兰州市新生儿不良结局的危险因素分析
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摘要
目的分析兰州市新生儿不良结局的发生情况及危险因素,为预防和控制新生儿不良结局的发生提供基础依据。方法采用病例对照研究方法,将明确诊断为不良结局的新生儿作为病例组,正常新生儿作为对照组,用非条件Logistic回归模型进行分析。结果母亲小学及以下学历(OR=1.83,95%CI:[1.18,2.83])、常住地在农村(OR=1.41,95%CI:[1.10,1.82])、未定期及未产前检查(OR=6.61,95%CI:[3.64,12.00])、双胎及以上(OR=18.70,95%CI:[7.73,61.11])、孕次≥3次(OR=1.52,95%CI:[1.12,2.07])、妊娠高血压综合征(OR=4.78,95%CI:[2.87,7.97])、妊娠糖尿病(OR=4.60,95%CI:[1.91,11.08])、妊娠肝内胆汁淤积症(OR=9.70,95%CI:[1.16,81.24])、胎盘异常(OR=4.16,95%CI:[1.09,15.79])、羊水粪染(OR=3.52,95%CI:[1.82,6.83])、胎膜早破(OR=3.67,95%CI:[2.77,4.85])均与新生儿不良结局发生有关。结论母亲小学及以下学历、常住地在农村、未定期及未产前检查、双胎及以上、孕次≥3次、妊娠高血压综合征、妊娠糖尿病、妊娠肝内胆汁淤积症、胎盘异常、羊水粪染、胎膜早破是新生儿不良结局的独立危险因素。
Objective To analyze the incidence and the risk factors of neonatal adverse outcomes in Lanzhou City, provide basic basis for the prevention and control of neonatal adverse outcomes. Methods A case control study was performed, the newborns diagnosed as neonatal adverse outcomes were assigned in case group while normal newborns in control group. Logistic regression was carried out to analyze the risk factors.Results Low education level of gravida(OR=1.83, 95% CI: [1.18, 2.83]), long-term rural life(OR=1.41, 95%CI: [1.10, 1.82]), irregular prenatal examination(OR = 6.61, 95% CI: [3.64, 12.00]), multiple births(OR =18.70, 95% CI: [7.73, 61.11]), more than two times of pregnacy(OR=1.52, 95% CI: [1.12, 2.07]), pregnancyinduced hypertension syndrome(OR = 4.78, 95% CI: [2.87, 7.97]), gestational diabetes mellitus(OR = 4.60,95%CI: [1.91, 11.08]), intrahepatic cholestasis of pregnancy(OR=9.70, 95% CI: [1.16, 81.24]), placental abnormalities(OR = 4.16, 95% CI: [1.09, 15.79]), amniotic fluid turbidity(OR = 3.52, 95% CI: [1.82, 6.83]) and premature rupture of the fetal membranes(OR = 3.67, 95% CI: [2.77, 4.85]) are positively correlated with incidence of neonatal adverse outcomes. Conclusion Low education level of gravida, long-term rural life,irregular prenatal examination, multiple births, more than two times of pregnacy, pregnancy-induced hypertension syndrome, gestational diabetes mellitus, intrahepatic cholestasis of pregnancy, placental abnormalities,amniotic fluid turbidity and premature rupture of the fetal membranes are independent risk factors of neonatal adverse outcomes.
Objective To analyze the incidence and the risk factors of neonatal adverse outcomes in Lanzhou City, provide basic basis for the prevention and control of neonatal adverse outcomes. Methods A case control study was performed, the newborns diagnosed as neonatal adverse outcomes were assigned in case group while normal newborns in control group. Logistic regression was carried out to analyze the risk factors.Results Low education level of gravida(OR=1.83, 95% CI: [1.18, 2.83]), long-term rural life(OR=1.41, 95%CI: [1.10, 1.82]), irregular prenatal examination(OR = 6.61, 95% CI: [3.64, 12.00]), multiple births(OR =18.70, 95% CI: [7.73, 61.11]), more than two times of pregnacy(OR=1.52, 95% CI: [1.12, 2.07]), pregnancyinduced hypertension syndrome(OR = 4.78, 95% CI: [2.87, 7.97]), gestational diabetes mellitus(OR = 4.60,95%CI: [1.91, 11.08]), intrahepatic cholestasis of pregnancy(OR=9.70, 95% CI: [1.16, 81.24]), placental abnormalities(OR = 4.16, 95% CI: [1.09, 15.79]), amniotic fluid turbidity(OR = 3.52, 95% CI: [1.82, 6.83]) and premature rupture of the fetal membranes(OR = 3.67, 95% CI: [2.77, 4.85]) are positively correlated with incidence of neonatal adverse outcomes. Conclusion Low education level of gravida, long-term rural life,irregular prenatal examination, multiple births, more than two times of pregnacy, pregnancy-induced hypertension syndrome, gestational diabetes mellitus, intrahepatic cholestasis of pregnancy, placental abnormalities,amniotic fluid turbidity and premature rupture of the fetal membranes are independent risk factors of neonatal adverse outcomes.
