Interconception Preventive Care and Recurrence of Pregnancy Complications for Medicaid-Insured Women
Interconception Preventive Care and Recurrence of Pregnancy Complications for Medicaid-Insured Women
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DOI：
10.1089/jwh.2021.0355
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发表时间：
2022-02-28
影响因子：
3.5
通讯作者：
Lorch，Scott A.
中科院分区：
文献类型：
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作者：
Gregory，Emily F.;Passarella，Molly;Lorch，Scott A.
背景：妊娠并发症可能复发，并与潜在的可改变的风险相关。减少重复妊娠complications.Materials和方法：这一回顾性队列使用了2007-2012年医疗补助要求从12个州的怀孕期预防保健的作用。包括首次分娩并发早产、高血压或糖尿病、36个月内再次分娩以及首次分娩后≥11/12个月符合医疗补助资格的女性。Logistic回归分析评估了指数出生后一年预防性就诊的暴露与随后妊娠的早产、高血压或糖尿病的主要结局之间的关联。回归调整混杂因素，包括人口统计学（年龄，种族和民族，农村居住，国家），指数妊娠功能（并发症，产前检查，多胎妊娠，产妇和婴儿住院时间，年），访问，以解决并发症在指数出生，interpregnancy interval.Results：在17,372名妇女，平均年龄为24.3 ± 5.3岁，种族/民族为50.3%非西班牙裔白色，27.2%非西班牙裔黑人，11.9%西班牙裔。在初次妊娠中，43.3%的孕妇发生早产，39.2%的孕妇发生高血压，34.2%的孕妇发生糖尿病。在指数妊娠后的一年中，54.7%的人至少有一次预防性就诊。在第二次怀孕中，47.7%的人经历了早产、高血压或糖尿病。早产的复发率为28.1%，高血压的复发率为38.0%，糖尿病的复发率为48.3%。预防访问与降低高血压在随后的怀孕（OR 0.88，95%CI 0.82-0.97），但没有减少早产或diabetes.Conclusions：预防访问后，索引出生并发早产，高血压，或糖尿病与10%的风险降低高血压在随后的怀孕，但没有减少糖尿病或早产。一些并发症可能比其他并发症更适合于受孕预防服务。
Background:Pregnancy complications may recur and are associated with potentially modifiable risks. The role of interconception preventive care in reducing repeat pregnancy complications is understudied.Materials and Methods:This retrospective cohort used 2007–2012 Medicaid claims from 12 states. Included women who had an index birth complicated by prematurity, hypertension, or diabetes, a subsequent birth within 36 months, and Medicaid eligibility for ≥11 of 12 months after index birth. Logistic regression assessed for an association between the exposure of preventive visits in the year after index birth and primary outcomes of prematurity, hypertension, or diabetes in the subsequent pregnancy. Regression adjusted for confounders including demographics (age, race and ethnicity, rural residence, state), index pregnancy features (complications, prenatal visits,multiple gestation, maternal and infant length of stay, year), visits to address complications in the index birth, and interpregnancy interval.Results:Of 17,372 women, mean age was 24.3 ± 5.3 years, and race/ethnicity was 50.3% non-Hispanic White, 27.2% non-Hispanic Black, and 11.9% Hispanic. In the index pregnancy 43.3% experienced prematurity, 39.2% experienced hypertension, and 34.2% experienced diabetes. In the year after the index pregnancy, 54.7% had at least one preventive visit. In the second pregnancy, 47.7% experienced prematurity, hypertension, or diabetes. Recurrence rates were 28.1% for preterm birth, 38.0% for hypertension, and 48.3% for diabetes. Preventive visits were associated with reduced hypertension in the subsequent pregnancy (OR 0.88, 95% CI 0.82–0.97) but not reduced preterm birth or diabetes.Conclusions:Preventive visits after an index birth complicated by prematurity, hypertension, or diabetes were associated with 10% lower odds of hypertension in a subsequent pregnancy, but not with reductions in diabetes or prematurity. Some complications may be more amenable to interconception preventive services than others.