兰州市低体重儿的影响因素分析
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摘要
目的探索围生期早产低体重儿(LBWI)和足月LBWI的危险因素,为制定控制LBWI发生的干预措施、降低其发病率及提高出生人口素质提供基础数据。方法采用整群抽样方法,选取兰州市妇幼保健院2015—2018年住院分娩的孕产妇和新生儿作为研究对象;采用1∶2和1∶3匹配的病例对照研究方法,将明确诊断为早产LBWI和足月LBWI作为病例组,分别按照出生年月和胎龄配对,选择正常新生儿作为对照组,并用条件Logistic回归进行因素分析。结果不常规产前检查(OR=2.20,95%CI:[1.30,3.72])、妊娠高血压综合征(OR=3.03,95%CI:[1.85,4.97])、妊娠肝内胆汁淤积症(OR=2.80,95%CI:[1.06,7.42])、胎膜早破(OR=2.98,95%CI:[2.02,4.40])、胎儿窘迫(OR=1.82,95%CI:[1.00,3.31])、双胎及以上(OR=2.57,95%CI:[1.42,4.67])与早产LBWI的发生有关;女婴(OR=1.69,95%CI:[1.11,2.56])、不常规产前检查(OR=3.38,95%CI:[1.68,6.78])、胎儿窘迫(OR=5.59,95%CI:[2.81,11.12])、双胎及以上(OR=3.13,95%CI:[1.64,5.99])与足月LBWI的发生有关。结论 LBWI与围生期情况有关,且在早产和足月间存在差异;不常规产前检查、胎儿窘迫、双胎及以上是早产LBWI和足月LBWI共同危险因素,而妊娠高血压综合征、妊娠肝内胆汁淤积症和胎膜早破仅是早产LBWI的危险因素。
Objective To explore the risk factors of preterm low birth weight infant(LBWI) and full term LBWI during pregnancy, provide basic data for interventions controlling LBWI, reducing it's incidence and improving the quality of the birth population. Methods The cluster sampling method was adopted to select pregnancy women and infants hospitalized for childbirth in Lanzhou City Maternity and Child-care Hospital from 2015 to 2018 as the research objects. A 1∶2 and 1∶3 matched case-control study was performed to ex-plore factors using conditional Logistic regression, the diagnosis for preterm low birth weight and full term low birth weight were assigned to the case group, control group matched by the date of birth and gestational age respectively. Results Irregular prenatal examination(OR = 2.20, 95%CI: [1.30, 3.72]), pregnancy-induced hypertension syndrome(OR = 3.03, 95% CI: [1.85, 4.97]), intrahepatic cholestasis of pregnancy(OR = 2.80,95% CI: [1.06, 7.42]), premature rupture of membranes(OR = 2.98, 95% CI: [2.02, 4.40]), fetal distress(OR = 1.82, 95% CI: [1.00, 3.31]) and multiple births(OR = 2.57, 95% CI: [1.42, 4.67]) were positively correlated with the incidence of preterm LBWI; baby girl(OR=1.69, 95% CI: [1.11, 2.56]), irregular prenatal examination(OR = 3.38, 95% CI: [1.68, 6.78]), fetal distress(OR = 5.59, 95% CI: [2.81, 11.12]), multiple births(OR = 3.13, 95% CI: 1.64, 5.99]) were positively correlated with the incidence of full term LBWI.Conclusion Perinatal stage conditions were related to LBWI, and there were differences between preterm LBWI and full term LBWI. Irregular prenatal examination, fatal distress and multiple births are common risk factors for preterm LBWI and full term LBWI, while pregnancy-induced hypertension syndrome, intrahepatic cholestasis of pregnancy and premature rupture of membranes were the only risk factors for preterm LBWI.
Objective To explore the risk factors of preterm low birth weight infant(LBWI) and full term LBWI during pregnancy, provide basic data for interventions controlling LBWI, reducing it's incidence and improving the quality of the birth population. Methods The cluster sampling method was adopted to select pregnancy women and infants hospitalized for childbirth in Lanzhou City Maternity and Child-care Hospital from 2015 to 2018 as the research objects. A 1∶2 and 1∶3 matched case-control study was performed to ex-plore factors using conditional Logistic regression, the diagnosis for preterm low birth weight and full term low birth weight were assigned to the case group, control group matched by the date of birth and gestational age respectively. Results Irregular prenatal examination(OR = 2.20, 95%CI: [1.30, 3.72]), pregnancy-induced hypertension syndrome(OR = 3.03, 95% CI: [1.85, 4.97]), intrahepatic cholestasis of pregnancy(OR = 2.80,95% CI: [1.06, 7.42]), premature rupture of membranes(OR = 2.98, 95% CI: [2.02, 4.40]), fetal distress(OR = 1.82, 95% CI: [1.00, 3.31]) and multiple births(OR = 2.57, 95% CI: [1.42, 4.67]) were positively correlated with the incidence of preterm LBWI; baby girl(OR=1.69, 95% CI: [1.11, 2.56]), irregular prenatal examination(OR = 3.38, 95% CI: [1.68, 6.78]), fetal distress(OR = 5.59, 95% CI: [2.81, 11.12]), multiple births(OR = 3.13, 95% CI: 1.64, 5.99]) were positively correlated with the incidence of full term LBWI.Conclusion Perinatal stage conditions were related to LBWI, and there were differences between preterm LBWI and full term LBWI. Irregular prenatal examination, fatal distress and multiple births are common risk factors for preterm LBWI and full term LBWI, while pregnancy-induced hypertension syndrome, intrahepatic cholestasis of pregnancy and premature rupture of membranes were the only risk factors for preterm LBWI.
