背景:社会剥夺是不良妊娠结局的主要危险因素。然而,很少有研究评估旨在降低社会脆弱性对妊娠结局影响的干预措施.
目的:比较接受个性化妊娠随访(PPFU)以解决社会脆弱性与标准护理的患者的妊娠结局。
方法:2020年至2021年在单个机构进行的回顾性比较队列。共有3958名具有社会脆弱性的妇女在14个孕周后分娩了单胎,其中686例患者患有PPFU。社会脆弱性是由以下特征中的至少一个来定义的:社会孤立,住房条件差或不安全,没有与工作相关的家庭收入,以及缺乏标准健康保险(这四个变量组合为社会剥夺指数(SDI)),最近的移民(<12个月),怀孕期间的人际暴力,残疾或未成年,怀孕期间成瘾比较了接受PPFU和标准护理的患者的母亲特征和妊娠结局。不良妊娠结局之间的关联(37孕周前早产(GW),34吉瓦之前早产,小于胎龄(SGA)和PPFU采用多变量逻辑回归和倾向评分匹配进行检测.
结果:对SDI进行调整后,产妇年龄,奇偶校验,身体质量指数,母亲来源和怀孕前的高医疗和产科风险水平,PPFU是37孕周(GW)前早产的独立保护因素(aOR=0.63,95CI[0.46~0.86])。34GW之前的早产结果相似(aOR=0.53,95CI[0.34-0.79])。PPFU与SGA之间无相关性(aOR=1.06,95CI[0.86–1.30])。使用相同的变量对PPFU进行倾向评分调整(PSa)OR,结果相似,PSaOR=0.63,95CI[0.46-0.86]对于37GW之前的早产,对于34GW之前的早产,PSaOR=0.52,95CI[0.34-0.78],对于SGA,PSaOR=1.07,95CI[0.86-1.33]。
结论:这项工作表明PPFU改善了妊娠结局,并强调在怀孕期间检测社会脆弱性是一个主要的健康问题。
BACKGROUND: Social deprivation is a major risk factor of adverse pregnancy outcomes. Yet, there is few studies evaluating interventions aiming at reducing the impact of social vulnerability on pregnancy outcomes.
OBJECTIVE: To compare pregnancy outcomes between patients that received personalized pregnancy follow-up (PPFU) to address social vulnerability versus standard care.
METHODS: Retrospective comparative cohort in a single institution between 2020 and 2021. A total of 3958 women with social vulnerability that delivered a singleton after 14 gestational weeks were included, within which 686 patients had a PPFU. Social vulnerability was defined by the presence of at least one of the following characteristics: social isolation, poor or insecure housing conditions, no work-related household income, and absence of standard health insurance (these four variables were combined as a social deprivation index (SDI)), recent immigration (< 12 month), interpersonal violence during pregnancy, being handicaped or minor, addiction during pregnancy. Maternal characteristics and pregnancy outcomes were compared between patients that received PPFU versus standard care. The associations between poor pregnancy outcomes (premature birth before 37 gestational weeks (GW), premature birth before 34 GW, small for gestational age (
SGA) and PPFU were tested using multivariate logistic regression and propensity score matching.
RESULTS: After adjustment on SDI, maternal age, parity, body mass index, maternal origin and both high medical and obstetrical risk level before pregnancy, PPFU was an independent protective factor of premature birth before 37 gestational weeks (GW) (aOR = 0.63, 95%CI[0.46-0.86]). The result was similar for premature birth before 34 GW (aOR = 0.53, 95%CI [0.34-0.79]). There was no association between PPFU and
SGA (aOR = 1.06, 95%CI [0.86 - 1.30]). Propensity score adjusted (PSa) OR for PPFU using the same variables unveiled similar results, PSaOR = 0.63, 95%CI[0.46-0.86] for premature birth before 37 GW, PSaOR = 0.52, 95%CI [0.34-0.78] for premature birth before 34 GW and PSaOR = 1.07, 95%CI [0.86 - 1.33] for
SGA.
CONCLUSIONS: This work suggests that PPFU improves pregnancy outcomes and emphasizes that the detection of social vulnerability during pregnancy is a major health issue.