Pre-pregnancy and Early Prenatal Care are Associated with Lower Risk of Ectopic Pregnancy Complications in the Medicaid Population: 2004-08.
Pre-pregnancy and Early Prenatal Care are Associated with Lower Risk of Ectopic Pregnancy Complications in the Medicaid Population: 2004-08.
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DOI：
10.1111/ppe.12327
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发表时间：
2017-01
影响因子：
2.8
通讯作者：
Lauderdale DS
中科院分区：
文献类型：
--
作者：
Stulberg DB;Cain L;Hasham Dahlquist I;Lauderdale DS
宫外孕导致产妇发病率和死亡率很高。与有私人保险的妇女相比，有医疗补助或没有保险的妇女并发症更常见。目前还不清楚，如果更充分地利用医疗补助所涵盖的孕前预防性护理和产前护理，是否会减少并发症。医疗补助索赔被用来确定一个临床队列的妇女谁经历了宫外孕在2004年至2008年期间的所有女性医疗补助登记从一个大的14个州的人口，年龄15-44。诊断和程序代码用于识别异位妊娠和相关并发症。主要结局是与异位妊娠相关的并发症：输血、绝育或住院时间超过2天。独立变量为异位妊娠前1年内的预防保健记录和4个月内的产前保健记录。控制种族、年龄和居住州，在异位妊娠前1年内未接受任何医疗补助覆盖的预防性护理的妇女发生异位妊娠并发症的风险独立高于接受过的妇女（RR 1.12，95%置信区间（CI）1.09，1.16），在4个月内未接受任何医疗补助覆盖的产前护理的患者中，与接受治疗的患者相比（RR 1.89，95% CI 1.83，1.96）。在医疗补助受益人中，孕前和产前护理与宫外孕并发症风险降低独立相关。
Ectopic pregnancy causes significant maternal morbidity and mortality. Complications are more common among women with Medicaid or no insurance compared to those with private insurance. It is unknown whether preventive care prior to pregnancy and prenatal care, which are covered by Medicaid, would decrease complications if they were more fully utilised. Medicaid claims were used to identify a clinical cohort of women who experienced an ectopic pregnancy during 2004–08 among all female Medicaid enrolees from a large 14-state population, ages 15–44. Diagnosis and procedure codes were used to identify ectopic pregnancies and associated complications. The primary outcomes were complications associated with ectopic pregnancy: blood transfusion, sterilisation, or hospitalisation with length of stay greater than 2 days. Independent variables were documentation of preventive care within 1 year prior to the ectopic pregnancy and prenatal care within 4 months prior. Controlling for race, age, and state of residence, women’s risks of any ectopic pregnancy complication were independently higher among those who did not receive any Medicaid-covered preventive care within 1 year before the ectopic pregnancy compared to those who did (RR 1.12, 95% confidence interval (CI) 1.09, 1.16), and among those who did not receive any Medicaid-covered prenatal care within 4 months prior, compared to those who did (RR 1.89, 95% CI 1.83, 1.96). Pre-pregnancy and prenatal care are independently associated with decreased risk of ectopic pregnancy complications among Medicaid beneficiaries.
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