浙江省嘉兴地区初孕妇女自然流产状况研究

目的 了解浙江省嘉兴地区初孕妇女自然流产状况及分布特征.方法 资料来源于北京大学生育健康研究所嘉兴地区围产保健监测及自然流产数据.研究对象为嘉兴地区1993-1995年登记的准备结婚及生育并最终怀孕(不包括人工流产、宫外孕及葡萄胎)的初孕妇女14769名.结果 嘉兴地区初孕妇女自然流产率为9.8%(1454/14769,95%CI:9.3～10.3),平均妊娠诊断孕周为(7.6±2.1)周,平均流产孕周为(10.1±3.1)周.早期(≤12周)自然流产率为7.3%(95%CI:6.8～7.7),占总流产的73.7%.流产集中发生在8～13周,占37.7%.经多因素Cox回归分析,生育年龄≥30岁、农民、文化程度高者自然流产率较高.结论 嘉兴地区初孕妇女自然流产率高于国内其他地区;自然流产主要发生在8～13孕周.     

Spontaneous abortion and maternal work in greenhouses

BACKGROUND: A positive association between maternal occupational exposure to pesticide and spontaneous abortion has been reported in some studies. Work in greenhouses may imply exposure of pregnant women to pesticides continuously and at elevated level. METHODS: A total of 717 women working in greenhouses provided information on 973 pregnancies, including 110 spontaneous abortions. These pregnancies were classified as exposed or not exposed according to maternal occupation, re-entry activities and application of pesticides in greenhouses during at least 1 month in the first trimester of pregnancy. The ORs for spontaneous abortion were estimated through a generalised estimate equations model for all orders of pregnancy together, and through a logistic regression model limited to first pregnancies. RESULTS: Increased risks of spontaneous abortion were found for maternal re-entry activities within 24 hr after pesticides were applied (all orders of pregnancy: OR 3.2, 95% CI 1.3-7.7; first pregnancies: OR 3.8, 95% CI 1.0-13.9) and for those who applied pesticides (all orders of pregnancy: OR 2.6, 95% CI 1.0-6.6; first pregnancies: OR 3.7, 95% CI 0.7-20,6) CONCLUSIONS: The observed results support the hypothesis of an association between maternal work in greenhouses and spontaneous abortion. The main limitations of the study are lack of information on the specific chemicals used and the small number of pregnancies heavily exposed to pesticides.     

Mifepristone-induced abortion and vaginal bleeding in subsequent pregnancy

BackgroundThe aim of this study is to explore the effect of first-trimester mifepristone-induced abortion on vaginal bleeding in subsequent pregnancy.Study DesignThis observational cohort study was conducted during 1998–2001 at antenatal clinics in Beijing, Chengdu, and Shanghai, China. The study enrolled 4,931 women with one previous mifepristone-induced abortion, 4,925 women with no history of induced abortion, and 4,800 women with one previous surgical abortion and followed them through pregnancy and childbirth.ResultsThe rates of vaginal bleeding in pregnant women with a history of medical abortion, no abortion, and surgical abortion were 16.5%, 13.9%, and 17.3%, respectively. The women with medical abortion had a higher risk (adjusted relative risk (aRR)=1.17, 95% confidence interval (CI): 1.07, 1.29) of vaginal bleeding compared with those with no abortion but similar risk to prior surgical abortion. When the correlation between medical abortion and vaginal bleeding was examined by period, increased risk was observed only in the early period (<16 gestational weeks) (aRR=1.25, 95% CI: 1.12, 1.39). The comparison between subgroups of medical abortion and no abortion showed that the observed risks increased particularly in those with abortion at gestational age ≤7 weeks (aRR=1.33, 95% CI: 1.18, 1.49), those followed by a postabortion curettage (aRR=1.58, 95% CI: 1.37, 1.84) or complications (aRR=1.99, 95% CI: 1.67, 2.37). There was no difference between women with medical abortion and women with surgical abortion in the occurrence of vaginal bleeding for either period.ConclusionsOne previous mifepristone-induced abortion increased the risk of vaginal bleeding in early gestation period of subsequent pregnancy compared with no abortion, especially if abortion occurred before 7 weeks of gestation and was followed by a curettage or complications.     

