Analysis On The Status And Willingness Of Preconception Examination In Xuhui District

BackgroundBirth defect has gradually become an important population health issue. Preconception care is one of primary prevention of birth defects to reduce the low birth weight and other adverse pregnancy outcomes. Preconception examination is the main content of preconception care. It is an important and necessary means to promote prenatal and postnatal care and to ensure maternal and child health.In Xuhui District, Shanghai, the implementation of the national free preconception examination began in2010. So far, nearly2000couples had received this service, but compared to7-8thousand annual the newlyweds and live births was still very low.The study is divided into two parts. The first part is based on a two-year’s population data who had received the preconception medical examination to analyze current health status and risk of birth defects; the second part is to investigate newlyweds to know their willingness and needs of preconception examination.ObjectivesThrough the description of health status of population who received the preconception examination combined with the willingness and needs of newlyweds, to expand the coverage of preconception examination and to improve this policy.Methods1. Based on physical examination data of1174couples who had taken part in "free preconception eugenics medical examination project" form April2010to May2012,around two major aspects of risk assessment of birth defect and health screening, to set up three-level indicators, adopted the method of statistical description to describe the indicator of every level.2. Carried out questionnaire on458newlyweds, a total of916people, in Xuhui District Registration Center from5September to22September2012. Survey content included demographic characteristics, awareness of the policy, the willingness and needs of preconception examination.Results 1. Health status and risk assessment of birth defects during population who received preconception examination1.1Health status:during2294examiners, the positive people of all kinds of disease were1522(66.3%). Rreproductive system diseases detected in963(41.9%); infectious diseases detected in124(5.4%). During1172women examiners, the highest positive rate was reproductive system disease, up to71.2%; the detection rate of thyroid disease (nodules and hypothyroidism) was13.1%; the detection rate of infectious disease was6.5%. During1122men examiners, the highest positive rate was systemic disease, up to38.5%. The detection rate of hypertensive disease and liver damage were respectively19.6%and18.8%; the detection rate of infectious disease was4.3%.1.2Risk screening of fetal safety:women indicators related to birth defects and growth retardation were:teratogenic microbial infection, susceptible to rubella virus, hypothyroidism, history of adverse bred, passive smoking, substance use, environmental teratogens contact history, old age motherhood and family genetic history. The positive rate of any risk factors was53.9%. Teratogenic microbial infection screening positive rate was3.1%; the susceptible to rubella virus positive rate was30.4%; hypothyroidism screening positive rate was9.9%; self-reported rate of history of adverse bred was36.5%; self-reported rate of passive smoking was9.1%; self-reported rate of substance use was2.2%; self-reported rate of environmental teratogenic contact history was12.4%; the rate of the elderly motherhood was3.9%; self-reported rate of family history of genetic was1.11%.2. The willingness and needs of newlyweds of preconception examination2.1The rate of intending to receive examination:56.1%of458newlyweds had recent pregnancy plan;81.6%of couples who had recent pregnancy plan intended to take part in preconception examination.92.8%of the couples who had no recent pregnancy plan intended to take part in preconception examination.2.2The rate of awareness of policy:the self-reported awareness rate of "free preconception examination" of newlyweds was58.0%. Self-reported awareness rate of policy of people who had recent pregnancy plan and had no recent pregnancy plan were respectively62.1%and52.8%, having no significant difference. There were also no statistical significant difference between people who intended to and that who didn’t intend to join examination.2.3The needs of preconception examination:nearly90%of newlyweds who intended to join examination were to look forward to a healthy child;80%wanted to select a municipal hospital;74%hoped that the examinations were free, but but3/4couple denied their participation was because of the free.74%of couples having no participation intention thought they were not necessary to join.2.4The influence of participation to preconception examination:no recent pregnancy plan was main influence factor. Age affected whether couples planned to pregnant, couples who wanted children1year older than couples who didn’t want children; Multi-factor analysis also found that had own house,lived with their parents, low work pressure couples were more likely to have pregnancy plan.Conclusion1. The health status of the population who participating in preconception examination was unoptimistic; the detection rate of all diseases obviously exceeded the rate of premarital check and gynecopathy census, which might be associated with the biased sample. The positive rate of fetal safety risk screening was high, which indicates preconception examination is of great significance.2. The primary preventive measures after preconception examination should follow up energetically. Such as, women who are lack of rubella immunity accept vaccination to reduce the occurrence rate of congenital rubella svndrome:women who before conception and during pregnancy replenish folic acid or multivitamin containing folic acid in order to reduce the occurrence rate of neural tube defects; manag diabetes, high blood pressure, thyroid disease before pregnu(?)y.3. The benefit of preconception examination for fetus security would to the focus of publicity in the future, while the intention of newlyweds recently participating in examination was not high, the extent to understand the project was insufficient, the opinion of "have no disease not to check-up" also exists certainly.4. Free was not fundamental means to expand the coverage of peconception examination, but solve the payment problem can promote examination behavior; use of medical insurance, set up the basic service packages to meet the couple’s needs of preconception examination.