首页 >>2020年02期
陕西省育龄妇女围孕期产检次数与双胎新生儿小于胎龄儿发生风险的关联研究
作者:张彬艳 李敏敏 刘阿敏 武文韬 虢海月 高翔宇 吴晨璐 商苏杭 颜虹 党少农

摘要:

目的  探讨陕西省育龄妇女围孕期产前检查(产检)次数与双胎新生儿小于胎龄儿(SGA)发生风险的关联。方法  采用多阶段整群随机抽样方法,于2013年7至12月在陕西省30个区(县)对30 027名2010年1月至2013年11月期间怀孕且结局明确的育龄妇女进行面对面问卷调查,回顾性收集人口学信息、孕产史、孕期生活方式、疾病史、营养素补充及孕期保健等资料。通过查阅出生证明获取新生儿的胎龄和出生体重等资料,按出生胎次登记为双胎A和双胎B。最终将资料完整的356名育龄妇女及其双胎新生儿纳入分析。采用广义估计方程模型分析产检次数与SGA发生风险的关联。结果  育龄妇女年龄为(27.44±4.68)岁;农村居民占79.49%(283名);产检≥7次者占44.38% (158名)。新生儿胎龄和出生体重分别为(37.64±2.51)周和(2 510±497)g,双胎A和双胎B的SGA发生率分别为51.40%(183/356)和53.37%(190/356),其中产检≥7次者双胎A和双胎B的SGA发生率分别为44.30%(70/158)和42.41%(67/158),低于产检<7次者[分别为57.07%(113/198)和62.12%(123/198)](P值分别为0.017和<0.001)。广义估计方程模型分析结果显示,以产检<7次者为参照,调整产次、出生胎次、居住地、母亲年龄、职业、文化程度、家庭财富指数、被动吸烟、妊娠高血压综合征、围孕期服用叶酸和围孕期服用铁剂、新生儿性别等因素后,产检≥7次者发生SGA的OR(95%CI)值为0.60(0.40~0.91)。结论  产检≥7次可降低陕西省双胎新生儿SGA的发生风险。

关键词:怀孕期间;产前保健;出生体重;双生

Abstract:

Objective  To explore the association between the frequency of prenatal care in childbearing aged women and risk of small for gestational age (SGA) among neonatal twins in Shaanxi Province.Methods  From July to December 2013, a total of 30 027 childbearing aged women, who were pregnant from January 2010 to November 2013 and had definite outcomes, were selected from 30 districts (counties) of Shaanxi Province by using the multi-stage random sampling method. The questionnaires with a face-to-face survey method were used to retrospectively collect demographic information, pregnancy history, lifestyle during pregnancy, disease history, nutritional supplements, and health care during pregnancy. Information on the gestational age and birth weight of the newborn were obtained by consulting the medical certificate of birth and were registered as twin A and twin B by birth order. Finally, 356 childbearing aged women and their twin babies with complete data were included in the analysis. A generalized estimation equation model was used to analyze the association between the frequency of prenatal care and the risk of SGA among neonatal twins.Results  The age of childbearing aged women was (27.44±4.68) years old, of which 79.49% (283 women) were rural residents and 44.38% (158 women) had seven or more times prenatal care. The gestational age and birth weight were (37.64±2.51) weeks and (2 510±497) g, respectively. The prevalence of SGA was 51.40% (183/356) for twin A and 53.37% (190/356) for twin B, respectively. The prevalence of SGA was 44.30% (70/158) for twin A with seven or more times prenatal care and 42.41% (67/158) for twin B with seven or more times prenatal care, which was lower than that for twins with less than seven times prenatal care, respectively [57.07% (113/198) and 62.12% (123/198)] (P values were 0.017 and <0.001). The results of generalized estimation equation model suggested that compared to those with less than seven times prenatal care, after adjusting for parity, birth order, place of residence, maternal age, occupation, education, family wealth index, passive smoking, pregnancy-induced hypertension syndrome, folic acid, and iron supplement during perinatal period, and gender of the newborn, the OR (95%CI) of risk of SGA among childbearing aged women with seven or more times prenatal care was 0.60 (0.40-0.91).Conclusion  Seven or more times prenatal care could reduce the risk of SGA among neonatal twins in Shanxi Province.

Key words: Peripartum period;Prenatal care;Birth weight;Twins

发表日期:2020/2

引用本文:

图/表:

  • 10.3760/cma.j.issn.0253-9624.2020.02.003.T001:表1 不同产前检查次数育龄妇女及新生儿基本特征比较[名(%)];

    10.3760/cma.j.issn.0253-9624.2020.02.003.T001:表1 不同产前检查次数育龄妇女及新生儿基本特征比较[名(%)];

参考文献:

