Clinical, provider and sociodemographic predictors of late initiation of antenatal care in England and Wales
Clinical, provider and sociodemographic predictors of late initiation of antenatal care in England and Wales
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DOI：
10.1111/j.1471-0528.2002.00524.x
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发表时间：
2002-03-01
影响因子：
5.8
通讯作者：
Maresh, M
中科院分区：
文献类型：
--
作者：
Kupek, E;Petrou, S;Maresh, M
目的确定影响英格兰和威尔士产前保健开始时间较晚的因素。设计构建多变量二项回归模型，以检验临床、提供者和社会人口学特征与产前保健开始时间较晚之间的关系。设置北方英格兰和北威尔士的9个产科单位。1994年8月1日至1995年7月31日期间分娩活产或死胎的771名单胎妊娠妇女。所有的分析都是基于17，765结果高产科风险初产妇在妊娠10周后开始产前检查的可能性比低产科风险对照组高13.4（调整后OR 1.134，95%CI 1.011，1.272; P = 0.0312），孕18周后开始产前检查的可能性增加34.3%（调整后OR 1.343，95%CI 1.046，1.724; P = 0.0208）。高产科风险状态和产前护理启动晚之间的这种关联在经产妇女中并没有复制。当检查其他独立变量对预约时胎龄的影响时，以下特征与妊娠10周时未能开始产前护理相关（P小于或等于0.05）：预约时的母亲年龄，吸烟状况，种族，预约时的医院类型，计划的产前护理模式和计划的分娩地点。采用妊娠18周的标准加剧了临床和社会人口学特征与产前保健延迟启动之间的关联，但似乎淡化了提供者特征与产前保健延迟启动之间的关联。结论迫切需要进一步研究，以确定延迟预订者的具体关注点，确定新的干预措施可能鼓励人们接受服务的领域，并衡量更多地传播有关产前保健服务的信息可能产生的影响。
Objective To identify factors that are predictive of late initiation of antenatal care in England and Wales.Design A multivariate binomial regression model was constructed to examine the association between clinical, provider and sociodemographic characteristics and late initiation of antenatal care.Setting Nine maternity units in Northern England and North Wales.Population A total of 20,771 women with a singleton pregnancy who delivered a liveborn or stillborn baby between 1 August 1994 and 31 July 1995. All analyses were based on the 17,765 (85.5%) women for whom information on gestational age at initial presentation for antenatal care and other variables incorporated into the regression model was retrievable from the case records.Results Primiparous women of high obstetric risk were 13.4% more likely to initiate antenatal care after 10 weeks of gestation than a low risk reference group (adjusted OR 1.134, 95% CI 1.011, 1.272; P = 0.0312), and 34.3% more likely to initiate antenatal care after 18 weeks of gestation (adjusted OR 1.343, 95% CI 1.046, 1.724; P = 0.0208). This association between high obstetric risk status and late initiation of antenatal care was not replicated among multiparous women. When the effects of other independent variables on gestational age at booking were examined, the following characteristics were associated with failure to initiate antenatal care by 10 weeks of gestation (P less than or equal to 0.05): maternal age at booking, smoking status, ethnicity, type of hospital at booking, the planned pattern of antenatal care and the planned place of delivery. Adopting a criterion of 18 weeks of gestation exacerbated the association between clinical and sociodemographic characteristics and late initiation of antenatal care, but appeared to dilute the association between provider characteristics and late initiation of antenatal care.Conclusions There is a pressing need for further research to identify the specific concerns of late bookers, to identify areas where new interventions might encourage the uptake of services and to gauge the likely impact of increased dissemination of information about the availability of antenatal care services.