孕期甲状腺激素敏感性与出生结局关系的队列研究

  目的  研究孕期妇女甲状腺激素敏感性与出生结局的关系。  方法  依托武汉市大型出生队列,以符合入选标准的5 411对孕妇-新生儿为研究对象。利用孕期体检的血清三碘甲状腺素(free triiodothyronine, FT3)、游离甲状腺素(free thyroxine, FT4)和甲状腺刺激激素(thyroid stimulating hormone, TSH),计算甲状腺激素中枢敏感性的指标:促甲状腺激素指数(thyroid stimulating hormone index, TSHI)、促甲状腺激素细胞-T4抵抗指数(thyrotroph thyroxine resistance index, TT4RI)和甲状腺反馈分位数指数(thyroid feedback quantile-based index, TFQI)。结局指标包括出生体重、出生孕周、出生体重Z评分,以及低出生体重、早产和小于胎龄儿(small for gestational age, SGA)。分别利用多元线性回归、logistic回归分析模型对甲状腺指标和出生结局中的连续型变量、分类变量进行回归分析,并控制可能混杂因素。  结果  FT4、TSHI、TFQI与出生体重和出生体重Z评分呈负相关(均P≤0.01);甲状腺激素敏感性指标TSHI、TT4RI、TFQI与SGA存在统计学意义的正相关(TSHI: OR=1.52, 95% CI: 1.12~2.06, P＜0.01; TT4RI: OR=1.15, 95% CI: 1.03~1.29, P=0.02; TFQI: OR=1.41, 95% CI: 1.10~1.81, P＜0.01);甲状腺功能和甲状腺激素敏感性与低出生体重、早产的差异均无统计学意义。将妊娠合并甲状腺功能减退(甲减)人群排除后进行敏感性分析,研究结果一致。  结论  孕期妇女甲状腺激素敏感性受损是不良出生结局SGA的独立风险因素。     

孕期运动和防辐射服使用与早产的关联性研究

目的分析孕期运动和防辐射服使用与早产之间的关联性,为预防早产提供依据。方法选取2011年1月-2012年12月在甘肃省妇幼保健院孕早期建卡并随访到分娩记录的孕妇为研究对象,由专业培训调查员采用一对一的方式进行《孕妇健康调查问卷》填写。分娩后,由医生从保健手册上摘抄分娩及新生儿情况,包括早产和足月产等信息。采用χ2检验进行早产相关影响因素的单因素分析,进一步应用二分类非条件Logistic回归模型分析孕期运动和防辐射服使用与早产之间的关系。结果纳入的5 614名孕妇中有668名发生早产,早产率为11.9%。孕妇年龄、文化程度、家庭人均月收入、孕前健康教育、妊娠高血压、子痫前期、吸烟和孕前喝茶是早产的影响因素(P<0.05);孕晚期运动可降低早产发生率,通过二分类非条件Logistic回归模型调整早产影响因素后OR值为0.749(95%CI:0.605~0.927)(P<0.05);孕期使用防辐射服能够降低早产率,且随着防辐射服使用频率增加早产率降低(P<0.05),总是使用防辐射服调整OR值为0.652(95%CI:0.494~0.862)(P<0.05)。结论孕晚期运动和使用防辐射服是早产的保护因素。     

