Elizabeth Simmons, Anna Austin, Mollie Wood, Alyssa J Mansfield, Karen Sheffield-Abdullah, Kavita Singh
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引用次数: 0
Abstract
Background: Compared to undergoing prenatal care with a physician, care with a midwife reduces the risk of medical interventions and complications during labor and delivery among low-risk pregnant individuals. However, many analyses that assess the relationship between midwifery-led care and birth outcomes condition on live births, potentially inducing a type of collider bias.
Objective: The objective was to analyse the change in prevalence of caesarean deliveries, primary and secondary postpartum haemorrhage, obstetric trauma, and maternal infection under hypothetical scenarios where midwifery-led prenatal care was increased.
Methods: Our sample included commercially insured, midwifery-eligible pregnant people in an insurance claims data source. We used g-computation to assess the change in prevalence of caesarean deliveries, primary and secondary postpartum haemorrhage, obstetric trauma, and maternal infection if 10%, 20%, and 50% more pregnant people enrolled in prenatal care with a midwife rather than a physician, among a cohort of low-risk pregnant people with commercial insurance in the U.S. between 2004 and 2015.
Results: With a 50% increase in midwifery-led care compared with no increase, we found the prevalence of caesarean deliveries was reduced by 5.4 percentage points (95% confidence interval [CI] -5.7, -5.1) and of maternal infection decreased by 1.3 percentage points (95% CI -1.6, -1.0), while the prevalence of primary postpartum haemorrhage increased by 0.5 percentage points (95% CI 0.4, 0.6) and of secondary postpartum haemorrhage increased by 0.6 percentage points (95% CI 0.4, 0.7).
Conclusions: Increasing midwifery-led prenatal care reduced the prevalence of caesarean deliveries and maternal infections and slightly increased the prevalence of primary and secondary postpartum haemorrhage. Our results were similar to those of studies among live birth cohorts.
背景：与接受医生产前护理相比，助产士护理降低了低风险孕妇在分娩和分娩过程中医疗干预和并发症的风险。然而，许多评估助产士主导的护理和分娩结果之间关系的分析对活产不利，可能会导致一种对撞机偏见。目的：目的是分析在助产士主导的产前护理增加的假设情况下，剖腹产、原发性和继发性产后出血、产科创伤和产妇感染的患病率的变化。方法：我们的样本包括保险索赔数据源中的商业保险，符合助产条件的孕妇。我们使用g计算来评估2004年至2015年间，在美国有商业保险的低风险孕妇队列中，如果有10%、20%和50%的孕妇参加助产士而不是医生的产前护理，剖腹产、原发性和继发性产后出血、产科创伤和孕产妇感染的患病率变化。结果：与没有增加相比，助产士主导的护理增加了50%，我们发现剖腹产的患病率降低了5.4个百分点（95%可信区间[CI] -5.7, -5.1），产妇感染的患病率降低了1.3个百分点（95% CI -1.6, -1.0），而原发性产后出血的患病率增加了0.5个百分点（95% CI 0.4, 0.6），继发性产后出血的患病率增加了0.6个百分点（95% CI 0.4, 0.7）。结论：增加助产士主导的产前护理降低了剖腹产和孕产妇感染的患病率，并略微增加了原发性和继发性产后出血的患病率。我们的结果与活产队列的研究结果相似。
期刊介绍：
Paediatric and Perinatal Epidemiology crosses the boundaries between the epidemiologist and the paediatrician, obstetrician or specialist in child health, ensuring that important paediatric and perinatal studies reach those clinicians for whom the results are especially relevant. In addition to original research articles, the Journal also includes commentaries, book reviews and annotations.
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