摘要
目的:分析武汉市常住孕妇死胎的发生率及其相关的孕期因素。方法:利用武汉市妇幼信息系统建立的出生队列,回顾性收集2011年1月1日至2017年9月30日武汉市常住且在市内产科机构分娩的孕妇的社会人口学特征、孕产史、孕期及产时信息等,选择其中死胎(包括死产)的资料进行回顾性分析。采用χ^(2)检验比较孕妇孕期因素在活产组与死胎组之间的差异,采用二分类logistic回归分析与死胎发生相关的影响因素。结果:研究时间内武汉市常住孕妇分娩509057例,其中活产组505839例,死胎组3218例(除外死产后为3155例),总体发生率6.32‰(3218/509507),年发生率4.90‰~8.11‰。活产组和死胎组比较显示,2组孕妇年龄构成[<25岁、25~30岁、30~35岁和>35岁的比例分别为19.28%(97544/505839)、48.45%(245077/505839)、26.09%(131952/505839)和6.18%(31266/505839)与19.36%(623/3218)、45.15%(1453/3218)、26.29%(846/3218)和9.20%(296/3218)]、文化程度[初中及以下、高中/中专和大学及以上分别为22.90%(115833/505839)、36.37%(183978/505839)和40.73%(206028/505839)与22.03%(709/3218)、38.72%(1246/3218)和39.25%(1263/3218)]、职业[脑力劳动/专业技术人员和体力劳动/自由职业分别为33.51%(169514/505839)和66.38%(335763/505839)与31.54%(1015/3218)和68.34%(2199/3218)]、居住区域[中心城区和郊区分别为70.00%(354365/505839)和30.00%(151474/505839)与76.32%(2456/3218)和23.68%(762/3218)]、受孕季节[春季(3~5月)、夏季(6~8月)、秋季(9~11月)和冬季(12~次年2月)分别为24.27%(122746/505839)、24.09%(121867/505839)、26.69%(135012/505839)和24.95%(126214/505839)与24.08%(775/3218)、23.87%(768/3218)、25.08%(807/3218)和26.97%(868/3218)]比较,差异均有统计学意义(P值均<0.05),而胎儿性别比例差异无统计学意义(P值>0.05);2组孕妇的孕次[1次和≥2次分别为49.32%(249484/505839)和50.68%(256355/505839)与47.02%(1513/3218)和52.98%(1705/3218)]、产次[1次和≥2次分别为73.60%(372316/505839)和26.40%(133523/505839)与77.07%(2480/3218)和22.93%(738/3218)]、既往死胎史[0.33%(842/256355)与0.65%(11/1705)]以及妊娠期高血压疾病[3.25%(16464/505839)与5.59%(180/3218)]、孕早期阴道出血[2.02%(10251/505839)与2.61%(84/3218)]、前置胎盘[0.98%(4963/505491)与2.64%(53/2009)]和羊水过少[2.52%(12764/505839)与1.90%(61/3218)]比例比较,差异均有统计学意义(P值均<0.05);而妊娠期糖尿病和既往自然流产史的比例比较,差异均无统计学意义(P值均>0.05)。排除死产后的死亡组与活产组上述指标比较的结果一致。二分类logistic回归分析显示,孕妇的分娩年龄>30岁(>35岁:OR=2.59,95%CI:2.25~2.98;30~35岁:OR=1.42,95%CI:1.30~1.56)、高中及以下学历(初中及以下:OR=1.37,95%CI:1.21~1.55;高中/中专:OR=1.28,95%CI:1.16~1.42)、从事体力劳动或自由职业(OR=1.18,95%CI:1.07~1.31)、居住在中心城区(OR=1.43,95%CI:1.31~1.57)、孕次≥2次(OR=1.32,95%CI:1.21~1.43)、产次1次(OR=1.76,95%CI:1.58~1.96)、妊娠期高血压疾病(OR=2.80,95%CI:2.40~3.27)、孕早期阴道出血(OR=1.35,95%CI:1.08~1.68)、前置胎盘(OR=10.86,95%CI:8.84~13.35)和既往死胎史(OR=2.27,95%CI:1.30~3.98)均是死胎发生的高危因素。结论:孕妇分娩年龄>30岁、受教育程度低、从事体力劳动或自由职业、有不良孕产史以及早期阴道出血、妊娠期高血压疾病、前置胎盘等均是发生死胎的高危因素。
Objective To analyze the incidence of stillbirth and the associated factors in pregnancy among pregnant residents in Wuhan.Methods A previous birth cohort was retrospectively reviewed.The cohort was based on Wuhan Maternal and Child Information System,and the perinatal information of pregnant residents in Wuhan from January 1,2011,to September 30,2017 and information of selected cases was collected,including socio-demographic characteristics,pregnant history,and healthcare information during pregnancy and labor.Data on stillbirth,including fetal death in uterus and in labor,were selected for this study.Chi-square test was adopted for comparing the differences in pregnancy-related factors between live birth and stllbirth,and binary logistic regressions for exploring the influencing factors associated with the occurrence of stllbirth.Results A total of 509057 deliveries in Wuhan were included in this study,including 505839 live births and 3218 stillbirths(3155 after exclusion of fetal death in labor),with an overall incidence of stillbirth of 6.32%o(3218/509057),and an annual incidence between 4.90%o to 8.11%o.Statistically significant differences were found between the live birth and stillbirth group in the following items:maternal age[<25 years old:19.28%(97544/505839)vs 19.36%(623/3218);25-30 years old:48.45%(245077/505839)vs 45.15%(1453/3218);30-35 years old:26.09%(131952/505839)vs 26.29%(846/3218);>35 years old:6.18%(31266/505839)vs 9.20%(296/3218)],educational background[middle school or below:22.90%(115833/505839)vs 22.03%(709/3218);high