目的 了解广州花都区小于胎龄儿发生率并分析其影响因素,为预防小于胎龄儿的发生提供科学依据。方法 于2017年10月-2018年9月在广州市花都区妇幼保健院招募住院分娩孕妇进入研究。根据纳入排除标准,共有3 509名单胎活产儿纳入到本次研究。收集新生儿胎龄、出生体重、产妇的一般情况、孕期营养素摄入、环境接触、生活行为方式等信息,计算小于胎龄儿的发生率,并对影响因素进行分析。结果 小于胎龄儿的发生率为8.78%(308/3 509)。羊水过少(OR=3.275,95%CI:2.043~5.250)、孕妇年龄≥35岁(OR=1.712,95%CI: 1.216~2.411),非广州市户籍(OR=1.620,95%CI:1.158~2.266;OR=1.660,95%CI:1.126~2.448 )、孕前低体重(OR=2.300,95%CI:1.515~3.827)、孕期增重不足(OR=2.286,95%CI:1.572~3.326)、孕期经常接触烟雾(OR=5.690,95%CI:1.401~23.104)是SGA发生的危险因素(P＜0.05)。妊娠糖尿病(OR=0.674,95%CI:0.456~0.996)、孕次多(OR=0.802,95%CI:0.716~0.897)的产妇小于胎龄儿的发生率较低。结论 小于胎龄儿的发生与多种因素有关,是社会因素、环境因素、妊娠并发症共同作用的结果。要防止SGA的发生,需要制定一个综合的干预措施。
Abstract
Objective To investigate the incidence of small for gestational age(SGA) in Huadu district of Guangzhou,and to analyze its risk factors,so as to provide evidence for prevention on SGA. Methods Totally 3 509 singleton live births in Guangzhou Huadu District Maternal and Child Health Hospital were enrolled in this study from October 2017 to September 2018.Data on neonatal gestational age,birth weight,maternal general condition,nutrient intake during pregnancy,environmental exposure,lifestyle behavior and so on were collected,the incidence of SGA was calculated,and the influencing factors were analyzed. Results The incidence of SGA infants was 8.78%(308/3 509).Multivariate Logistic analysis showed that oligoamnion(OR=3.275,95%CI:2.043-5.250),maternal age over 35 years old(OR=1.712,95%CI: 1.216-2.411),non-registered pregnant women(OR=1.620,95%CI:1.158-2.266;OR=1.660,95%CI:1.126-2.448 ),low weight prepregnancy(OR=2.300,95%CI:1.515-3.827),Low weight gain during pregnancy(OR=2.286,95%CI:1.572-3.326),frequent exposure to second-hand smoking(OR=5.690,95%CI:1.401~23.104) were risk factors for SGA(P＜0.05).Gestational diabetes mellitus(OR=0.674,95%CI:0.456-0.996), more gravidity(OR=0.802,95%CI:0.716-0.897) were protective factors for SGA(P＜0.05). Conclusions The occurrence of SGA is related to many factors,which is the result of the combination of social factors,environmental factors and pregnancy complications.To prevent the occurrence of SGA,comprehensive interventions are needed.
关键词
小于胎龄儿 /
发生率 /
影响因素
Key words
small for gestational age /
incidence /
risk factor
{{custom_sec.title}}
{{custom_sec.title}}
{{custom_sec.content}}
参考文献
[1] Mikolajczyk RT,Zhang J,Betran AP.A global reference for fetal-weight and birthweight percentiles [J].Lancet,2011,377(9780):1855-1861.
[2] Yu J,Flatley C,Greer RM,et al.Birth-weight centiles and the risk of serious adverse neonatal outcomes at term [J].J Perinat Med,2018,46(9):1048-1056.
[3] Madden JV,Flatley CJ,Kumar S.Term small-for-gestational-age infants from low-risk women are at significantly greater risk of adverse neonatal outcomes[J].Am J Obstet Gynecol,2018,218(5):525.
[4] Haidar ZA,Viteri OA,Nasab SH,et al.Composite neonatal and maternal morbidities with small-versus appropriate-for gestational age among uncomplicated obese women undergoing repeat cesarean delivery[J].J Matern Fetal Neonatal Med,2019,32(4):562-567.
[5] 黄清选,应琴.胎儿生长受限对学龄期儿童智力发育及行为的影响[J].中国妇幼保健,2016,31(22):4787-4789.
[6] Gur Z,Tsumi E,Wainstock T,et al.Association between delivery of small-for-gestational age neonate and long-term pediatric ophthalmic morbidity [J].Arch Gynecol Obstet,2018,298(6):1095-1099.
[7] 马宁,李丽华.胎儿期环境因素对脑发育的影响[J].中国儿童保健杂志,2015,23(8):821-823.
[8] 朱丽.中国不同胎龄新生儿出生体重曲线研制[J].中华儿科杂志,2015,53(2):97-103.
[9] 中华人民共和国国家和计划生育委员会,WS/T 428-2013.成人体重判定[S].2013.
[10] Institute of Medicine,National Research Council,Kathleen M,et al.Weight gain during pregnancy:reexamining the guidelines[M].Washington,DC:The National Academies Press,2009:32-46.
[11] 杨美桃,邓东锐.建立不良妊娠结局预警系统,改善患者结局[J].中华产科急救电子杂志,2015,4(3):135-139.
[12] 黄婉平,陈甘讷,夏芳芳,等.34426例高危妊娠变化影响因素及应对策略[J].中国妇幼保健,2017,32(7):1365-1368.
[13] 邵炎涛,黄东萍,刘顺,等.壮族地区孕前体质指数、孕期增重及孕期贫血对小于胎龄儿影响研究[J].中华疾病控制杂志,2018,22(7):663-666.
[14] Ota E,Haruna M,Suzuki M,et al.Maternal body mass index and gestational weight gain and their association with perinatal outcomes in Vietnam[J].Bull World Health Organ,2011,89(2):127-136.
[15] 施梦瑶,王雅斐,黄锟,等.孕前体重和孕期增重对胎儿生长受限影响的队列研究[J].中华预防医学杂志,2017,51(12):1074-1078.
[16] 韩思琪,陈雯,凌莉.流动特征对流动人口孕产妇基本公共卫生服务利用的影响探讨[J].现代预防医学,2017,44(1):94-98.
[17] 李卫芹,冷俊宏,王蕾棽,等.流产经历对再次妊娠时分娩结局的影响[J].中国妇幼保健,2017,32(1):103-106.
[18] 李辉霞,冯娜,郑剑飞,等.5012名单胎活产儿小于胎龄儿和大于胎龄儿发生率及其影响因素研究[J].中国儿童保健杂志,2017,25(5):463-466,447.
[19] Shin D,Song WO.Prepregnancy body mass index is an Independent risk factor for gestational hypertension,gestational diabetes,preterm labor,and small-and large-for-gestational-age infants[J].J Matern Fetal Neonatal Med,20 15,28(14):1679-1686.
[20] 李艳川,张雅,张矛,等.羊水过少与胎儿窘迫以及胎盘组织水通道蛋白9和凋亡蛋白Caspase7表达的关系[J].中国妇幼保健,2018,33(24):5976-5979.
[21] Quelhas D,Kompala C,Wittenbrink B,et al.The association between active tobacco use during pregnancy and growth outcomes of children under five years of age:a systematic review and meta-analysis [J].BMC Public Health,2018,18(12):1372.
基金
广州市科学研究专项(201707010239)
PDF(556 KB)
