早产危险因素的1:1配对病例对照研究

目的 较为全面地分析现代生活环境下早产的危险因素,为制定早产的预防策略和措施提供理论依据.方法 选择2009年3月1日～12月31日期间在广州市天河区妇幼保健院接受产前保健,并在该医院住院分娩的早产产妇和足月产产妇各102例为调查对象,进行1:1配对的病例对照研究.结果 ①孕早期贫血、孕期发生前置胎盘、子痫前期及子痫、孕20周后食欲差、孕期工作压力严重、孕期噪声暴露、孕期负性生活事件等是早产的危险因素(均P<0.05);②产前检查次数、孕期服用维生素及营养素是早产的保护因素(均P<0.05);③孕期被动吸烟、室内烧香和孕期使用蚊香(烟熏型)对早产的影响无统计学意义(均P>0.05).结论 ①孕早期贫血、前置胎盘、子痫前期及子痫、孕20周后食欲差、孕期工作压力严重、孕期噪声暴露、孕期发生负性生活事件等能增加早产的发生风险;②增加产前检查次数、孕期服用维生素及营养素能降低早产的发生风险;③尚未发现孕期被动吸烟等室内污染与早产存在关联,二者之间关系有待进一步研究确定.     

早产危险因素的病例对照研究

目的 通过分析早产危险因素,探讨降低早产发生率的干预措施.方法 采用病例对照研究方法,对2009年6月～2009年9月广州市某助产机构分娩的133例早产产妇及随机选择的293例足月产妇进行问卷调查和病例摘录,采用卡方检验进行单因素分析筛选出早产危险因素;多因素非条件Logistic回归进一步筛选早产的主要危险因素.结果 产妇高龄、文化程度低、家庭收入低及孕期使用电脑、有生殖系统感染、阴道流血、孕期体重增长低是早产危险因素,产妇有家族早产史、死胎史、既往早产史、多胎妊娠、胎膜早破、胎盘异常、羊水异常及孕次多会增加早产的风险(P<0.05),使用溶剂洗手和孕期使用空调为早产的保护性因素(均P<0.05).多因素Logistic回归分析各危险因素结果显示:发生早产的OR分别为:双胎妊娠19.161(95%CI:5.734～64.030),胎膜早破10.208 (95%CI:5.316～19.603),死胎史5.839 (95%CI:1.503～22.681),胎盘异常4.571(95%CI:1.734～11.989),孕期阴道流血2.894 (95%CI:1.387～6.040);早产保护因素的OR为:家庭收入高0.672(95%CI:0.492～0.918),孕期体重增长较多0.550(95%CI:0.335～0.905).结论 产妇有双胎妊娠、胎膜早破、死胎史、胎盘异常、孕期阴道流血为早产的主要危险因素,加强孕期健康教育、改善经济状况以及重视围产保健,对减少早产的发生至关重要.     

广西钦州市早产相关危险因素的研究

目的探讨广西钦州市新生儿早产的危险因素,为防治新生儿早产提供科学依据。方法在广西妇幼信息系统选择2015年5月至2016年3月在广西钦州市住院分娩单胎活产婴儿的产妇作为调查对象,按分娩孕周分为早期早产组(34周)、晚期早产组(34~36周)和对照组(≥37周)。收集产妇的一般资料和孕期资料,对可能引起早产的危险因素进行单因素分析和有序多分类logistic回归分析。结果本次调查共纳入10 122名产妇,早产发生率为3.99%(404/10 122)。单因素分析结果显示产妇的年龄、民族、文化程度、孕检次数、孕次、产次、羊水过多或过少、妊娠期高血压疾病、胎膜早破、前置胎盘及新生儿畸形在不同分娩孕周中的分布差异有统计学意义(P0.05)。有序多分类logistic回归分析显示,产妇年龄≥35岁(OR=0.623,95%CI:0.45~0.86)、孕次3次(OR=0.706,95%CI:0.52~0.96)、孕检次数6次(OR=0.312,95%CI:0.24~0.41)、羊水过多或过少(OR=0.375,95%CI:0.15~0.95)、胎膜早破(OR=0.224,95%CI:0.16~0.32)、前置胎盘(OR=0.173,95%CI:0.09~0.34)、新生儿畸形(OR=0.238,95%CI:0.12~0.48)是早产的危险因素。结论早产是多因素综合作用的结果,应关注高龄孕妇,积极提倡产前定期检查,针对危险因素尽早采取综合性控制措施以减少早产的发生。     