Relations of gestational length and timing and type of incomplete pregnancy to ovarian cancer risk

While the protective nature of parity with respect to ovarian cancer has been well documented, whether a history of incomplete pregnancy affects ovarian cancer risk is uncertain. Data collected from 739 epithelial ovarian cancer cases and 1,313 community controls in the Delaware Valley from 1994 to 1998 were used to evaluate the relation between gestational length and timing of first induced or spontaneous abortion and ovarian cancer risk. Incomplete pregnancy was not associated with ovarian cancer among nulliparous women or among ever-pregnant women either before or after adjustment for relevant confounders (for nulliparous women, odds ratio (OR) = 1.12, 95% confidence interval (CI): 0.66, 1.89; for ever-pregnant women, OR = 0.95, 95% CI: 0.76, 1.18). Among unigravid women, one full-term pregnancy was more protective than an incomplete pregnancy (adjusted OR = 0.29, 95% CI: 0.15, 0.57). These results were independent of the type of pregnancy loss. Among ever-pregnant women, a spontaneous abortion before a first birth provided significant protection (adjusted OR = 0.47, 95% CI: 0.30, 0.75), while no significant effect was found for an induced abortion prior to a first birth (adjusted OR = 0.80, 95% CI: 0.44, 1.47). These data do not support an independent association between incomplete pregnancies, either spontaneous or induced, and ovarian cancer risk.     

Paternal and Maternal Smoking Habits before Conception and During the First Trimester: Relation to Spontaneous Abortion

PURPOSE: This study examined the association between maternal smoking before and during the first trimester of pregnancy and spontaneous abortion.

METHODS: We have been conducting a hospital-based case-control study on risk factors for spontaneous abortion in the greater Milan area. We collected information from 782 cases of spontaneous abortions and 1543 controls (women who delivered at term healthy infants).

RESULTS: With respect to never smokers, the odds ratio (OR) were 0.7 (95%, confidence interval (CI), 0.5–1.0) for women who quit smoking and 1.3 (95% CI, 1.0–1.6) for those who continued during pregnancy. Women who smoked more than 10 cigarettes/day in the first trimester were at increased risk of miscarriage, with an OR of 1.4 (95% CI, 1.0–2.1). No relationship was evident between the number of cigarettes smoked before conception and the risk of abortion. Likewise, no association emerged between paternal smoking and miscarriage. Moreover, no significant interaction or modification effect was obtained when strata of age and other major characteristics were investigated.

CONCLUSIONS: The risk of abortion associated with cigarette smoking during the first trimester of pregnancy was measurable and noticeable in this population, and accounted for 9% (95% CI, 6–13%) of all cases. The increased risk of spontaneous abortion in women smoking during pregnancy is a further reason to encourage pregnant women to quit.     

A(H1N1)v2009: a controlled observational prospective cohort study on vaccine safety in pregnancy

Background

A(H1N1)v2009 influenza vaccination of pregnant women was a challenge for health care providers, as little safety data were available.

Methods

We prospectively followed the pregnancies of women who were vaccinated at any time during pregnancy or ≤4 weeks prior to conception and compared these outcomes to a control cohort matched by the estimated date of birth. Primary endpoints: rate of spontaneous abortion and major malformations. Secondary endpoints: preeclampsia, gestational age at birth, and birth weight.

Results

Pregnancy outcome of 323 women immunized with adjuvanted or non-adjuvanted A(H1N1)v2009 influenza vaccines from 2009-09-28 to 2010-03-31 were compared to 1329 control subjects. The risk for spontaneous abortions (HR 0.89; 95% CI 0.36–2.19) and the rate of major malformations (all trimesters: OR 0.87; 95% CI 0.38–1.77; preconception and first trimester exposure: OR 0.79; 95% CI 0.13–2.64) did not vary between the two cohorts. Furthermore, there was no increase in preeclampsia, prematurity, and intrauterine growth retardation in the vaccinated cohort.