孕前超重/肥胖与婴儿不良出生结局关系前瞻性队列研究

  目的  探讨妇女连续两次妊娠间孕前体重变化与早产、低出生体重、巨大儿、小于胎龄儿及大于胎龄儿的关系。  方法  基于广东省妇幼卫生信息系统,收集2015 — 2020年具有两次分娩记录的6 589名孕妇及其分娩婴儿的资料,将生育间体质指数（BMI）变化分为4组（< – 1、 – 1～、1～、 ≥ 3）,使用logistic回归模型分析两次妊娠间孕前BMI变化与不良出生结局的关联。  结果   本研究纳入的6 589名孕产妇及其子女早产、低出生体重儿、巨大儿、小于胎龄儿、大于胎龄儿的发生率分别为5.6 %、4.7 %、2.4 %、11.4 %和5.4 %。logistic回归结果显示,相对于BMI变化 − 1～的参照组,BMI变化1～组发生巨大儿风险增加66 %（OR = 1.66,95 % CI = 1.13～2.24）,BMI变化 ≥ 3组发生巨大儿、大于胎龄儿的风险分别增加131 %（OR = 2.31,95 % CI = 1.42～3.70）、87 %（OR = 1.87,95 % CI = 1.33～2.60）。BMI每增加1,小于胎龄儿风险降低7 %（OR = 0.93,95 % CI = 0.89～0.97）。各组发生早产、低出生体重的风险与对照组相比差异均无统计学意义（P > 0.05）。  结论  两次妊娠间体重的增长与巨大儿及大于胎龄儿的风险增加相关。应加强对妇女妊娠期及分娩后的体重管理,以降低二胎巨大儿、大于胎龄儿的发生风险。     

孕早期家用化学品使用与妊娠结局关系

目的 探讨孕早期家用化学品使用与3种不良妊娠结局（早产、低出生体重、小于胎龄儿）的关联情况。方法 选取在安徽省合肥、芜湖、马鞍山市妇幼保健部门进行孕产期保健体检并分娩单胎活产儿的10 269名育龄妇女为研究对象,分析不同特征育龄妇女孕早期家用化学品使用情况与不良妊娠结局关系。结果 美白霜的使用频率最高,其他家用化学品的使用频率较低,6 827人（66.5%）表示几乎不使用除美白霜以外的家用化学品;调查对象早产、低出生体重、小于胎龄儿发生率分别为3.4%、1.8%、3.2%;以几乎不用为对照组,二项logistic回归结果显示,家用化学品使用与低出生体重（RR=1.11,95%CI=0.83～1.49）、小于胎龄儿之间（RR=1.07,95%CI=0.85～1.33）无统计学关联,甚至在早产组呈现出一种保护效应（RR=0.73,95%CI=0.58～0.91）。结论育龄妇女孕早期家用化学品使用与3种不良妊娠结局不存在关联。     

孕早期呕吐与不良妊娠结局关系出生队列研究

目的 探讨孕早期呕吐与3种不良妊娠结局(早产、低出生体重、小于胎龄儿)的关系.方法 样本人群来自于安徽者马鞍山市出生队列,以2008年10月-2010年10月在马鞍山市妇幼保健机构孕早期建卡并随访到分娩记录的5 084名孕妇为研究对象,采用x2检验和logistic回归模型分析孕早期不同呕吐程度与3种不良妊娠结局的关系.结果 队列中4 653名单胎活产儿母亲在孕早期发生剧吐的有175人,占3.8％;轻微呕吐有2 937人,占63.1％,无呕吐有1 541人,占33.1％;多因素logistic回归分析结果显示,孕早期发生轻微呕吐是发生小于胎龄儿的保护因素(RR=0.66,95％CI=0.45～0.96);孕早期剧呕是发生小于胎龄儿的危险因素(RR =2.76,95％CI=1.51 ～5.05).结论 孕早期轻微呕吐和剧吐对小于胎龄儿的发生有不同影响.     