女性孕期工作状态对早产的影响研究

目的探讨女性孕期工作状态对早产的影响。方法选取兰州市某省级妇幼保健院2016年7月1日-2017年7月31日非病理性即将早产分娩(孕周37周)的150名住院孕产妇(早产组)及同期住院分娩的即将足月(孕周≥38周且42周)的450名孕妇(足月组)作为研究对象,调查一般情况及孕期工作状态。通过多因素Logistic回归法分析孕期工作状态与早产儿的关系。结果 26. 64%的孕妇选择孕后继续工作,16. 87%的孕妇在孕后间断请假,14. 21%的孕妇选择孕后辞职待产,还有43. 35%的孕妇属于待业待产。在孕期工作的孕妇中,从事脑力劳动及视屏终端作业(如电脑、手机操作等)的孕妇占比最大。早产组与足月组孕妇孕期工作付出得分比较差异无统计学意义(P0. 05)。多因素非条件Logistic回归分析显示:孕后工作规律性差及工作回报感低是孕期工作孕妇早产的独立危险因素。结论孕期工作不规律及工作回报感低可增加早产风险。注重职业女性孕期心理调适,合理安排工作节奏是职业卫生的重中之重。     

流动人口产妇住院分娩状况及影响因素分析

[目的]了解流动人口住院分娩率及影响因素,为今后提高流动人口产妇住院分娩宰提供依据.[方法]在海淀区3个乡卫生院的计划免疫日,对陪同孩子进行计划免疫的、属于调查对象的母亲进行面对面问卷调查.[结果]调查的630名流动人口产妇住院分娩率79.2%.多因素Logistic回归分析表明,孕期产检次数、初查孕周、到医院产检次数、是否计划外妊娠和产妇文化程度影响住院分娩率.[结论]海淀区流动人口产妇住院分娩率远远低于海淀区户籍农村产妇住院分娩率.要提高流动人口住院分娩率,需要对流动人口孕产妇、其丈夫和老乡进行相关教育,建立"平价分娩医院",严厉打击非法产前检查和非法接生.     

早产影响因素的多分类Logistic回归分析

目的探讨早产儿发生的危险因素.方法采用病例对照研究法对227名早产儿(孕周＜33周73人,33～36周154人)和750名对照组进行相关因素调查,用多分类Logistic回归分析法进行危险因素分析.结果与分娩孕周＜33周早产儿有关的因素是:母亲孕前体质指数≥28者、有人工流产史、孕早期发热、母亲文化水平为小学及以下者,首次产前检查血红蛋白低于100g/L者、尿蛋白和尿糖阳性等因素是分娩孕周＜33周早产儿的危险因素.与分娩孕周在33～36周早产儿有关的因素有:母亲分娩年龄大于35岁、母亲孕期吸烟及饮酒、年家庭收入低及父亲吸烟等因素.父亲职业为农民、多胎妊娠、孕期精神刺激、产前检查次数少、前置胎盘和妊高症等因素是二者的共同危险因素.结论早产是多种因素联合作用的结果,应采取综合性措施降低早产儿的发生率.     

巨大儿发生率及其影响因素研究

[目的]探讨巨大儿发生率及产妇分娩巨大儿的危险因素，为尽早识别出高风险产妇、预防巨大儿发生提供参考。[方法]收集曲靖市妇幼保健院2021年1月1日-12月31日在院分娩的7590例孕产妇，选取与出生体重有关的孕期相关危险因素，采用非条件Logistic回归分析危险因素的聚集情况。[结果]分娩巨大儿的产妇中，62.87%的产妇出现危险因素的聚集，当有2种危险因素聚集时，即年龄≥30岁有妊娠合并肥胖的产妇(OR=9.282,P<0.05)、妊娠糖尿病的经产妇(OR=9.282,P<0.05)分娩巨大儿的风险最高；3种因素聚集时，即身高≥160 cm合并妊娠肥胖的经产妇(OR=22.277,P<0.05)分娩巨大儿的风险最高；4种因素聚集时，即年龄≥30岁合并妊娠肥胖和妊娠糖尿病的经产妇(OR=18.564,P<0.05)分娩巨大儿的风险最高；有5种危险因素的产妇(OR=25.315,P<0.05)分娩巨大儿的风险高于其他所有产妇。[结论]孕期危险因素聚集可升高发生巨大儿的风险，孕期应及早识别并重视有风险特征的产妇，加强健康教育和孕期保健，减少巨大儿的发生。     

