| Background:Although there is a significant reduction of neonatal and maternal mortality rates, because of improvement of maternal nutritional status as well as prenatal care, the incidence of adverse pregnancy outcomes, such as birth defects, spontaneous abortion, premature delivery, low birth weight, still the same.Event of adverse pregnancy outcomes is adverse impact for both women and their offspring, thus reducing the occurrence of adverse pregnancy outcomes has become a primary goal of the project of promoting maternal and child health. Through the theory of Chinese medicine, preconception is one of the most important period of women during childbearing age. This view has been gradually confirmed by modern research:pregnancy outcome does largely depend on the physical condition, lifestyle and reproductive history of women before pregnancy.But how is the relationship between women’s preconception health status (daily symptoms, or varieties of yin&yang imbalance status) and adverse pregnancy outcomes? It’s still a question need to answer.Objective:By means of psychologcal, epidemiologcal and statistical methods, this paper explores the correlation between perconcetption health status and adverse pregnancy outcomes, in order to build a preconception risk assessment, which can assess women’s pregnancy risk through the health status of women before pregnancy. Depend on it, this paper present the concept of Chinese medicine preconception care model.Methods:①development of women’s health status assessment tools:Based on early literature research and under the principle of Chinese medicine, this paper developed a questionnaire to assess women’s health status, then adjust, amend and this questionnaire by means of expert advice and the crowd survey. Finally, the reliability and validity of questionnaire has been test. ②cohort study (preconceptional information collection):To explore the impact factors on women’s health status before pregnancy, as well as accumulate sufficient sample queue to find the relationship between female pre-pregnancy health status and adverse pregnancy outcomes, we collect pre-pregnancy information on women during childbearing age in Fengtai District, Beijing. Information includes:basic information, habits, family history, disease history, reproductive history, contraceptive methods, pregnancy situation, and health status assessed by questionnaire developed above.③cohort study (pregnancy outcome follow-up):From the above female queue, we follow-up pregnancy outcomes by telephone or face-to-face interview. We use logistic regression model to analysis the relationship between women’s health status before pregnancy (daily symptoms, or varieties of yin&yang imbalance status) and adverse pregnancy outcomes.④Proposed and evaluation on Chinese preconception care model:Based on result above, we present the concept and connotation of the Chinese medicine preconception care, and compared the effect between Chinese preconception risk assessement tool and current preconception testing tool.Results:①development of women’s health status assessment tools:Based on the results of pre-test on338women of childbearing age, the questionnaire has been adjusted in containing31items in seven dimensions ultimately. From July to August in2009, we survey this questionnaire among770women for testing it’s reliability and validity. The statistical analysis showed that this questionnaire has good reliability and validity. The questionnaire’s overall cronbach’s alpha coefficient is0.86, indicating good reliability; factor analysis of the results is consistent with theoretical ideas, which indicats good construct validity; by compared to "Chinese constitution classification and judgment", we can see the questionnaire has good criterion validity.Epidemiological survey on women’s preconception health status:Since August2009to December2010, an epidemiological study of6707women of childbearing age in Fengtai District has been conducted. Among these women, only0.4%of women have the habit of smoking, drinking, exposure to harmful substances or noise, most women aren’t eat picky food, while most women have access to computers (91.63%), and some feed pets (15.85%). As to the family history,8.43%of diabetes, the majority have no other adverse family history, sickness history or present illness. Relatively, more female has adverse reproductive history, such as abortion (15.8%), medical abortion (7.6%) and spontaneous abortion (2.4%). Nevertheless, statistics still show that nearly half (47.30%) women of childbearing age exists yin or yang biased, in urgent need of pre-pregnancy conditioning.This part showed that women’s preconception health status, is closely related with age, dietary habits, family diabetes history, reproductive history and other risk factors.③Relationship between adverse pregnancy outcome and preconception health status:From January to December2011, a follow-up of1523cases of pregnancy outcome has been conducted. The result is,762cases in all has pregnanted,167in pregnancy,541non-pregnancy, and53missed. The total rate of adverse pregnancy outcomes is16.67%, includes8.40%macrosomia,5.0%abortion,2.23%preterm birth,1.05%low birth weight.Each adverse pregnancy outcome appears differences of preconception syndrome type:abortion appears Shi stagnation, Yang deficiency, Qi stagnation or blood stasis type, premature appears Shi stagnation or Yang deficiency, macrosomia appears Qi stagnation or Yang deficiency, while low birth weight infant appears Yang or Yin deficiency type-based.Some daily symptoms before pregnancy have significance of indicating adverse pregnancy outcomes:"thick greasy tongue further" indicates the overall adverse pregnancy outcome (OR:1.68,95%CI:1.03-2.76),"spontaneous" indicates the risk of miscarriage (OR:2.88,95%CI:1.09-7.59),"deep color of menstruation " is the risk symptom of intrauterus fetal growth retardation (OR:12.2,95%CI:1.03-144.2), and "increased urinary frequency","constipation" and "deep sigh" are all risk symptoms of preterm delivery (increased urinary frequency OR:6.31,95%CI1.1-36.13; constipation OR:14,95%CI:2.33-84.12; deep sigh OR,:13.92,95%CI:13.92-123.44). ④Based on results above, this paper present the preconception risk assessment and health promotion strategies, considered as two basic elements of Chinese medicine preconception care model.Finally, we compared the effect between Chinese preconception risk assessement tool and current preconception testing tool. We calculated the detection rate of adverse pregnancy outcomes (the number of adverse pregnancy outcomes among all pregnancy risk population/total number of adverse pregnancy outcome) to measure the effect. The result is, by using Chinese medicine tool, the detection rate is35.71%, which is slightly higher than pregnancy test (31.52%), while combined both, the overall rate rose up to58.68%.Conclusion:Based on a large scale cohort study, this paper indicated the interrelated between adverse pregnancy outcome, preconception health status (daily symptoms, or varieties of yin&yang imbalance status), and normal risk factors. The combined effects of normal risk factors reflected in the women complained of daily symptoms, special combination of daily symptoms indicates special TCM syndrome status, at last the preconception TCM status suggesting the risk of pregnancy outcome. Therefore, by assessing and intervening each of preconception normal risk factors, daily symptoms or TCM status, may reduce the risk of adverse pregnancy outcomes.Thus, this paper present the preconception risk assessment and health promotion strategies, considered as two basic elements of Chinese medicine preconception care model. This model is, by assessing and intervening women’s pregnancy risk through the health status of women before pregnancy, under TCM theory, to improve pregnancy outcome. |
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