Conclusion

The results of our study do not indicate a risk for the pregnant woman and the developing embryo/fetus after H1N1 vaccination. We provide and apply methods novel in observational studies on pregnancy outcome, especially if a single dose exposure is investigated.     

Mifepristone-induced abortion and vaginal bleeding in subsequent pregnancy

Background

The aim of this study is to explore the effect of first-trimester mifepristone-induced abortion on vaginal bleeding in subsequent pregnancy.

Study Design

This observational cohort study was conducted during 1998–2001 at antenatal clinics in Beijing, Chengdu, and Shanghai, China. The study enrolled 4,931 women with one previous mifepristone-induced abortion, 4,925 women with no history of induced abortion, and 4,800 women with one previous surgical abortion and followed them through pregnancy and childbirth.

Results

The rates of vaginal bleeding in pregnant women with a history of medical abortion, no abortion, and surgical abortion were 16.5%, 13.9%, and 17.3%, respectively. The women with medical abortion had a higher risk (adjusted relative risk (aRR)=1.17, 95% confidence interval (CI): 1.07, 1.29) of vaginal bleeding compared with those with no abortion but similar risk to prior surgical abortion. When the correlation between medical abortion and vaginal bleeding was examined by period, increased risk was observed only in the early period (<16 gestational weeks) (aRR=1.25, 95% CI: 1.12, 1.39). The comparison between subgroups of medical abortion and no abortion showed that the observed risks increased particularly in those with abortion at gestational age ≤7 weeks (aRR=1.33, 95% CI: 1.18, 1.49), those followed by a postabortion curettage (aRR=1.58, 95% CI: 1.37, 1.84) or complications (aRR=1.99, 95% CI: 1.67, 2.37). There was no difference between women with medical abortion and women with surgical abortion in the occurrence of vaginal bleeding for either period.

Conclusions

One previous mifepristone-induced abortion increased the risk of vaginal bleeding in early gestation period of subsequent pregnancy compared with no abortion, especially if abortion occurred before 7 weeks of gestation and was followed by a curettage or complications.     

2014 - 2017年北京市通州区孕早期临床甲状腺功能减退流行现况

目的 了解北京市通州区孕早期临床甲状腺功能减退（临床甲减）的流行现况及其影响因素。方法 收集2014年1月1日 - 2017年12月31日于通州区妇幼保健院产检的27 100例单胎妊娠妇女的社会人口学特征、既往史、家族史及本次妊娠情况等资料,分析孕妇妊娠早期临床甲减的流行现况,通过多因素logistic回归探讨影响临床甲减的相关危险因素。结果 2014 - 2017年通州区产检妇女妊娠早期临床甲减的患病率为1.52%（411/27 100）。单因素分析显示,糖尿病家族史者、自然流产史者、无剖宫产史者、以及初产妇的妊娠早期临床甲减患病率较高（均P＜0.05）。多因素logistic回归分析显示,自然流产史（OR = 1.499,95% CI:1.049～2.142）、糖尿病家族史（OR = 2.542,95% CI:1.544～4.186）是妊娠早期临床甲减的独立危险因素（均P＜0.05）。结论 北京市通州区妊娠早期临床甲减患病情况不应忽视。自然流产史及糖尿病家族史与孕早期临床甲减有关联,未来可加强妊娠早期临床甲减的高危人群的关注,促进临床甲减的防治。     