10407名单胎活产儿SGA发生率及其影响因素的队列研究

目的:了解安徽省8地市小于胎龄儿(SGA)发生情况并分析其影响因素。方法:选择安徽省8地市妇幼保健部门首次保健服务的孕妇为研究对象,填写《孕产期母婴健康记录表》,收集母亲的社会人口统计学特征和孕前6个月及孕早期环境暴露因素,同时于孕晚期收集孕期妊娠期高血压等妊娠合并症及并发症的发生情况,记录单胎活产儿出生信息,运用χ2检验和多因素Logistics回归模型分析人口统计学特征与环境暴露对SGA的影响。结果:SGA发生率为3.4%(357/10 407),将SGA按重量指数分型,匀称型SGA占55.2%(197/357),非匀称型SGA占43.4%(155/357);将SGA按身长/头围分型,为匀称型SGA占73.7%(263/357),非匀称型SGA占4.2%(15/357)。多因素Logistic回归模型结果显示,孕妇为城市户口、孕早期发生妊娠呕吐但未做医疗处理、孕期头3个月服用微量元素坚持1个月以上是SGA发生的保护因素,OR值分别为0.71(95%CI:0.57～0.89)、0.79(95%CI:0.63～0.99)、0.30(95%CI:0.11～0.81);胎儿性别为女、孕前BMI<18.5、发生妊娠呕吐并去医院就诊为SGA的危险因素,OR值分别为1.83(95%CI:1.47～2.29)、1.46(95%CI:1.16～1.85)、1.72(95%CI:1.12～2.65)。结论:孕妇孕前BMI较低及妊娠呕吐等会影响SGA的发生,加强孕前和孕期保健,应重视妊娠呕吐的发生,发生时应及时就诊以减少SGA的发生。     

孕前体质指数与4种不良妊娠结局关系

目的探讨孕前体质指数(BMI)与4种不良妊娠结局(小于胎龄儿、大于胎龄儿、低出生体重儿、巨大儿)的关系。方法以2008年10月—2010年10月在安徽省8个地市的妇幼保健机构孕早期建卡并随访到分娩记录的12 355名孕妇为对象,采用χ2检验和非条件Logistic回归分析模型,分析孕前BMI与4种不良妊娠结局的关系。结果孕妇孕前BMI均数为(20.19±2.348)kg/m²,过低2 834人(22.9%),正常8 745人(70.8%),超重及肥胖776人(6.3%);调整年龄、户籍地、孕次等混杂因素后,对孕前BMI与胎龄儿组和体重儿组分别进行关联性分析,结果显示,孕前BMI过低是发生小于胎龄儿的危险因素(OR=1.320,95%CI=1.068～1.631);孕前超重及肥胖是发生大于胎龄儿和巨大儿的危险因素(OR=1.758,95%CI=1.503～2.056;OR=1.870,95%CI=1.540～2.271)。结论孕前BMI过低或者过高均会影响妊娠结局。     

孕期抑郁与早产的关系研究

目的探讨孕期抑郁是否增加早产、低出生体质量儿及小于胎龄儿等不良妊娠结局的风险,为孕期抑郁孕妇潜在的危险因素加以有效的干预提供参考。方法采用前瞻性队列研究设计,在深圳市南山区妇幼保健院招募单胎孕妇共1 377例进入统计分析。于孕中期(孕13～28周)使用爱丁堡产后抑郁筛查量表(EPDS)进行孕期抑郁症状的评估,评分≥12分作为孕期抑郁的诊断标准。通过深圳市妇幼保健系统查询并导出孕妇妊娠结局及相关人口学指标,运用多因素Logistic回归分析孕期抑郁与早产、低出生体质量等不良妊娠结局的关系。结果孕期抑郁的检出率为19.0%,正常组和孕期抑郁组的EPDS得分分别为6.5±2.9和13.8±2.0,差异有统计学意义(P0.05)。年龄≥35岁和户籍类型为深圳户籍的孕妇发生孕期抑郁的比例较低。在校正了孕妇年龄、教育程度、户籍类型、孕前体质指数(BMI)、二手烟、产次及胎儿性别等混杂因素后,孕期抑郁可显著增加早产的发生风险(OR=1.97; 95%CI:1.07～3.63),但与低出生体质量的关联在校正混杂因素后不再显著(OR=1.99; 95%CI:0.68～5.80)。本研究未发现孕期抑郁与小于胎龄儿、大于胎龄儿及巨大儿等有相关关系。分层分析中孕期抑郁与早产的关联在年龄35岁、非深圳户籍及胎儿性别为男性的孕妇中更为显著。结论孕期抑郁显著增加早产的发生风险,这一不利影响在年龄35岁、非深圳户籍及胎儿性别为男性的孕妇群体中更为明显。     