引文
[1]谭梅娟,李靖,张艳芳.不良妊娠结局的影响因素与妊娠合并精神分裂症对妊娠结局的影响研究[J].实用预防医学, 2018, 25(12):1470—1472
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[4]雷方良,李姗姗,屈鹏飞,等.孕产妇不良妊娠结局危险因素的病例对照研究[J].西安交通大学学报:医学版,2017, 38(1):100—103
[5]郑玉,朱焱,辛丽梅,等.贵州省农村育龄妇女不良妊娠结局现状及影响因素分析[J].现代预防医学, 2018, 45(2):247—250, 258
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[7]秦海霞,王慧玲,杜敏霞,等.河南卫辉市农村地区育龄妇女不良妊娠风险流行病学调查[J].中国公共卫生,2017, 33(7):1115—1118
[8]杜宝琴,支聪聪,刘淑敏,等. 350例妇女孕前保健资料分析[J].中国妇幼保健, 2013, 28(21):3403—3405
[9]冯玉莲.定期产检对减少高危产妇母婴并发症及降低死亡率的作用[J].中外医疗, 2013, 32(29):94—95
[10]刘小玲,王明娜.规律产检对子痫前期孕妇妊娠结局及行为习惯的影响[J].中国妇幼保健, 2017, 32(4):707—709
[11]张玮.定期产检对降低孕妇母婴并发症的临床价值[J].中国城乡企业卫生, 2017, 32(4):35—36
[12] Bla M, Alencar GP, Zpd S, et al. Hospitalizations due to complications of pregnancy and maternal and perinatal outcomes in a cohort of pregnant women in the Brazilian Unitied National health system in Sao Paulo, Brazil[J].Cad Saude Publica, 2018, 34(1):e00188016
[13] Qin Jia-bi, Sheng Xiao-qi, Wang Hua, et.al. Worldwide prevalence of adverse pregnancy outcomes associated with in vitro fertilization/intracytoplasmic sperm injection among multiple births:a systematic review and Metaanalysis based on cohort studies[J]. Archives of Gynecology and Obstetrics, 2017, 295(3):577—597
[14]唐文燕,谭玮,丁香平,等.不同季节与早产儿/低出生体重儿发生规律的相关性研究[J].中国妇幼保健,2013, 28(23):3772—3774
[15] Kennady G, Kottarathara MJ, Kottarathara AJ, et al.Maternal and neonatal outcomes in pregnancy induced hypertension:an observational study[J]. Clinical and Experimental Obstetrics&Gynecology, 2017, 44(1):110—112
[16] Tussupkaliyev A, Gaiday A, Bermagambetova S, et al.Hypertension of pregnancy associated with hypergomocysteinemia of the first trimester of pregnancy[J]. Georgian Medical News, 2018, 276:40—46
[17] Yamamoto R, Ishii K, Muto H, et al. Incidence of and risk factors for severe maternal complications associated with hypertensive disorders after 36 weeks'gestation in uncomplicated twin pregnancies:a prospective cohort study[J]. Journal of Obstetrics&Gynaecology Research,2018, 44(7):1221—1227
[18] Rao Jia-ming, Fan Da-zhi, Wu Shu-zhen, et al. Trend and risk factors of low birth weight and macrosomia in South China, 2005—2017:a retrospective observational study[J]. Scientific Reports, 2018, 8(1):3393
[19]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
[20] Mitao M, Nathaniel PR, Obure J, et al. Risk factors and adverse perinatal outcome associated with low birth weight in Northern Tanzania:a registry-based retrospective cohort study[J]. Asian Pacific Journal of Reproduction, 2016, 5(1):75—79
[21] Malits J, Blustein J, Trasande L, et al. Perfluorooctanoic acid and low birth weight:estimates of US attributable burden and economic costs from 2003 through 2014[J].International Journal of Hygiene and Environmental Health, 2018, 221(2):269—275
[22] Black RE, Morris SS, Bryce J. Where and why are 10million children dying every year?[J]. The Lancet, 2003,361(9376):2226—2234
[23]谢幸,苟文丽.妇产科学[M].第8版.北京:人民卫生出版社, 2014:118
[2] Blencowe H, Cousens S, Oestergaard MZ, et al. National,regional, and worldwide estimates of preterm birth rates in the year 2010 with time trends since 1990 for selected countries:a systematic analysis and implications[J]. The Lancet, 2012, 379(9832):2162—2172
