群體產前照護比個別的效果更好


  Dec. 1, 2003--根據一項發表於十一月份產科與婦科學期刊的前瞻性試驗結果顯示,群體產前照護比個別的產前照護能提供更好結果,群體照護明顯使早產兒有更好的體重增加情況。
  
  來自美國康乃狄克州紐哈芬市耶魯大學的第一作者Jeannette R. Ickovics在新聞稿中表示,這些結果會影響到將來產前照護服務的設計和型式。
  
  在這項匹配世代研究中,458位婦女的一半在24週懷孕期或24週之前接受例行性的個別產前照護,和其他的一半接受新型的群體產前照護-集中懷孕,這些婦女是從美國喬治亞州亞特蘭大市或康乃狄克州紐哈芬市的三所公立診所招收,他們大多數是黑人或是西班牙人而且社經地位低,這二組世代都經由診所、年齡、種族和嬰兒出生日期匹配過。
  
  在最初的產科招收之後,集中懷孕計畫的婦女被邀求加入其他8到12位懷孕期相同的婦女以接受懷孕、分娩、和早期養育的群體產前照護、教育和技能發展。
  
  作者表示,群體產前照護提供結構上的創新,允許更多的照護者-病患間互動,因此也提供了滿足臨床上、心理上、社會和行為因素的機會以提升健康的懷孕。
  
  集中懷孕組母親分娩的嬰兒有較高的出生體重(P < .01),特別是早產分娩,這組的早產兒比個別照護組的嬰兒幾乎重一鎊(平均體重:2,398 g vs. 1,990 g; P < .05)。
  
  群組照護病患的嬰兒也比較少是低出生體重(低於 2,500 g; 16 vs. 23位嬰兒);極低的出身體重(低於1,500g;三vs.六位嬰兒);早產(少於33週;二vs.七位嬰兒);或是新生兒死亡(零vs.三位嬰兒),但是這些發現都不具統計意義。
  
  研究限制包括沒有隨機分配,因此可能會在婦女選組及個別照護產生自我-選擇的誤差,Ickovics醫師表示,我們認為集中懷孕計畫可能改善所有婦女與孩子的健康結果,而我們特別期望群體照護能幫助減低不同人種的不良出生結果。
  

Better Outcomes With Group Tha

By Laurie Barclay, MD
Medscape Medical News

Dec. 1, 2003 — Group prenatal care provides better outcomes than individual prenatal care, according to the results of a prospective trial published in the November issue of Obstetrics and Gynecology. Group care was associated with significantly better weight gain for preterm infants.

"These results could impact the design and delivery of future prenatal care services," lead author Jeannette R. Ickovics, from Yale University in New Haven, Connecticut, says in a news release.

In this matched cohort study, half of 458 women entering prenatal care at or before 24 weeks' gestation received routine individual care, and the other half received Centering Pregnancy, a new model of group prenatal care. The women were recruited from three public clinics in Atlanta, Georgia, or New Haven, Connecticut, and they were predominantly black or Hispanic and of low socioeconomic status. The two cohorts were matched by clinic, age, race, and infant birth date.

After initial obstetric intake, women in the Centering Pregnancy program were invited to join eight to 12 other women due during the same month for group prenatal care, education, and skills building on pregnancy, childbirth, and early parenting.

"Group prenatal care provides a structural innovation, permitting more time for provider-patient interaction and therefore the opportunity to address clinical as well as psychological, social and behavioral factors to promote healthy pregnancy," the authors write.

Infant delivered by mothers in the Centering Pregnancy group had higher birth weight (P < .01), especially for preterm deliveries. Preterm infants in this group were almost one pound heavier than infants in the individual care group (mean, 2,398 g vs. 1,990 g; P < .05).

Infants of group care patients were also less likely to be low birth weight (less than 2,500 g; 16 vs. 23 infants); very low birth weight (less than 1,500 g; three vs. six infants); early preterm (less than 33 weeks; two vs. seven infants); or to experience neonatal loss (none vs. three infants), but these findings were not statistically significant.

Study limitations include lack of randomization that could have resulted in self-selection bias for women selecting group vs. individual care.

"We think that the Centering Pregnancy program has the potential to improve health outcomes for all women and their children, but we are especially hopeful that group care could help reduce racial disparities in poor birth outcomes," Dr. Ickovics says.

Obstet Gynecol. 2003;102:000-000

Reviewed by Gary D. Vogin, MD

    
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