引文
[1]王卫平,毛萌,李廷玉,等.儿科学[M].北京:人民卫生出版社, 2013:93
[2]丁海燕,夏木斯叶·木依都力,李敏超,等.舟山市2002—2015年出生体重变化与不良出生结局及影响因素分析[J].中华疾病控制杂志, 2018, 22(4):380—385
[3] Wei D, Azen C, Bhombal S, et al. Congenital heart disease in low-birth-weight infants:effects of small for gestational age(SGA)status and maturity on postoperative outcomes[J]. Pediatric Cardiology, 2015, 36(1):1—7
[4] Viswanathan S, Khasawneh W, McNelis K, et al. Metabolic bone disease:a continued challenge in extremely low birth weight infants[J]. Journal of Parenteral and Enteral Nutrition, 2014, 38(8):982—990
[5] Borah M, Baruah R. Morbidity status of low birth weight babies in rural areas of Assam:a prospective longitudinal study[J]. Journal of Family Medicine and Primary Care,2015, 4(3):380—383
[6] Johnson KA, Healy E, Dooley B, et al. Children born with very low birth weight show difficulties with sustained attention but not response inhibition[J]. Child Neuropsychology:a Journal on Normal and Abnormal Development in Childhood and Adolescence, 2015, 21(5):629—647
[7] Williamson KE, Jakobson LS, Saunders DR, et al. Local and global aspects of biological motion perception in children born at very low birth weight[J]. Child Neuropsychology:a Journal on Normal and Abnormal Development in Childhood and Adolescence, 2015, 21(5):603—628
[8] Poole KL, Schmidt LA, Missiuna C, et al. Motor Coordination difficulties in extremely low birth weight survivors across four decades[J]. Journal of Developmental and Behavioral Pediatrics:2015, 36(7):521—528
[9] Yang G. Marketing'less harmful, low-tar'cigarettes is a key strategy of the industry to counter tobacco control in China[J]. Tobacco Control, 2014, 23(2):167—172
[10] Silverwood RJ, Pierce M, Hardy R, et al. Low birth weight, later renal function, and the roles of adulthood blood pressure, diabetes, and obesity in a British birth cohort[J]. Kidney International, 2013, 84(6):1262—1270
[11]綦斐,贾晓蓉,刘辉,等.青岛市成年人吸烟、被动吸烟行为及认知现状调查[J].中华疾病控制杂志, 2017,21(5):439—443
[12] Chen Z, Peto R, Zhou M, et al. Contrasting male and female trends in tobacco-attributed mortality in China:evidence from successive nationwide prospective cohort studies[J]. The Lancet, 2015, 386(10002):1447—1456
[13]谢幸,苟文丽.妇产科学[M].北京:人民卫生出版社,2014
[14]魏克伦,刘邵基.新生儿常见疾病诊断与处理[M].北京:人民卫生出版社, 2013
[15]李福钱.低出生体重儿相关危险因素及预后研究[J].中国妇幼保健, 2014, 29(1):84—85
[16]吴连方,苟文丽.分娩学[M].北京:人民卫生出版社,2003
[17]唐代婷,王松柏,李玉萍,等.母亲孕期生活习惯与低出生体重关系病例对照研究[J].中国公共卫生, 2016,32(12):1724—1728
[18]周敏,张小松,郝波,等.西部388例足月低出生体重儿危险因素的病例对照研究[J].中国儿童保健杂志,2013, 21(11):1136—1138
[19]程可萍,杨爱娟. 68例极低出生体重儿发生原因及出生后并发症的临床分析[J].中国妇幼保健, 2010,25(2):198—199
[20]宋倪媛,陈徐,李霞,等.子痫前期患者髓过氧化物酶和水通道蛋白的表达及其与胎儿发育的相关性[J].兰州大学学报:医学版, 2015, 41(4):48—51, 54
[21]姚荣英,韩慧,张玉媛.早产相关危险因素的调查分析[J].蚌埠医学院学报, 2005, 30(6):26—27, 30
[22]张艳波.早产病因的分析与防治[J].中国妇幼保健,2010, 25(2):284—285
[23]王欣,张亚玮,冯永亮,等.不良妊娠结局影响因素的病例对照研究[J].中国妇幼保健, 2013, 28(18):2948—2950
[24] Labbe C, Delesalle C, Creveuil C, et al. Early and later intrahepatic cholestasis of pregnancy(ICP):study of adverse pregnancy outcomes[J]. Gynecologie, Obstetrique,Fertilite&Senologie, 2018, 46(4):388—394
[25]罗银亚.妇产科临床早产危险因素的研究及分析[J].名医, 2018, 9:31
[26] Luke B, Hediger M, Min SJ, et al. Gender mix in twins and fetal growth, length of gestation and adult cancer risk[J]. Paediatric and Perinatal Epidemiology, 2005,19(1):41—47
