The changing pattern of prenatal care utilization in the United States, 1981-1995, using different prenatal care indices
The changing pattern of prenatal care utilization in the United States, 1981-1995, using different prenatal care indices
复制标题
DOI：
10.1001/jama.279.20.1623
复制
发表时间：
1998-05-27
影响因子：
120.7
通讯作者：
Frigoletto, FD
中科院分区：
文献类型：
--
作者：
Kogan, MD;Martin, JA;Frigoletto, FD
背景。-传统上用于检查产前护理充分性的两项措施表明，产前护理利用率在整个1980年代保持不变，仅在1990年代才开始略有上升。近年来，制定了新的措施，其中包括一个类别，即接受超过建议护理量的妇女（密集使用）。比较1981年至1995年美国总人口和选定亚人口产前护理趋势监测中的新旧指数。第二，研究与接受集约利用相关的因素。国家出生记录的横截面和趋势分析。美国.主题. - 1981年至1995年间所有活产婴儿（N= 5400万）。根据4项指数（旧指数：医学研究所指数和开始护理的三个月，新指数：R-GINDEX和产前护理利用率指数）得出的产前护理利用率趋势。采用多元Logistic回归分析方法对1981年和1995年产前加强护理的风险进行评估。较新的指数表明，在整个研究期间，产前护理利用率呈稳步上升趋势（R-GINDEX，密集或充分利用率，1981年为32.7%，1995年为47.1%;产前护理利用率指数，密集利用率，1981年为18.4%，1995年为28.8%），特别是密集利用率。与1981年相比，1995年多胞胎妇女更有可能进行密集利用（R-GINDEX，22.8%对8.5%）。青少年更有可能开始护理晚于成年人，但类似比例的青少年和成年人有密集的利用。低风险妇女的密集使用也逐年稳步增加。与1981年和1995年接受密集使用的可能性更大相关的因素是多胎生育、双胎分娩、已婚和母亲年龄35岁或以上。1981年至1995年期间，尽早开始护理并至少接受建议次数的就诊的妇女比例有所增加。这种变化是未被发现的更传统的产前护理指标。这些增加有成本和实践的影响，并提出了一个矛盾，因为以前的研究表明，早产率和低出生体重在这段时间没有改善。
Context.-Two measures traditionally used to examine adequacy of prenatal care indicate that prenatal care utilization remained unchanged through the 1980s and only began to rise slightly in the 1990s. In recent years, new measures have been developed that include a category for women who receive more than the recommended amount of care (intensive utilization).Objective.-To compare the older and newer indices in the monitoring of prenatal care trends in the United States from 1981 to 1995, for the overall population and for selected subpopulations. Second, to examine factors associated with receiving intensive utilization.Design.-Cross-sectional and trend analysis of national birth records.Setting.-The United States.Subjects.-All live births between 1981 and 1995 (N=54 million).Main Outcome Measures.-Trends in prenatal care utilization, according to 4 indices (the older indices: the Institute of Medicine Index and the trimester that care began, and the newer indices: the R-GINDEX and the Adequacy of Prenatal Care Utilization Index). Multiple logistic regression was used to assess the risk of intensive prenatal care use in 1981 and 1995.Results.-The newer indices showed a steadily increasing trend toward more prenatal care use throughout the study period (R-GINDEX, intensive or adequate use, 32.7% in 1981 to 47.1% in 1995; the Adequacy of Prenatal Care Utilization Index, intensive use, 18.4% in 1981 to 28.8% in 1995), especially for intensive utilization. Women having a multiple birth were much more likely to have had intensive utilization in 1995 compared with 1981 (R-GINDEX, 22.8% vs 8.5%). Teenagers were more likely to begin care later than adults, but similar proportions of teens and adults had intensive utilization. Intensive use among low-risk women also increased steadily each year. Factors associated with a greater likelihood of receiving intensive use in 1981 and 1995 were having a multiple birth, primiparity, being married, and maternal age of 35 years or older.Conclusions.-The proportion of women who began care early and received at least the recommended number of visits increased between 1981 and 1995. This change was undetected by more traditional prenatal care indices. These increases have cost and practice implications and suggest a paradox since previous studies have shown that rates of preterm delivery and low birth weight did not improve during this time.