在孕产妇健康指标中考虑死产:跨国分析
Ursula Gazeley1, Hallie Eilerts-Spinelli2, Joshua Wilde1,3
1Leverhulme Centre for Demographic Science, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom.
EClinicalMedicine
|July 7, 2025
概括
当包括所有怀孕结果,而不仅仅是活产儿时,产妇死亡率指标更准确. 在计算中使用总出生数或总怀孕数可以显著减少死亡率估计的偏差.
科学领域:
- 人口统计学 人口统计学
- 公共卫生 公共卫生
- 流行病学 流行病学
背景情况:
- 孕产妇指标通常使用活胎作为分母,不包括死胎,流产和诱导堕胎.
- 这种不一致性使趋势的解释变得复杂,并可能导致监测所有妊娠结果的优先级不足.
- 当前的指标可能无法完全捕捉与怀孕相关的发病率和死亡率的范围.
研究的目的:
- 评估使用总分娩或总怀孕作为分母对产妇和与怀孕有关的死亡率 (MMR和PRMR) 估计的影响.
- 突出当前孕产妇健康指标中的不一致性.
- 倡导在孕产妇健康监测中采用更具包容性的分母.
主要方法:
- 利用46个国家的1996-2023年人口和健康调查 (DHS) 数据.
- 估计了导致活产,死产或流产/流产的怀孕比例.
- 使用兄弟姐妹的生存史计算MMR和PRMR,调整分母的总出生和总怀孕.
主要成果:
- 怀孕结果分布的跨国显著变化被观察到.
- 使用出生总数作为分母将MMR和PRMR降低了高达2.8%.
- 使用总怀孕减少了MMR和PRMR高达23%,但需要更好的流产和诱导堕胎数据.
结论:
- 与怀孕相关的死亡率可以发生在任何结果;指标应该反映这一点.
- 将出生总数作为分母是越来越可行的,并加强了制度化死产报告的理由.
- 在全球孕产妇指标中可靠使用总怀孕之前,需要对流产和诱导堕胎数据进行进一步的研究.
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