[2]丁海燕,夏木斯叶·木依都力,李敏超,等.舟山市2002—2015年出生体重变化与不良出生结局及影响因素分析[J].中华疾病控制杂志, 2018, 22(4):380—385
[3] Wei D, Azen C, Bhombal S, et al. Congenital heart disease in low-birth-weight infants:effects of small for gestational age(SGA)status and maturity on postoperative outcomes[J]. Pediatric Cardiology, 2015, 36(1):1—7
[4] Viswanathan S, Khasawneh W, McNelis K, et al. Metabolic bone disease:a continued challenge in extremely low birth weight infants[J]. Journal of Parenteral and Enteral Nutrition, 2014, 38(8):982—990
[5] Borah M, Baruah R. Morbidity status of low birth weight babies in rural areas of Assam:a prospective longitudinal study[J]. Journal of Family Medicine and Primary Care,2015, 4(3):380—383
[6] Johnson KA, Healy E, Dooley B, et al. Children born with very low birth weight show difficulties with sustained attention but not response inhibition[J]. Child Neuropsychology:a Journal on Normal and Abnormal Development in Childhood and Adolescence, 2015, 21(5):629—647
[7] Williamson KE, Jakobson LS, Saunders DR, et al. Local and global aspects of biological motion perception in children born at very low birth weight[J]. Child Neuropsychology:a Journal on Normal and Abnormal Development in Childhood and Adolescence, 2015, 21(5):603—628
[8] Poole KL, Schmidt LA, Missiuna C, et al. Motor Coordination difficulties in extremely low birth weight survivors across four decades[J]. Journal of Developmental and Behavioral Pediatrics:2015, 36(7):521—528
[9] Yang G. Marketing'less harmful, low-tar'cigarettes is a key strategy of the industry to counter tobacco control in China[J]. Tobacco Control, 2014, 23(2):167—172
[10] Silverwood RJ, Pierce M, Hardy R, et al. Low birth weight, later renal function, and the roles of adulthood blood pressure, diabetes, and obesity in a British birth cohort[J]. Kidney International, 2013, 84(6):1262—1270
[11]綦斐,贾晓蓉,刘辉,等.青岛市成年人吸烟、被动吸烟行为及认知现状调查[J].中华疾病控制杂志, 2017,21(5):439—443
[12] Chen Z, Peto R, Zhou M, et al. Contrasting male and female trends in tobacco-attributed mortality in China:evidence from successive nationwide prospective cohort studies[J]. The Lancet, 2015, 386(10002):1447—1456
[13]谢幸,苟文丽.妇产科学[M].北京:人民卫生出版社,2014
[14]魏克伦,刘邵基.新生儿常见疾病诊断与处理[M].北京:人民卫生出版社, 2013
[15]李福钱.低出生体重儿相关危险因素及预后研究[J].中国妇幼保健, 2014, 29(1):84—85
[16]吴连方,苟文丽.分娩学[M].北京:人民卫生出版社,2003
[17]唐代婷,王松柏,李玉萍,等.母亲孕期生活习惯与低出生体重关系病例对照研究[J].中国公共卫生, 2016,32(12):1724—1728
[18]周敏,张小松,郝波,等.西部388例足月低出生体重儿危险因素的病例对照研究[J].中国儿童保健杂志,2013, 21(11):1136—1138
[19]程可萍,杨爱娟. 68例极低出生体重儿发生原因及出生后并发症的临床分析[J].中国妇幼保健, 2010,25(2):198—199
[20]宋倪媛,陈徐,李霞,等.子痫前期患者髓过氧化物酶和水通道蛋白的表达及其与胎儿发育的相关性[J].兰州大学学报:医学版, 2015, 41(4):48—51, 54
[21]姚荣英,韩慧,张玉媛.早产相关危险因素的调查分析[J].蚌埠医学院学报, 2005, 30(6):26—27, 30
[22]张艳波.早产病因的分析与防治[J].中国妇幼保健,2010, 25(2):284—285
[23]王欣,张亚玮,冯永亮,等.不良妊娠结局影响因素的病例对照研究[J].中国妇幼保健, 2013, 28(18):2948—2950
[24] Labbe C, Delesalle C, Creveuil C, et al. Early and later intrahepatic cholestasis of pregnancy(ICP):study of adverse pregnancy outcomes[J]. Gynecologie, Obstetrique,Fertilite&Senologie, 2018, 46(4):388—394
[25]罗银亚.妇产科临床早产危险因素的研究及分析[J].名医, 2018, 9:31
[26] Luke B, Hediger M, Min SJ, et al. Gender mix in twins and fetal growth, length of gestation and adult cancer risk[J]. Paediatric and Perinatal Epidemiology, 2005,19(1):41—47