目的 了解北京市通州区2013-2017年单胎妊娠孕妇的早产发生情况及影响因素,为降低早产的发生提供科学依据。方法 采用回顾性队列研究的方法,通过医院电子信息系统获得2013-2017年单胎孕妇的社会人口学资料、孕产史及本次妊娠情况,分析早产发生率以及不同因素对早产发生率的影响,采用多因素Logistic回归分析早产的危险因素。结果 2013-2017年通州区单胎孕妇的早产发生率为4.1%(1 418/34 726)。其中,自发性早产和治疗性早产分别占68.8%(975/1 418)和31.2%(443/1 418)。产妇年龄≥35岁(OR=1.314,95%CI:1.113～1.551)、经产妇(OR=1.399,95%CI:1.223～1.600)、男胎(OR=1.237,95%CI:1.100～1.390)、前置胎盘(OR=10.162,95%CI:7.100～14.546)、胎盘早剥(OR=9.201,95%CI:6.596～12.837)、胎膜早破(OR=3.328,95%CI:2.953～3.750)、妊娠期糖尿病(OR=1.232,95%CI:1.082～1.403)、妊娠期高血压疾病(OR=3.283,95%CI:2.755～3.911)是早产的危险因素。其中,产妇失业或待业(OR=1.159,95%CI:1.003~1.339)、丈夫年龄≥35岁(OR=1.243,95%CI:1.036~1.490)、初次妊娠(OR=1.407,95%CI:1.157~1.710)、经产妇(OR=1.295,95%CI:1.049~1.598)、男胎(OR=1.273,95%CI:1.109~1.462)是自发性早产的危险因素。结论 对于年龄≥35岁,经产妇,男胎、前置胎盘、胎盘早剥、胎膜早破、妊娠期糖尿病及高血压疾病的孕妇,应及早采取预防措施以降低早产发生率。
Abstract
Objective To know about the prevalence and risk factors of preterm birth among singletons from 2013 to 2017 in Tongzhou district of Beijing,in order to provide scientific evidence for effective interventions to reduce preterm birth rate. Methods The information of all pregnant women with singleton births from 2013 to 2017 were collected from hospital information system,including demographic data,pregnancy history and current pregnancy information.A retrospective study was conducted to analyze the incidence and influencing factors of preterm birth,and multivariate Logistic regression analysis was used for exploring the risk factors related to preterm birth. Results The prevalence rate of preterm birth in Tongzhou district of Beijing from 2013 to 2017 was 4.1% (1 418/34 726).Spontaneous preterm birth and iatrogenic preterm birth accounted for 68.8%(975/1 418) and 31.2%(443/1 418) of all preterm birth,respectively. Maternal age≥35 years old (OR=1.314,95%CI:1.113-1.551),multipara(OR=1.399,95%CI:1.223-1.600),male fetus(OR=1.237,95%CI: 1.100-1.390),placenta previa (OR=10.162,95%CI:7.100-14.546),placental abruption (OR=9.201,95%CI: 6.596-12.837),premature rupture of membranes(OR=3.328,95%CI:2.953-3.750),gestational diabetes mellitus (OR=1.232,95%CI:1.082-1.403),and hypertensive disorder complicating pregnancy (OR=3.283,95%CI:2.755-3.911) were risk factors of preterm birth.Being unemployed or underemployed (OR=1.159,95%CI:1.003-1.339),paternal age≥35 years old(OR=1.243,95%CI:1.036-1.490),being pregnant for the first time (OR=1.407,95%CI:1.157-1.710),multipara(OR=1.295,95%CI:1.049-1.598),and male fetus (OR=1.273,95%CI:1.109-1.462)were risk factors of spontaneous preterm birth. Conclusion For pregnant women who were over 35 years old,multipara,with male fetus,placenta previa,placental abruption,premature rupture of membranes,complicated with gestational diabetes mellitus and hypertensive disorder,it is supposed to take preventive measures in order to reduce the premature rate.
关键词
早产 /
危险因素 /
高龄产妇 /
妊娠合并症
Key words
preterm birth /
risk factors /
advanced maternal age /
pregnancy complications
{{custom_sec.title}}
{{custom_sec.title}}
{{custom_sec.content}}
参考文献
[1] WHO.Recommended definitions,terminology and format for statistical tables related to the perinatal period and use of a new certificate for cause of perinatal deaths.Modifications recommended by FIGO as amended October 14,1976[J].Acta Obstet Gynecol Scand,1977,56(3): 247-253.