人工流产女性非意愿妊娠现状调查分析

目的了解天津地区人工流产女性非意愿妊娠的现状,减少女性非意愿妊娠和重复流产的发生,维护和促进女性生殖健康。方法采用现况调查的方法,对天津医科大学第二医院计划生育科8 745例要求人工流产的女性进行问卷调查。主要调查内容包括一般人口学特征、人工流产情况以及非意愿妊娠原因等情况。以人工流产次数≥2次的患者为病例组,只有1次人工流产的患者为对照组,进行病例-对照研究。结果 8 745例人工流产患者,其中重复流产者共5 648例,占65.2%;在重复流产者中,≥3次者占全部对象的33.0%。患者意外妊娠原因主要为未避孕(50.1%)和避孕失败(34.4%)。多因素分析显示,年龄大者(OR=2.38,95%CI:2.10~2.69)和有过生育者(OR=1.50,95%CI:1.32~1.70)发生重复流产的风险较高。结论我国育龄妇女人工流产率及重复人工流产率均较高,应进一步开展人工流产后关爱服务,促进高效避孕方法的使用,从而保障女性身心健康。     

Early Abortion in Family Medicine: Clinical Outcomes

PURPOSE Clinical innovations have made it more feasible to incorporate early abortion into family medicine, yet the outcomes of early abortion procedures in this setting have not been well studied. We wished to assess the outcomes of first-trimester medication and aspiration abortion procedures by family physicians.METHODS Prospective observational cohort study conducted from August 2001 to February 2005 of 2,550 women who sought pregnancy termination in 4 clinical practices of family medicine departments and 1 private office/training site.RESULTS The rate of successful uncomplicated procedures for medication was 96.5% (95% confidence interval [CI], 95.5%–97.0%) and for aspiration was 99.9% (CI, 99.3%–1). Adverse events and complications of medication abortions were failed procedure (ongoing pregnancy; n = 19, 1.45%); incomplete abortion (n = 16, 1.22%); hemorrhage (n = 9, 0.69%); and patient request for aspiration (n = 1, 0.08%). One (0.08%) missed ectopic pregnancy was seen among patients receiving medication. Four types of adverse outcomes were encountered with aspiration: incomplete abortion requiring re-aspiration (n = 21, 1.83%); hemorrhage during the procedure (n = 4, 0.35%); missed ectopic pregnancy (n = 3, 0.26%); and minor endometritis (n = 1, 0.09%). Missed ectopic pregnancies were successfully treated in the inpatient setting without mortality (overall hospitalization rate of 0.16 of 100). All other complications were managed within outpatient family medicine sites. Rates of complication did not vary by experience of physician or by site of care (residency vs private practice).CONCLUSIONS Complications of medication and aspiration procedures occurred at a low rate, and most were minor and managed without incident.     

Violence against young Australian women and association with reproductive events: a cross-sectional analysis of a national population sample

OBJECTIVE: This study aimed to investigate associations between violence and younger women's reproductive events using Survey 1 (1996) data of the Younger cohort of the Australian Longitudinal Study of Women's Health (ALSWH). METHODS: Multinomial regression, using composite variables for both violence and reproductive events, adjusting for socioeconomic variables and weighted for rural and remote areas. RESULTS: 23.8% of 14,784 women aged 18 to 23 years reported violence; 12.6% reported non-partner violence in the previous year; and 11.2% reported ever having had a violent relationship with a partner. Of the latter group, 43% (4.8% overall) also reported violence in the past year. Compared with women reporting no violence, women reporting partner but not recent violence (OR 2.55, 95% CI 2.10-3.09) or partner and recent violence (OR 3.96, 95% CI 3.18-4.93) were significantly more likely to have had one or more pregnancies. Conversely, having had a pregnancy (2561) was associated with an 80% increase in prevalence of any violence and a 230% increase in partner violence. Among women who had a pregnancy, having had a miscarriage or termination was associated with violence. Partner and recent violence is strongly associated with having had a miscarriage, whether alone (OR = 2.85, 95% CI 1.74-4.66), with a termination (OR = 4.60, 2.26-9.35), or with birth, miscarriage and a termination (OR = 4.12, 1.89-9.00). CONCLUSIONS AND IMPLICATIONS: Violence among young women of childbearing age is a factor for which doctors should be vigilant, well-trained and supported to identify and manage effectively.     

