy group were marginally more likely to report any breastfeeding at the postpartum visit and to attend the postpartum visit (RR 1.31, p = 0.05 and RR 1.17, p = 0.05 respectively), but were no less likely to have a rapid repeat pregnancy (RR 0.90, p = 0.57). Conclusions: Women in CenteringPregnancy groups had increased uptake of LARC compared with a similar cohort of women in traditional PNC. Other potential benefits of CenteringPregnancy, including breastfeeding and attendance at the postpartum visit require further study.