[2] Liu L,Oza S,Hogan D,et al.Global,regional,and national causes of under-5 mortality in 2000-15: an updated systematic analysis with implications for the sustainable development doals[J].Lancet,2016,388(10063): 3027-3035.
[3] Kersbergen KJ,Leroy F,Isgum I,et al.Relation between clinical risk factors,early cortical changes,and neurodevelopmental outcome in preterm infants[J].Neuroimage,2016,142: 301-310.
[4] Nuyt AM,Lavoie JC,Mohamed I,et al.Adult consequences of extremely preterm birth: cardiovascular and metabolic diseases risk factors,mechanisms,and prevention avenues[J].Clin Perinatol,2017,44(2): 315-332.
[5] World Health Organization.Born too soon: the global action report on preterm birth[R].Geneva: WHO,2012.
[6] World Health Organization.Recommendations on interventions to improve preterm birth outcomes[R].Geneva: WHO,2015.
[7] 刘兰,刘建蒙,刘英惠,等.中国10县(市)1993—2005年单胎儿早产流行状况研究[J].中华流行病学杂志,2007,(11): 1051-1054.
[8] 边旭明,付晨薇.早产的定义分类和诊断[J].现代妇产科进展,2011,20(3): 164-165.
[9] 王希,康楚云,高燕秋,等.中国3省市21家医院早产发生的相关因素及结局研究[J].中国生育健康杂志,2014,25(1): 1-5.
[10] 徐蓉,王菁,刘菊凝,等.苏州市早产与低出生体重的趋势及危险因素研究[J].中国妇幼保健,2016,31(22): 4793-4796.
[11] 张小松,赵更力,杨慧霞,等.15家城市医疗机构早产发生情况及影响因素分析[J].中华围产医学杂志,2016,19(6): 456-461.
[12] 郭战坤,马京梅,范玲,等.北京地区早产发生现状及早产儿结局的调查分析[J].中华妇产科杂志,2010,45(2): 99-103.
[13] Pike KC,Lucas JS.Respiratory consequences of late preterm birth[J].Paediatr Respir Rev,2015,16(3): 182-188.
[14] Teune MJ,Bakhuizen S,Gyamfi Bannerman C,et al.A systematic review of severe morbidity in infants born late preterm[J].Am J Obstet Gynecol,2011,205(4): 374 e1-347e9.
[15] Naeye R L.Maternal age,obstetric complications,and the outcome of pregnancy[J].Obstet Gynecol,1983,61(2): 210-216.
[16] Zhang X,Zhou M,Chen L,et al.Risk factors for preterm birth: a case-control study in rural area of western China[J].Int J Clin Exp Med,2015,8(3): 4527-4532.
[17] Check JH,Lee G,Epstein R,et al.Increased rate of preterm deliveries in untreated women with luteal phase deficiencies.Preliminary report[J].Gynecol Obstet Invest,1992,33(3): 183-184.
[18] 胡彦,李岚,黄文珍,等.我院近10年早产危险因素改变的回顾性研究[J].海南医学,2016,27(20): 3356-3358.
[19] Erez O,Novack L,Klaitman V,et al.Early preterm delivery due to placenta previa is an independent risk factor for a subsequent spontaneous preterm birth[J].BMC Pregnancy Childbirth,2012,12(1): 82.
[20] 冯永亮,彭婷婷,王芳,等.妊娠期高血压疾病对出生结局的影响及相关因素[J].中华疾病控制杂志,2014,18(2): 131-134.
[21] 韩轲,陈维清,黄杏端,等.妊娠期糖代谢异常对妊娠的不良影响[J].中国糖尿病杂志,2008,16(3): 134-136.
[22] Kintiraki E,Papakatsika S,Kotronis G,et al.Pregnancy-induced hypertension[J].Hormones (Athens),2015,14(2): 211-223.
[23] Alio AP,Salihu HM,Mcintosh C,et al.The effect of paternal age on fetal birth outcomes[J].Am J Mens Health,2012,6(5): 427-435.
[24] Reichman NE,Teitler JO.Paternal age as a risk factor for low birth weight[J].Am J Public Health,2006,96(5): 862-866.
[25] 李静,毛宝宏,丁仲军,等.兰州地区早产影响因素的研究[J].中国妇幼健康研究,2017,28(10): 1165-1167.
[26] Li C,Liang Z,Bloom MS,et al.Temporal trends of preterm birth in Shenzhen,China: a retrospective study[J].Reprod Health,2018,15(1): 47.
基金
国家自然科学基金青年项目(81703240)
PDF(624 KB)