Risks of repeated miscarriage

There is a lack of well-designed epidemiological studies of possible risk factors for repeated miscarriage. In this Swedish population-based case-control study, we investigated the association between sociodemographic and anthropometric factors, obstetric history and life-style factors, with respect to the risks of first-trimester repeated miscarriage. Information on maternal characteristics was collected through in-person interviews. Plasma blood samples were analysed for cotinine and folate concentrations. Adjusted odds ratios (OR) with 95% confidence interval [CI] were used to estimate the relative risk of repeated miscarriage. The risks of repeated miscarriage were increased for women aged > or = 35 years (adjusted OR 2.9 [95% CI 1.4, 5.8]), as well as for women aged < or = 24 years (OR 2.8 [95% CI 1.1, 6.8]). Women with a history of at least one preceding miscarriage prior to the two index pregnancies, women reporting prolonged time to conceive, and women with a history of myoma, faced a more than fourfold increased risk of repeated miscarriage. Smokers were at an increased risk of repeated miscarriage (OR 2.1 [95% CI 1.1, 4.1]). Among non-smoking women with high caffeine intake, there was an increased risk of repeated miscarriage, whereas there was no such association among smokers. Low plasma folate levels were not associated with increased risks.     

药物流产与手术流产对我国未育妇女再次妊娠影响比较的系统综述和Meta分析

目的 系统评价药物流产（medical abortion,MA）与手术流产（surgical abortion,SA）对我国未育妇女再次妊娠带来的影响,从而为意外怀孕妇女选择流产时提供一定的参考建议。方法 在线检索PubMed、Cochrane Library、Web of Science、Ovid、Embase、中国知网（China national knowledge infrastructure,CNKI）、中国生物医学文献数据库（Chinese biomedicine literature database,CBM）、万方数据库与重庆维普信息数据库,按照纳入标准纳入文献,并进行文献质量评价。运用Review Manager 5.3软件进行统计分析。结果 本研究共纳入7项队列研究,包含2 946例初产妇。结果表明,除MA后再次妊娠的先兆流产（OR=0.38,95%CI:0.28~0.52）,产后出血（OR=0.35,95%CI:0.25~0.48）、胎盘前置（OR=0.53,95%CI:0.31~0.90）、胎盘粘连（OR=0.33,95%CI:0.23~0.48）和胎盘残留（OR=0.22,95%CI:0.14~0.35）发生率较SA组低外,其他高危妊娠的发生率差异无统计学意义（均有P>0.05）。结论 MA优于SA,可以作为育龄妇女非意愿妊娠的首选。但流产对再次妊娠仍然存在伤害,对于妇女来说,应当重视首次怀孕,从根本上减少流产对孕妇本身及再次妊娠分娩带来的不良影响。     

Spontaneous abortions among Finnish flight attendants.

We conducted a retrospective cohort study to investigate whether work as a cabin attendant is related to an increased risk for spontaneous abortion. Data on female cabin crew members were linked to medical records on pregnancies. There were 1751 eligible pregnancies for the final analysis. Flight attendants who worked during early pregnancy had a slightly elevated risk of spontaneous abortion, as compared with attendants who were pregnant outside a time span of active flying (odds ratio [OR] = 1.3; 95% confidence interval [CI], 0.9 to 1.8). During the earliest years of the study period (1973 through 1977), the risk seemed to be decreased (OR = 0.4; 95% CI, 0.2 to 1.1), whereas during the later years (1978 through 1994) the risk was increased (OR = 1.6; 95% CI, 1.1 to 2.4). The results are in agreement with earlier studies, showing suggestive evidence of a slightly increased risk of spontaneous abortion among female cabin crew members.     

Does pregnancy or pregnancy loss increase later maternal risk of diabetes?

