早産予防を目的とした地域密着型の前向きな介入策の有効性

Efficacy of a prospective community-based intervention to prevent preterm birth.

抄録

目的:

早産予防のための地域密着型の介入試験を評価する。

OBJECTIVES: To evaluate a community-based intervention trial for the prevention of preterm birth.

方法:

本試験は、日本の天草地域と人吉・球磨地域の妊婦を対象に行われた。早産のリスクが高い妊婦には，予防的な抗生物質の経口投与が推奨された。また、歯周病検査の受診を勧めた。適切な歯磨きの説明を行い，必要に応じてフルマウススケーリングを実施した．

METHODS: This trial was conducted on pregnant women in the Amakusa area, and in the Hitoyoshi-Kuma area, both in Japan. Prophylactic oral antibiotics were recommended for pregnant women with high-risk on preterm birth. The subjects were also encouraged to undergo a periodontal examination. An explanation of proper tooth brushing was given and full mouth scaling was allowed if deemed necessary.

結果:

天草地区では720名、人吉球磨地区では373名の同意を得た対象者のうち、天草地区では100名（13.9％）、人吉球磨地区では71名（19.0％）に細菌性膣炎が認められた。天草在住者93名、人吉球磨在住者39名に予防的な抗生物質が処方された。歯周病検査を受けた対象者では，天草市民の47.7％，人吉球磨市民の59.7％に歯周病が認められた．これらの女性は，妊娠中に非外科的治療を行うことで歯周病が改善されていた．超低出生体重児（VLBW）の発生率を各地域の過去6年間の平均値と比較すると、調査年のVLBW発生率は天草で46.4％、人吉球磨で69.7％と低かった。

RESULTS: Of 720 consented subjects in the Amakusa area and of 373 in the Hitoyoshi-Kuma area, bacterial vaginosis was found in 100 (13.9%) Amakusa residents and 71 (19.0%) Hitoyoshi-Kuma residents. Prophylactic antibiotics were prescribed for 93 Amakusa residents and 39 Hitoyoshi-Kuma residents. Among subjects who underwent a periodontal examination, periodontal disease was found in 47.7% of Amakusa residents and 59.7% of Hitoyoshi-Kuma residents. Periodontal health was improved among these women by a nonsurgical intervention during their pregnancy. Comparing the incidences of very low birth weight (VLBW) with the averages during the preceding 6 years in each area, the incidences of VLBW was 46.4% lower in Amakusa and 69.7% Hitoyoshi-Kuma during the study year.

結論:

地域に根ざした多面的な介入により、VLBW児の発生率を低下させることができる可能性がある。

CONCLUSIONS: A community-based multifaceted intervention might reduce the incidence of VLBW infants.