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目的:评价Herrera产前生物社会心理模型预测低出生体重的效果及其在上海地区的适用性。方法:前瞻性队列研究。对前来医院接受产前检查的孕13周及以上的孕妇进行调查、随访,利用Herrera产前生物社会心理模型分别在13~27孕周、28~32孕周和33孕周~分娩三个时期对孕妇的妊娠情况进行评分。记录研究对象的围产期结局。结果:Herrera模型判定的高危妊娠者分娩低出生体重儿的危险性增大(OR:32·1,95%CI:4·3~238·9),模型的阳性预测值和阴性预测值分别为19·0%和99·3%。ROC曲线分析发现,33孕周~分娩时期模型评分预测效果优于其他两个时期,取域值为3和4分之间时灵敏度和特异度分别为88·0%和77·3%。结论:Herrera模型可以有效预测低出生体重,但该模型部分指标尤其是社会心理因素指标,不太适宜上海孕产妇妊娠期危险因素评价,该模型在上海推广尚需进一步的改进和验证。
OBJECTIVE: To evaluate the effect of Herrera prenatal bio-psycho-social model in predicting low birth weight and its applicability in Shanghai. Methods: Prospective cohort study. Investigation and follow-up of pregnant women who came to the hospital for prenatal check-up of 13 weeks and above followed up with Herrera prenatal bio-psychosocial model at 13 to 27 gestational weeks, 28 to 32 gestational weeks and 33 gestational weeks respectively Period of pregnancy on the situation of pregnant women score. Record the study’s perinatal outcome. Results: The risk of childbirth in low-birth-weight infants determined by Herrera model was increased (OR: 32 · 1, 95% CI: 4.3-238 · 9). The positive predictive value and negative predictive value were 19.0% and 99.3%. The ROC curve analysis showed that the model predictive value from 33 gestational weeks to childbirth was better than the other two periods. The sensitivity and specificity of the models with the range of 3 to 4 were 88.0% and 77.3% respectively. Conclusion: The Herrera model can effectively predict low birth weight. However, some indicators of the model, especially the indicators of social and psychological factors, are not suitable for the evaluation of risk factors during pregnancy in Shanghai. The model need further improvement and verification in Shanghai.