school:36.37%(183978/505839)vs 38.72%(1246/3218);college or above:40.73%(206028/505839)vs 39.25%(1263/3218)],occupation[brainworker or professionals:33.51%(169514/505839)vs 31.54%(1015/3218);manual or freelance worker:66.38%(335763/505839)vs 68.34%(2199/3218)l,residential area[urban area:70.00%(354365/505839)vs 76.32%(2456/3218);rural area:30.00%(151474/505839)vs 23.68%(762/3218)],and time of conception[spring(March to May):24.27%(122746/505839)vs 24.08%(775/3218);summer(June to August):24.09%(121867/505839)vs 23.87%(768/3218);fall(September to November):26.69%(135012/505839)vs 25.08%(807/3218);winter(December to next February):24.95%(126214/505839)vs 26.97%(868/3218)(all P<0.05),but no significant difference was found in fetal gender(P>0.05).Besides,gravidity[once:49.32%(249484/505839)vs 47.02%(1513/3218);0ver twice:50.68%(256355/505839)vs 52.98%(1705/3218)],parity[once:73.60%(372316/505839)vs 77.07%(2480/3218);over twice:26.40%(133523/505839)vs 22.93%(738/3218)],history of stillbirth[0.33%(842/256355)vs 0.65%(11/1705)],hypertensive disorders in pregnancy[3.25%(16464/505839)vs 5.59%(180/3218)],first trimester vaginal bleeding[2.02%(10251/505839)vs 2.61%(84/3218)],placenta previa[0.98%(4963/505491)vs 2.64%(53/2009)],and oligohydramnios[2.52%(12764/505839)vs 1.90%(61/3218)]differed significantly between the two groups(all P<0.05).However,no significant difference was found between the two groups in terms of the proportion of women with gestational diabetes mellitus and previous spontaneous abortion(both P>0.05).After exclusion of fetal death in labor from the 3218 stillbirths,the same results were achieved.Binary logistic regression analysis showed that women who were over 30 years old(30-35 years old:OR=1.42,95%CI:1.30-1.56;>35 years old:OR=2.59,95%CI:2.25-2.98),with a high school degree or below(middle school or below:OR=1.37,95%CI:1.21-1.55;high school:OR=1.28,95%CI:1.16-1.42),manual or freelance worker(OR=1.18,95%CI:1.07-1.31),in the urban area(OR=1.43,95%CI:1.31-1.57),and gravidity≥2 times(OR=1.32,95%CI:1.21-1.43),primiparity(OR=1.76,95%CI:1.58-1.96),gestational hypertension(OR=2.80,95%CI:2.40-3.27),vaginal bleeding in the first trimester(OR=1.35,95%CI:1.08-1.68),placenta previa(OR=10.86,95%CI:8.84-13.35)and history of stillbirth(OR=2.27,95%CI:1.30-3.98)were all risk factors of stillbirth.Conclusion Pregnant women who were over 30 years old,less educated,manual worker or freelance or with a history of adverse pregnancy,vaginal bleeding in the first trimester,hypertension in pregnancy,and placenta previa are at higher risk of stillbirth.
作者
谭亚飞
张瑜
杨逸凡
张艳
彭畅
彭安娜
周爱芬
Yafei Tan;Yu Zhang;Yifan Yang;Yan Zhang;Chang Peng;Anna Peng;Aifen Zhou(Department of Child Healthcare for Community,Wuhan Children's Hospital(Wuhan Maternal and Child Healthcare Hospital),Tongji Medical College,Huazhong University of Science&Technology,Wuhan 430014,China;Department of Gynecology and Obstetrics,Wuhan Children's Hospital(Wuhan Maternal and Child Healthcare Hospital),Tongji Medical College,Huazhong University of Science&Technology,Wuhan 430014,China;Department of Child Healthcare,Wuhan Children's Hospital(Wuhan Maternal and Child Healthcare Hospital),Tongji Medical College,Huazhong University of Science&Technology,Wuhan 430014,China;Department of Maternal,Child and Adolescent Health,School of Public Health,Huazhong University of Science and Technology,Wuhan 430030,China)
出处
《中华围产医学杂志》
CAS
CSCD
北大核心
2023年第7期566-574,共9页
Chinese Journal of Perinatal Medicine
基金
湖北省卫生健康科研基金青年重点项目(WJ2019H401)
武汉市卫生健康科研基金(WQ19Q04)。
关键词
死胎
妊娠并发症
影响因素分析
队列研究
Fetal death
Pregnancy complications
Root cause analysis
Cohort studies
作者简介
通信作者:周爱芬,Email:april1972@163.com,电话:027-82433284。