Evidence that childbearing is associated with future development of diabetes remains conflicting and the role of pregnancy loss in this association has not been investigated. We aimed to examine whether pregnancy and/or pregnancy loss (miscarriage, abortion, or stillbirth) are associated with maternal higher risk of diabetes later in life, using a population-based prospective cohort study (mean follow-up = 10.7 years), including 13,612 women (aged 35-65 at baseline). We found pregnancy per se did not change the risk of diabetes after considering the effect of education, smoking, alcohol consumption, physical activity, BMI, waist/hip ratio, hypertension, and hyperlipidemia (fully-adjusted OR: 1.04, 95 % CI: 0.82-1.31). Having more than four live births was associated with around two times higher risk of diabetes later in life (fully-adjusted OR: 1.77, 95 % CI: 1.12-2.80). Having more than two miscarriages was associated with about two-fold higher risk of diabetes (fully-adjusted Odd ratio (OR): 1.85, 95 % CI: 1.17-2.93). After further adjustment for parity, the higher risk of diabetes in those who had history of more than two miscarriages did not change substantially (OR: 1.82; 95 % CI: 1.15-2.88), but the association between more than four live births and diabetes disappeared when the role of pregnancy loss was considered (fully-adjusted HR: 1.06; 95 % CI: 0.54-2.08). No significant association was found between abortion, stillbirth and risk of maternal diabetes. Pregnancy per se did not increase risk of diabetes. Women who experience more than two miscarriages are at around two times higher risk of diabetes later in life. The association between high parity and diabetes is mediated by history of miscarriages and known risk factors of diabetes. The underlying reason for association between miscarriage and diabetes needs further investigation.     

Echography in the first pregnancy trimester has prognostic value

Clinical and ultrasound data of 403 first-trimester pregnancies were collected prospectively. Consequences for determination of gestational age as well as the risk of spontaneous abortion were investigated. There was a clear relation between embryonal growth delay and the risk of spontaneous abortion: the risk of spontaneous abortion was significantly higher if the crown-rump length lagged 7 or more days behind the expected gestation time based on the duration of the amenorrhoea (16% versus 5.0%; p less than 0.01). It is important to know the exact duration of pregnancy, because a difference of one or two weeks can be critical in terms of survival or disability. 22.7% of the pregnant women who had a regular menstrual cycle before this pregnancy appeared to have an embryonal growth delay of seven days or more in relation to the reference curve. This illustrates the necessity of crown-rump length measurements in order to obtain accurate assessment of gestational age, which is fundamental in obstetric care.     

Physically strenuous work during pregnancy and risk of preterm birth

The aim of the study was to examine the risk of preterm birth following physically strenuous work during pregnancy. We included 343 pregnant women referred to an occupational medical clinic. Data on preterm birth and covariates were retrieved from the Danish Birth Registry. Risk estimates were computed by logistic regression using a population sample of gainfully employed women as reference (n = 345,915). The risk of preterm birth was increased in women lifting heavy loads during pregnancy (OR 1.40, 95% CI [0.88, 2.23]) but not in women with physically strenuous work (OR 0.98, 95% CI [0.66, 1.46]). The mean gestational age in the heavy-lifting group compared to the reference group was 2.4 days shorter (95% CI [0.36, 4.41]). The study challenges earlier reassuring findings as heavy-lifting pregnant women had a reduced gestational age, indicating a possibility of increased risk of preterm birth.     