[1]MorrisRK, OliverEA, MalinG, et al. Effectiveness of interventions for the prevention of small-for-gestational age fetuses and perinatal mortality: a review of systematic reviews[J]. Acta Obstet Gynecol Scand,2013,92(2):143-151. DOI: 10.1111/aogs.12029.
[2]朱丽,张蓉,张淑莲,等.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.DOI: 10.3760/cma.j.issn.0578-1310.2015.02.007.
[3]HogeveenM, BlomHJ, den HeijerM. Maternal homocysteine and small-for-gestational-age offspring: systematic review and meta-analysis[J]. Am J Clin Nutr, 2012,95(1):130-136. DOI: 10.3945/ajcn.111.016212.
[4]吴巍巍,胡连鑫,邱丽倩,等. 2008—2013年浙江省多胎发生情况及其围生期结局分析[J].中华预防医学杂志,2015,49(3):265-268. DOI: 10.3760/cma.j.issn.0253-9624.2015.03.015.
[5]王傲,刘彩霞.双胎小于孕龄儿的多因素分析[J].中国医科大学学报,2015,44(12):1106-1109.DOI:10.3969/j.issn.0258-4646.2015.12.013.
[6]van WelyM, TwiskM, MolBW, et al. Is twin pregnancy necessarily an adverse outcome of assistedreproductive technologies?[J]. Hum Reprod, 2006,21(11):2736-2738. DOI: 10.1093/humrep/del249.
[7]张若,屈鹏飞,党少农,等.陕西省妇女产前检查与子女出生体重关系的多水平线性模型分析[J].西安交通大学学报(医学版),2016,37(6):910-914. DOI: 10.7652/jdyxb201606028.
[8]YangJ, ChengY, PeiL, et al. Maternal iron intake during pregnancy and birth outcomes: a cross-sectional study in Northwest China[J]. Br J Nutr, 2017,117(6):862-871. DOI: 10.1017/S0007114517000691.
[9]杨姣梅,党少农,程悦,等.陕西单胎孕妇膳食模式及其影响因素研究[J].中华预防医学杂志,2017,51(8):766-768. DOI: 10.3760/cma.j.issn.0253-9624.2017.08.020.
[10]中华医学会妇产科学分会产科学组.孕前和孕期保健指南(2018)[J].中华围产医学杂志,2018,21(3):145-152. DOI: 10.3760/cma.j.issn.1007-9408.2018.03.001.
[11]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. DOI: 10.3760/cma.j.issn.0253-9624.2017.12.005.
[12]戴琳琳,胡文斌,罗晓明,等.产前保健与文化程度对低出生体重风险的交互作用[J].中华流行病学杂志,2014,35(5):533-536. DOI: 10.3760/cma.j.issn.0254-6450.2014.05.014.
[13]王颖,李玫,解冰洁,等.妊娠期高血压疾病对小于胎龄儿的影响及潜在交互作用研究[J].中华流行病学杂志,2016,37(9):1283-1287. DOI: 10.3760/cma.j.issn.0254-6450.2016.09.020.
[14]张弘.双胎妊娠围产期结局分析[J].中国医药导刊,2009,11(11):1834-1835. DOI: 10.3969/j.issn.1009-0959.2009.11.011.
[15]白丽丽,恩和巴雅尔,李玉玲,等. 5-羟色胺转运体启动子区基因型与学龄双生子儿童心理行为问题的相关性[J].中华行为医学与脑科学杂志,2016,25(6):487-492. DOI: 10.3760/cma.j.issn.1674-6554.2016.06.002.
[16]KibelM, KahnM, ShermanC, et al. Placental abnormalities differ between small for gestational age fetuses in dichorionic twin and singleton pregnancies[J]. Placenta, 2017,60:28-35. DOI: 10.1016/j.placenta.2017.10.002.
[17]PollackH, LantzPM, FrohnaJG. Maternal smoking and adverse birth outcomes among singletons and twins[J]. Am J Public Health, 2000,90(3):395-400. DOI: 10.2105/ajph.90.3.395.
[18]周艳娜,李玉玲.多巴胺D4受体基因多态性与学龄双生子儿童行为问题的关系研究[J].中华行为医学与脑科学杂志,2017,26(4):293-299. DOI: 10.3760/cma.j.issn.1674-6554.2017.04.002.
[19]姚菲,缪华章,祝新红,等.广东省双胎新生儿胎龄别出生体重百分位数曲线研究[J].中国生育健康杂志,2018,29(2):126-133. DOI: 10.3969/j.issn.1671-878X.2018.02.005.
[20]FoxNS, RebarberA, KlauserCK, et al. Intrauterine growth restriction in twin pregnancies: incidence and associated risk factors[J]. Am J Perinatol, 2011,28(4):267-272. DOI: 10.1055/s-0030-1270116.
[21]RegevRH, ReichmanB. Prematurity and intrauterine growth retardation--double jeopardy?[J]. Clin Perinatol, 2004,31(3):453-473. DOI: 10.1016/j.clp.2004.04.017.
[22]BoghossianNS, GeraciM, EdwardsEM,et al. Morbidity and mortality in small for gestational age infants at 22 to 29 weeks′ gestation[J].Pediatrics, 2018,141(2): pii: e20172533. DOI:10.1542/peds.2017-2533.

用户评论 0条

用户名: 密码: 登陆 注册
 
  • 9
  • 3
  •  4 : 页次:0/0页 共0条记录 5条/每页
    关于我们 | 专家风采 | 会员注册 | 继续教育
    地 址:北京市西城区东河沿街69号正弘大厦511室 邮 编:100052
    电话:010-51322302
    版权所有 中华医学会及中华预防医学杂志编辑部
    京ICP备 07035254 号