[3]刘凯,秦英,王治民,等.甘肃省人民医院2006—2015年围产儿出生缺陷发生率变化趋势[J].兰州大学学报:医学版, 2017, 43(4):51—55
[4]雷方良,李姗姗,屈鹏飞,等.孕产妇不良妊娠结局危险因素的病例对照研究[J].西安交通大学学报:医学版,2017, 38(1):100—103
[5]郑玉,朱焱,辛丽梅,等.贵州省农村育龄妇女不良妊娠结局现状及影响因素分析[J].现代预防医学, 2018, 45(2):247—250, 258
[6]詹兵煌,尹丽群,叶玉娥,等.巨大儿产生相关危险因素分析及合理选择分娩方式[J].中国医药科学, 2017, 7(6):80—82, 157
[7]秦海霞,王慧玲,杜敏霞,等.河南卫辉市农村地区育龄妇女不良妊娠风险流行病学调查[J].中国公共卫生,2017, 33(7):1115—1118
[8]杜宝琴,支聪聪,刘淑敏,等. 350例妇女孕前保健资料分析[J].中国妇幼保健, 2013, 28(21):3403—3405
[9]冯玉莲.定期产检对减少高危产妇母婴并发症及降低死亡率的作用[J].中外医疗, 2013, 32(29):94—95
[10]刘小玲,王明娜.规律产检对子痫前期孕妇妊娠结局及行为习惯的影响[J].中国妇幼保健, 2017, 32(4):707—709
[11]张玮.定期产检对降低孕妇母婴并发症的临床价值[J].中国城乡企业卫生, 2017, 32(4):35—36
[12] Bla M, Alencar GP, Zpd S, et al. Hospitalizations due to complications of pregnancy and maternal and perinatal outcomes in a cohort of pregnant women in the Brazilian Unitied National health system in Sao Paulo, Brazil[J].Cad Saude Publica, 2018, 34(1):e00188016
[13] Qin Jia-bi, Sheng Xiao-qi, Wang Hua, et.al. Worldwide prevalence of adverse pregnancy outcomes associated with in vitro fertilization/intracytoplasmic sperm injection among multiple births:a systematic review and Metaanalysis based on cohort studies[J]. Archives of Gynecology and Obstetrics, 2017, 295(3):577—597
[14]唐文燕,谭玮,丁香平,等.不同季节与早产儿/低出生体重儿发生规律的相关性研究[J].中国妇幼保健,2013, 28(23):3772—3774
[15] Kennady G, Kottarathara MJ, Kottarathara AJ, et al.Maternal and neonatal outcomes in pregnancy induced hypertension:an observational study[J]. Clinical and Experimental Obstetrics&Gynecology, 2017, 44(1):110—112
[16] Tussupkaliyev A, Gaiday A, Bermagambetova S, et al.Hypertension of pregnancy associated with hypergomocysteinemia of the first trimester of pregnancy[J]. Georgian Medical News, 2018, 276:40—46
[17] Yamamoto R, Ishii K, Muto H, et al. Incidence of and risk factors for severe maternal complications associated with hypertensive disorders after 36 weeks'gestation in uncomplicated twin pregnancies:a prospective cohort study[J]. Journal of Obstetrics&Gynaecology Research,2018, 44(7):1221—1227
[18] Rao Jia-ming, Fan Da-zhi, Wu Shu-zhen, et al. Trend and risk factors of low birth weight and macrosomia in South China, 2005—2017:a retrospective observational study[J]. Scientific Reports, 2018, 8(1):3393
[19]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
[20] Mitao M, Nathaniel PR, Obure J, et al. Risk factors and adverse perinatal outcome associated with low birth weight in Northern Tanzania:a registry-based retrospective cohort study[J]. Asian Pacific Journal of Reproduction, 2016, 5(1):75—79
[21] Malits J, Blustein J, Trasande L, et al. Perfluorooctanoic acid and low birth weight:estimates of US attributable burden and economic costs from 2003 through 2014[J].International Journal of Hygiene and Environmental Health, 2018, 221(2):269—275
[22] Black RE, Morris SS, Bryce J. Where and why are 10million children dying every year?[J]. The Lancet, 2003,361(9376):2226—2234
[23]谢幸,苟文丽.妇产科学[M].第8版.北京:人民卫生出版社, 2014:118
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