北京市顺义区早产危险因素分析

目的分析造成顺义区孕妇早产发生的危险因素,为制定早产有效的干预措施提供科学依据,从而减少早产儿的出生,促进儿童身心健康和提高生命质量。方法对2009年8月1日-2010年7月31日在顺义区妇幼保健院住院分娩的早产的产妇171例进行现场问卷调查,同时1:1比例匹配同一天分娩的正常产的产妇171例进行病例对照研究。结果单因素条件回归分析早产的危险因素占前五位的是妊娠高血压疾病、胎盘异常、晚孕生殖系统感染、孕期前三个月体重增加≥4kg、胎膜早破,保护因素是均衡饮食、产前检查;多因素条件回归分析结果显示,当调整了孕妇年龄因素后,产前检查10次以上是早产的保护因素。居住在农村,妊娠期高血压疾病、产次、胎膜早破、孕期前3月体重增加是早产的危险因素。孕晚期生殖系统感染是早产的可疑危险因素。结论加强孕期保健可降低早产的发生。     

苏州市早产与低出生体重的趋势及危险因素研究

目的了解苏州市活产分娩婴儿中早产儿和低出生体重儿的发生率并探讨相关危险因素。方法选取2009-2013年苏州市单胎分娩的产妇189 935例为研究对象,收集产妇年龄、产次、孕次、孕周、新生儿出生体重等指标,利用χ~2检验及多因素Logistic回归模型评估相关性。结果 2009-2013年苏州市早产率及低出生体重率均呈现上升趋势,总体早产率为7.0%,低出生体重率为5.2%。孕妇文化程度为高中/职高、大专及以上、产次为2次是早产与低出生体重的保护因素,孕妇年龄40岁、剖宫产是早产与低出生体重的危险因素,孕次≥5次是早产的危险因素,孕妇年龄为20~40岁、孕次2~4次是低出生体重的保护因素。结论早产及低出生体重的发生是多因素联合作用造成的,因此在妇幼保健工作中应有计划、有针对性、有重点地开展孕前及孕期保健宣传,提高自我保健意识,对降低早产及低出生体重发生率有重要意义。     

准妈妈如何正确认识及预防早产

早产是指在妊娠满28周而不足37周之间分娩者,可影响分娩方式,增加早产儿并发症发生风险及病死率。那么,影响早产的因素有哪些?早产会对妊娠结局产生如何影响?孕期准妈妈们应如何预防早产?本文为准妈妈们解答以上问题,帮助准妈妈正确认识及预防早产,以保障孕妇孕期安全及顺利分娩,避免早产。     

北京市276例低出生体重儿影响因素的配对病例对照研究

目的探讨北京市产妇孕前和孕期各种因素对低出生体重的影响,为预防和减少低出生体重的发生及制定干预措施提供依据。方法采用1∶1配对病例对照的研究方法,对2010年7月至2011年12月间在北京市海淀区妇幼保健院出生的276例低出生体重儿及其对照新生儿母亲进行问卷调查,并用条件logistic回归对影响低出生体重发生的有关因素进行单因素和多因素分析。结果产妇日常膳食结构均衡和产前检查次数>8次与低出生体重发生危险降低有关,OR值分别为0.44和0.28;而孕期体重增加偏少(≤10kg)、有孕早期先兆流产、有妊娠合并症,以及有胎盘或胎膜异常与低出生体重发生危险增加有关,OR值在2.31～3.04之间。结论低出生体重的发生是多因素联合作用所致,应有计划、有针对性、有重点地实施干预措施。     

武汉市出生缺陷影响因素的病例对照研究

目的探讨武汉市中心城区出生缺陷的影响因素,为出生缺陷干预提供科学依据。方法采用1∶4配对病例对照研究,对386例出生缺陷儿的产妇、1 544例正常儿的产妇进行回顾性调查。使用SAS9.2统计软件进行统计分析,采用描述性统计分析、单因素Logistic回归分析和多因素1∶4匹配条件Logistic回归分析方法。结果有统计学意义的因素有:产妇孕期接触致畸因素(OR=1.602)、被动吸烟(OR=1.002)、孕期健康状况好(OR=0.943)、孕期坚持运动(OR=0.955)、剖宫产(OR=0.863)和曾分娩活产次数(OR=0.712)。结论产妇孕期接触致畸因素和被动吸烟是出生缺陷的危险因素,孕期健康状况好、孕期坚持运动、剖宫产和曾分娩活产次数是出生缺陷的保护因素。     

