多层次产后计划生育干预对降低产后12个月内意外怀孕率和人工流产率的影响：中国的一项分组随机对照研究。

IF 2.8 2区医学 Q1 OBSTETRICS & GYNECOLOGY

Contraception Pub Date : 2025-02-01 DOI:10.1016/j.contraception.2024.110753

Yuyan Li , Yan Zhang , Dong Yuan , Li Shan , Xiaojing Dong , Liqun Wang , Yuanzhong Zhou , Weixin Liu , Xiaojun Wang , Lifang Jiang , Xiaoyu Hu , Wei Xia , Xiaochen Huang , Jiandong Song , Liangping Wang , Li Jiang , Hanfeng Ye , Yanfei Zhou , Yan Che

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引用次数: 0

摘要

研究目的：评估中国多层次产后计划生育干预措施对减少意外怀孕和人工流产的影响：研究设计：研究设计：我们开展了一项分组随机干预研究，以评估多层次产后计划生育干预对产后 12 个月内意外怀孕率和人工流产率的影响。研究纳入了 36 家医院，并按 1:1 的比例随机分配到两组，从 2019 年 1 月开始，每家医院招募 180 名孕妇。干预措施包括三个关键阶段的综合避孕教育和咨询，即妊娠三个月、分娩和产后几个时间点。我们使用生命表和多层次考克斯回归进行数据分析：我们招募了 6315 名参与者，其中干预组 3116 人，对照组 3199 人。干预组的 12 个月累计意外怀孕率和人工流产率（分别为 2.74% [95% CI, 2.16-3.46] 和 1.43% [95% CI, 1.01-2.03]）明显低于对照组（分别为 6.99% [95% CI, 6.00-8.14] 和 3.85% [95% CI, 3.09-4.79]）。多层次考克斯回归显示，干预组的意外怀孕风险降低了 63%（HR 0.37 [95% CI, 0.19-0.71]），人工流产风险降低了 67%（HR 0.34 [95% CI, 0.16-0.69]）：这种多层次的 PPFP 干预措施能有效降低产后第一年内意外怀孕和人工流产的风险。我们建议将这种方法推广到全国其他提供产前教育课程和产后避孕服务的医院：ChiCTR1900023790。

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Effects of multilevel postpartum family planning intervention on the reduction of unintended pregnancy and induced abortion rates within 12 months of delivery: A cluster randomized controlled study in China

Objectives

This study aimed to evaluate the effects of a multilevel promoting postpartum family planning (PPFP) intervention on the reduction of unintended pregnancies and induced abortions in China.

Study design

We performed a cluster randomized intervention study to assess the effects of a multilevel PPFP intervention on the rates of unintended pregnancy and induced abortion within 12 months postpartum. Thirty-six hospitals were included and randomly allocated to two groups at a 1:1 ratio, enrolling 180 pregnant women per hospital starting in January 2019. The intervention included integrated contraceptive education and counseling at three critical stages, namely, the third trimester, delivery, and several postpartum time points. We used life table and multilevel Cox regression for data analysis.

Results

We recruited 6315 participants, namely, 3116 in the intervention group and 3199 in the control group. The 12-month cumulative rates of unintended pregnancy and induced abortion were significantly lower in the intervention group (2.74% [95% CI, 2.16–3.46] and 1.43% [95% CI, 1.01–2.03], respectively) than in the control group (6.99% [95% CI, 6.00–8.14] and 3.85% [95% CI, 3.09–4.79], respectively). Multilevel Cox regression revealed a 63% reduction in the risk of unintended pregnancy (hazard ratio 0.37 [95% CI, 0.19–0.71]) and a 66% reduction in the risk of induced abortion (hazard ratio 0.34 [95% CI, 0.16–0.69]) in the intervention group.

Conclusions

This multilevel PPFP intervention was effective in reducing the risk of unintended pregnancy and induced abortion within the first year after childbirth. We recommend scaling up this approach to other hospitals across the country that provide prenatal educational classes and postpartum contraceptive services.

Implications

Multifaceted PPFP interventions, which encompass contraceptive education during both pregnancy and the postpartum period, are effective in reducing unintended pregnancy rates in China. This strategy could be adopted in other similar health care settings worldwide.

Clinical Trials

ChiCTR1900023790

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来源期刊

Contraception 医学-妇产科学

CiteScore

4.70

自引率

17.20%

发文量

211

审稿时长

69 days

期刊介绍： Contraception has an open access mirror journal Contraception: X, sharing the same aims and scope, editorial team, submission system and rigorous peer review. The journal Contraception wishes to advance reproductive health through the rapid publication of the best and most interesting new scholarship regarding contraception and related fields such as abortion. The journal welcomes manuscripts from investigators working in the laboratory, clinical and social sciences, as well as public health and health professions education.