儿童1岁内体重指数加速生长的回顾性队列研究

目的 了解儿童1岁内体重指数加速生长的影响因素,为确定出生胎龄和出生体重对儿童加速生长是否存在交互作用提供参考依据。方法 采用回顾性队列研究,以中山市电子妇幼保健系统中2011年1月-2013年5月出生,并完成1岁内常规儿童保健的786名儿童为研究对象,采用单因素和多因素Logistic回归分析,对体重指数加速生长的影响因素进行分析。结果 1)多因素回归分析显示,出生胎龄、出生体重及母亲学历是儿童1岁内体重指数发生加速生长的影响因素。相对于足月儿,早产儿(Adjusted OR=19.88,95%CI:10.24~38.59)易于发生加速生长;相对于适于胎龄儿,小于胎龄儿(Adjusted OR=4.59,95%CI:2.56~8.23)易于发生加速生长,而大于胎龄儿(Adjusted OR=0.29,95%CI:0.12~0.69)不易发生加速生长;与母亲学历初中及以下比,母亲学历为本科及以上(Adjusted OR=0.38,95%CI:0.18~0.78)的儿童不易发生加速生长。2)交互作用分析显示,出生胎龄和出生体重对婴儿1岁内体重指数加速生长无交互作用(P＞0.05)。结论 早产和小于胎龄儿是影响婴儿1岁内体重指数发生加速生长的独立危险因素,母亲高学历为保护因素。     

孕期妇女血脂水平对子代小于胎龄儿影响的前瞻性研究

目的 通过前瞻性队列研究探讨孕期妇女血脂水平对子代小于胎龄儿的影响。方法 纳入成都市某医院单胎健康孕妇开展前瞻性随访,通过问卷调查于纳入时收集孕妇基本信息。采用血脂标准检测方法分别在孕早、中、晚期测定血清甘油三酯(TG)、总胆固醇(TC)、低密度脂蛋白胆固醇(LDL-C)及高密度脂蛋白胆固醇(HDL-C)水平,根据四分位数法将血脂水平由低到高分为四组(Q1～Q4)。通过医院信息系统收集子代出生体重,计算小于胎龄儿(SGA)发生率。采用多因素非条件logistic回归模型分析孕妇血脂水平对子代小于胎龄儿的影响。结果 最终纳入1 068例有效样本,SGA发生率为8.1%。孕妇孕早、中、晚期平均血脂水平(mmol/L)分别为：TG 1.32±0.50、2.42±0.97、3.52±1.47,TC 4.14±0.66、5.57±0.94、6.31±1.15,LDL-C 2.04±0.52、3.20±0.85、3.58±1.08,HDL-C 1.67±0.35、1.66±0.31、1.52±0.29。孕晚期TG Q3、Q4组SGA发生风险均较Q1组降低(Q3:OR=0.445,95%CI:0.2...     

Medical termination of pregnancy during the second versus the first trimester and its effects on subsequent pregnancy

Objective

The objective was to compare the risks of preterm birth, low birth weight, small for gestational age (SGA) infants and placental complications in subsequent pregnancy after second vs. first trimester medical termination of pregnancy (MTOP) in primigravid women.

Study Design

A total of 88,522 women who underwent termination of pregnancy during 2000–2009 were identified using Finnish health registers. Of them, primigravid women who underwent MTOP and had subsequent pregnancy ending in live birth up to the end of 2009 (n= 3843) were included in the study. The incidences and risks of preterm birth, low birth weight, SGA infants and placental complications after first- (n= 3427) vs. second-trimester MTOP (n= 416) were compared.