3 245例新生儿早产危险因素研究

目的：探讨新生儿早产的危险因素，为预防和控制早产提供科学依据。方法：收集1994－1998年在广西医科大学第一附属医院妇产科住院分娩的3245例新生及其母亲有关资料，采用非条件Logistic回归模型分析与早产有关的因素。结果：在纳入研究的3245例新生儿中，早产儿225例，发生率为6．93％；与早产发生有关的因素是：胎儿畸形（b=3.144,OR=23.19）、多胎妊娠（b=2.497,OR=12.14）、胎膜早破（b=0.827,OR=2.29）、产次(b=0.281,OR=1.33)、母亲职业（b=0.384,OR=1.47)、脐带长度（b=-0.037,OR=0.96)、产检查次数（b=-0.198,OR=0.82）。结论：胎儿畸形，多胎妊娠，胎膜早破，脐带过短、产次越多以及母亲职业是农民等因素能增加新生儿早产的危险性，而进行产前检查会降低早产的危险性。     

Teenage pregnancy and adverse birth outcomes: a large population based retrospective cohort study

BACKGROUND: Whether the association between teenage pregnancy and adverse birth outcomes could be explained by deleterious social environment, inadequate prenatal care, or biological immaturity remains controversial. The objective of this study was to determine whether teenage pregnancy is associated with increased adverse birth outcomes independent of known confounding factors. METHODS: We carried out a retrospective cohort study of 3,886,364 nulliparous pregnant women <25 years of age with a live singleton birth during 1995 and 2000 in the United States. RESULTS: All teenage groups were associated with increased risks for pre-term delivery, low birth weight and neonatal mortality. Infants born to teenage mothers aged 17 or younger had a higher risk for low Apgar score at 5 min. Further adjustment for weight gain during pregnancy did not change the observed association. Restricting the analysis to white married mothers with age-appropriate education level, adequate prenatal care, without smoking and alcohol use during pregnancy yielded similar results. CONCLUSIONS: Teenage pregnancy increases the risk of adverse birth outcomes that is independent of important known confounders. This finding challenges the accepted opinion that adverse birth outcome associated with teenage pregnancy is attributable to low socioeconomic status, inadequate prenatal care and inadequate weight gain during pregnancy.     

Some biological and social factors of risk associated with the birth of pre-term infants

The main purpose of the present study was to evaluate the effects of factors associated with spontaneous pre-term births so that the high risk woman could be identified before or at early stages of pregnancy. For this purpose, we have compared the measurements of 21 anthropometric traits and mean fluctuating asymmetry over 8 bilateral anthropometric traits, as well as age, occupation, education, previous obstetric history, complications during pregnancy, medicines received during and after pregnancy and some others in women who delivered babies of short (26-36 wk, n = 113 ind.) and normal gestational age (n = 103). Diseases and mean fluctuating asymmetry of eight morphological traits in the newborn infants themselves were also studied. Both univariate and multivariate analyses were carried out and these were in agreement, showing a highly significant increase in the morbidity rate (especially of respiratory diseases) among pre-term infants and in complications during pregnancy in their mothers. Among other variables associated with the current pre-term birth were previous spontaneous pre-term births, suggesting their special risk value. The estimate of the sib correlation in gestational age on the liability scale was about 0.63. Spearman and Pearson correlations in gestational age for siblings were 0.34 and 0.31, respectively.     

Does participation in a nurse visitation programme reduce the frequency of adverse perinatal outcomes in first-time mothers?

Children First (C1), a nurse home visitation programme for first-time mothers, was implemented statewide in Oklahoma in mid-1997. The objective of this study was to compare the risks of low (< 2500 g) and very low birthweight (< 1500 g), preterm (< 37 weeks) and very preterm (< 30 weeks) deliveries and infant mortality between mothers participating and not participating in C1. All 239,466 Oklahoma birth certificates were reviewed. The C1 and birth certificate databases were matched to identify C1 participants. Mother's age at delivery, education level, race, marital status, prior pregnancy loss or pregnancy risk factors, birthweight and gestational age at delivery were measured from the birth certificates. Death certificates were matched to the birth certificates to identify infant deaths. A Bayesian multivariable logistic regression was used to analyse the data. Among single mothers without pregnancy risk factors, the risks of all study outcomes were lower for participants in C1: adjusted odds ratio (aOR) 0.89, [95% Bayesian Credible Interval (BCI) 0.79, 1.00] for preterm delivery; aOR 0.71, [95% BCI 0.50, 0.98] for very preterm delivery; aOR 0.86, [95% BCI 0.75, 0.98] for low birthweight; aOR 0.77, [95% BCI 0.56, 1.02] for very low birthweight and aOR 0.36, [95% BCI 0.17, 0.63] for infant mortality. These risk reductions were not observed among married mothers. In both single and married mothers, the presence of pregnancy risk factors reduced the impact of C1 on lowering the risk of low birthweight and preterm deliveries. The C1 programme targets young, pregnant women of low socio-economic level. We found that among single mothers, the risks of perinatal adverse outcomes are reduced or similar to those found in non-participating mothers. A reduced effect of C1 in the presence of pregnancy risk factors may be because mothers with pregnancy risk factors who did not participate in C1 received better prenatal care, or that C1 interventions do not impact these particular factors. C1 shows promise in reducing infant mortality in single mothers. Lower incidence of preterm and very preterm deliveries is especially interesting and future analyses should focus on isolating programme components specifically associated with influencing these outcomes.     