Correlates of smoking in pregnant women in six Brazilian cities

OBJECTIVE: To evaluate sociodemographic and lifestyle correlates of smoking in pregnant women sampled from hospitals. METHODS: A cross-sectional study was conducted in 5,539 pregnant women aged 20 or more who sought medical attention in prenatal clinics of affiliate hospitals of the Brazilian National Health System in the cities of Manaus, Fortaleza, Salvador, Rio de Janeiro, S?o Paulo, and Porto Alegre from 1991 to 1995. Interviews were conducted using a standardized questionnaire that covered sociodemographics and smoking habits before and during pregnancy. Current smoking was defined as smoking at least one cigarette/day, former smoking as reporting having smoked at least one cigarette/day but having quit, and never smoking as never having smoked one cigarette/day. RESULTS: Smoking during pregnancy was associated with lower education (OR=2.13; CI 95%: 1.76-2.57) and greater parity (OR=1.84; CI 95%: 1.53-2.21). Positive associations were also found with increased gestational age and alcohol consumption. No significant association was found with skin color or occupation status. A protective effect was observed for women married or living with a partner (OR=0.55 CI 95%: 0.42-0.72). Having Manaus' women as a reference, Porto Alegre's women showed the greatest risk for smoking in pregnancy (OR=5.00; CI 95%: 3.35-7.38), followed by S?o Paulo's (OR=3.42; CI 95%: 2.25-5.20), Rio de Janeiro (OR=2.53; CI 95%: 1.65-3.88) and Fortaleza's (OR=2.56; CI 95%: 1.74-3.78). CONCLUSIONS: The study findings are similar to those described in the literature regarding education, parity, and marital status. However, no association with skin color was seen in the multivariate analysis. Former smokers had sociodemographic characteristics more similar to non-smokers than former smokers.     

Is conception delay a risk factor for reduced gestation or birthweight?

Previous studies have suggested an association between delays in conception and adverse perinatal outcomes, specifically, low birthweight and preterm birth. We investigated the relationship between conception delay (defined as >6 months to become pregnant) and three perinatal outcomes: low birthweight (LBW; <2500 g), preterm birth (PTB; <37 weeks), and small-for-gestational-age (SGA; <10th percentile weight for given gestational age) using data from the Collaborative Perinatal Project. The study cohort was limited to pregnancies with a known time-to-pregnancy (n = 8465; 15%). Generalised estimating equations were used to estimate odds ratios (OR) and 95% confidence intervals [CI] for risk of adverse perinatal outcomes accounting for the clustering of pregnancy outcomes for women with more than one pregnancy. After adjusting for confounders, all ORs were close to the null (LBW, OR = 1.01; 95% CI = 0.86, 1.20), (PTB, OR = 1.10; 95% CI = 0.95, 1.27), (SGA, OR = 1.06; 95% CI = 0.91, 1.25). Thus, we found no evidence to support an adverse relationship between conception delay and decrements in gestation or birthweight among this select sample of fertile women, even after varying the cut-point for defining conception delay.     

2013-2017年北京市通州区34637例孕妇妊娠期糖尿病流行情况及其影响因素研究

  目的  了解北京市通州区孕妇妊娠期糖尿病（gestational diabetes mellitus,GDM）的流行情况及其相关影响因素。  方法  收集2013年1月1日至2017年12月31日期间在北京市通州区妇幼保健院住院分娩的34 637例单胎孕妇的社会人口学特征、既往史、糖尿病家族史及本次妊娠情况等资料,分析孕妇GDM患病率,利用多因素Logistic回归分析GDM相关影响因素。  结果  34 637例单胎孕妇的GDM患病率为23.19%（8 034/34 637）。多因素分析显示,高龄（aOR=1.87,95%CI:1.71~2.05）、高文化程度（aOR=1.19~1.23）、2016-2017年分娩（aOR=1.46,95%CI:1.38~1.55）、巨大儿分娩史（aOR=1.27,95%CI:1.02~1.59）、剖宫产史（aOR=1.18,95%CI:1.08~1.30）、自然流产史（aOR=1.23,95%CI:1.10~1.37）、药物及人工流产史（aOR=1.08,95%CI:1.01~1.14）、糖尿病家族史（aOR=1.51,95%CI:1.26~1.83）、经产妇（aOR=1.24,95%CI:1.15~1.34）、孕前超重（aOR=2.02,95%CI:1.89~2.15）、孕前肥胖（aOR=3.11,95%CI:2.81~3.43）、采用辅助生殖技术怀孕者（aOR=1.47,95%CI:1.03~2.10）是GDM的独立危险因素。  结论  北京市通州区住院分娩的孕妇中GDM处于较高的流行水平。应针对影响GDM发病的相关危险因素,开展孕前及孕期健康教育,及时监测及预防GDM的发生,以促进母婴健康。