Results

Differences between the study groups in the incidences of preterm birth (3.9% in both groups), low birth weight (3.9% in the second- vs. 3.2% in the first-trimester group), SGA infants (2.4% vs. 2.5%) and placental complications (1.9% vs. 2.6%) were statistically insignificant. Second-trimester MTOP was associated with similar risks of preterm birth, low birth weight, SGA infants and placental complications compared with first-trimester MTOP after adjustment for background characteristics. After second-trimester MTOP, 51.2% of women underwent surgical evacuation, and 4.3% were diagnosed with infection. The differences in the risks of preterm birth, low birth weight, SGA infants and placental complications were statistically insignificant between women with vs. without these complications following second-trimester MTOP.

Conclusions

Second-trimester MTOP among primigravid women did not increase the risks of preterm birth, low birth weight, SGA infants or placental complications in subsequent pregnancy compared with first-trimester MTOP.

Implications

The present study suggests that medical termination of pregnancy in primigravid women during second vs. first trimester does not increase the risks of adverse outcomes in subsequent pregnancy and delivery. The data are of value when counseling women undergoing second-trimester TOP.     

妊高征与小于胎龄儿的相关性研究

目的:探讨妊高征与小于胎龄儿(SGA)之间的联系。方法:选取2000年1月~2004年10月在本院出生的单胎活产SGA病例共834例(男443例,女391例)作为病例组。以胎儿性别及出生孕周进行频数匹配,按1∶3的比例,采用完全随机抽样方法选取出生体重在10%~90%分位的适于胎龄儿2 502例(男1 329例,女1 173例)为对照组,比较病例组及对照组新生儿母亲孕期患妊高征的比例。结果:①病例组母亲患轻度、中度及重度妊高征比例分别是对照组的2.52(95%C I,1.35~4.69)、4.21(2.03~8.70)和5.15(3.10~8.54)倍;②分层分析表明,男性及女性病例组母亲妊高征的患病比例分别是对照组的4.45(2.72~7.27)和3.51(2.14~5.75)倍,男性及女性病例组母亲妊高征的患病优势比无显著差异,早产和足月病例组母亲患妊高征的比例分别为对照组的9.96(4.50~22.02)和3.21(2.15~4.78)倍,早产病例组母亲妊高征的患病优势比显著高于足月病例组;③校正性别、足月与否及母亲年龄的多因素分析结果与单因素分析结果类似。结论:妊高征可显著增加SGA发病的危险性。     

职业接触粉尘及吸烟对死亡影响的前瞻性队列研究

目的 研究接尘和吸烟对死亡的影响。方法 以1989－1992年广州实施并建立的职工职业健康监护档案为基础资料，选年龄≥30岁的接尘工人和无任何粉尘及其他有害物质接触的职工（对照组）61648名为研究对象，进行前瞻性队列研究。结果 （1）队列失访28例，死亡1186例，以恶性肿瘤死亡为主；（2）本队列男性多于女性，年龄35－44岁，主要为工人，中学文化，已婚，率42．2％，饮酒率32．8％；（3）调整相应混杂因素后，全死因、恶性肿瘤和呼吸系疾病死亡接尘者相对危险度（RR）分别为1．24、1．34和1．96，与对照组比较，差异均有显著性（P＜0．01），吸烟者RR分别为1．16、1．37和1．63，与不吸烟者比，前二者差异有显著性（P＜0．01）；既接尘又吸烟者上述相应死因死亡1RR分别为1．48、1．85和3．12，明显高于单纯接尘或单纯吸烟者，差异有显著性（P＜0．01）；（4）接尘对死亡的影响主要表现在职业接触矽尘和木尘。结论 接尘与吸烟均可致死亡危险性增加，并存在协同作用。     

Maternal social capital and birth outcomes in the mother-child cohort in Crete, Greece (Rhea study)