Sociodemographic predictors of antenatal and postpartum depressive symptoms among women in a medical group practice

OBJECTIVE: Data are scarce regarding the sociodemographic predictors of antenatal and postpartum depression. This study investigated whether race/ethnicity, age, finances, and partnership status were associated with antenatal and postpartum depressive symptoms. SETTING: 1662 participants in Project Viva, a US cohort study. DESIGN: Mothers indicated mid-pregnancy and six month postpartum depressive symptoms on the Edinburgh postpartum depression scale (EPDS). Associations of sociodemographic factors with odds of scoring >12 on the EPDS were estimated. MAIN RESULTS: The prevalence of depressive symptoms was 9% at mid-pregnancy and 8% postpartum. Black and Hispanic mothers had a higher prevalence of depressive symptoms compared with non-Hispanic white mothers. These associations were explained by lower income, financial hardship, and higher incidence of poor pregnancy outcome among minority women. Young maternal age was associated with greater risk of antenatal and postpartum depressive symptoms, largely attributable to the prevalence of financial hardship, unwanted pregnancy, and lack of a partner. The strongest risk factor for antenatal depressive symptoms was a history of depression (OR = 4.07; 95% CI 3.76, 4.40), and the strongest risk for postpartum depressive symptoms was depressive symptoms during pregnancy (6.78; 4.07, 11.31) or a history of depression before pregnancy (3.82; 2.31, 6.31). CONCLUSIONS: Financial hardship and unwanted pregnancy are associated with antenatal and postpartum depressive symptoms. Women with a history of depression and those with poor pregnancy outcomes are especially vulnerable to depressive symptoms during the childbearing year. Once these factors are taken in account, minority mothers have the same risk of antenatal and postpartum depressive symptoms as white mothers.     

Antenatal care received and its association with preterm birth in Greece

A total population sample of singleton births to mothers with certain dates of last menstrual period (LMP) was identified from the Greek National Perinatal Survey of April 1983. Two groups of mothers were considered separately, 3116 primigravidae and 6524 multigravidae, with preterm birth rates of 5.9% and 8.4% respectively. Of all the antenatal care factors tested, primigravidae showed significant associations (unadjusted) with haematocrit level and with drugs taken during pregnancy. The logistic regression analysis which followed showed that the only factor independently associated with preterm delivery for that group of mothers was drugs taken during this period: women taking no drugs (including vitamins and iron) had the highest risk of preterm delivery. In contrast, multigravidae showed significant unadjusted associations with a great variety of parameters of antenatal care. Nevertheless, in the logistic regression analysis only three proved to have independent significant associations: drugs taken during pregnancy (reduced risk among mothers taking vitamins and iron), hospital admission during pregnancy (mainly for cervical cerclage) and the pattern of antenatal care during the first two trimesters (those attending the recommended number of times having least risk).     

早产危险因素的病例对照研究

目的 调查早产发生的危险因素,为降你划产儿发生率、制定有效的预防措施提供依据。方法 采用配对病例对照研究将３２１例早产病例与同一医院出生的足月产例对照例１：１配比,进行条件Ｌｅｇｉｓｔｉｃ回归分析。结果 早产的危险因素有妊娠期特发性胆淤症、胎膜早破、前置胎盘和脐带打结,定期的产前保健是早产发生的保护因素。结论 早产与胆淤证、胎膜早破、前置胎盘和脐带打结有关。     

Antenatal and perinatal care in southern Italy. I. The mothers' reports

A population-based cross-sectional study of antenatal and perinatal care was performed in Campania, a region of southern Italy. One thousand three hundred women who had given birth in 1982 were interviewed. The number of antenatal visits was very low, less than 1% of the mothers having attended more than three times during pregnancy. The women at high obstetric risk did not attend more than those at low risk and certain aspects of their antenatal care were unsatisfactory. The place of birth was similar for high risk and low risk mothers, with 40% delivering in small private facilities (with few neonatal resuscitation facilities and often with inadequate infant transport services). The labour was induced or accelerated in 60% of the mothers. The organisation of perinatal care did not take into account many of the needs of the mothers such as presence of a relative at delivery, ambulation during labour, early relationship with the newborn, rooming-in, or encouragement to breastfeed.