This cohort study aimed to estimate the effect of individual maternal social capital during pregnancy on birth outcomes in the context of the Mother-child cohort (Rhea study), in Crete-Greece. Women were recruited from four prenatal clinics in Heraklion-Crete for one year beginning in February 2007. 610 women completed the self-administered Social Capital Questionnaire at about the 24th week of gestation. The scale assessed total maternal social capital and four social capital subscales: Participation in the Community, Feelings of Safety, Value of Life and Social Agency, and Tolerance of Diversity. Potential confounders included characteristics that have an established or potential association with the maternal social capital, and the birth outcomes (preterm birth, small weight for the gestational age, fetal weight growth restriction, weight, length and head circumference). The results of logistic and linear regression models indicated that there was an increase in the risk of preterm birth for every unit increase in maternal participation (range 12-48), and especially in the risk of medically indicated preterm birth. Although the findings suggest that participation is associated with an increased probability for preterm birth, we cannot know whether this is a protective or damaging social capital effect. Women who participate more in their communities may have enhanced access to information and/or resources, easier access to health care and support when they face maternal and fetal conditions that trigger the need for medical intervention. On the other hand, women may be more exposed to social and/or environmental stressors. Future research needs to distinguish between different types of participation and different components of social capital to better understand their associations with birth outcomes.     

血脂与高血压关系的前瞻性研究

目的 探讨基线血压正常者在随访期间发展为高血压的危险与基线时不同血脂变量水平的关系.方法 2000年4月建立年龄为34～74岁共8685人的研究队列,取得基线数据.2006年6月开始对其中基线调查满5年的对象进行随访;对进入随访、符合纳入标准且资料完整的2603名基线血压正常者在中位数随访6.38年期间发展为高血压的危险与基线不同血脂变量水平的关系进行分析.结果 基线血脂水平与随访期间高血压发生率之间有一定的联系,调整性别、年龄模型中,各血脂指标变量均与高血压有联系(趋势检验P<0.01);多变量调整模型中,HDL-C[αRR=0.71(95%CI:0.61～0.99)]、非HDL-C[αRR=1.28(95%CI:1.14～1.83)]、TC/HDL-C的比值[αRR=1.41(95%CI:1.25～2.03)]和TG[αRR=1.49(95%CI:1.30～2.13)]仍与高血压有联系(趋势检验P<0.05);进一步调整BMI后,减弱了各血脂指标变量与高血压联系的aRR,但aRR仍有统计学意义;用Cox模型调整基线SBP、DBP后各血脂指标变量与高血压关系的αRR有所降低,但HDL-C、TC/HDL-C比值、TG与高血压发病率仍有显著的联系.当剔除肥胖患者(BMl≥28)和已经诊断为糖尿病的这2个与高血压明显相关的危险因子后HDL-C(趋势检验P=0.01)、TG(趋势检验P<0.05)、非HDL-C(趋势检验P<0.05)和TC/HDL-C的比值(趋势检验P<0.05)仍然与高血压有联系.结论 血脂异常可能发生在高血压之前,即使排除了肥胖和糖尿病患者,或者调整了吸烟、饮酒甚至是基线SBP、DBP水平后,HDL-C、TC/HDL-C和TG仍与高血压有联系.     

Association of influenza vaccination during pregnancy with birth outcomes in Nicaragua

Background: Studies have shown that influenza vaccination during pregnancy reduces the risk of influenza disease in pregnant women and their offspring. Some have proposed that maternal vaccination may also have beneficial effects on birth outcomes. In 2014, we conducted an observational study to test this hypothesis using data from two large hospitals in Managua, Nicaragua.Methods: We conducted a retrospective cohort study to evaluate associations between influenza vaccination and birth outcomes. We carried out interviews and reviewed medical records post-partum to collect data on demographics, influenza vaccination during pregnancy, birth outcomes and other risk factors associated with adverse neonatal outcomes. We used influenza surveillance data to adjust for timing of influenza circulation. We assessed self-reports of influenza vaccination status by further reviewing medical records of those who self-reported but did not have readily available evidence of vaccination status. We performed multiple logistic regression (MLR) and propensity score matching (PSM).Results: A total of 3268 women were included in the final analysis. Of these, 55% had received influenza vaccination in 2014. Overall, we did not observe statistically significant associations between influenza vaccination and birth outcomes after adjusting for risk factors, with either MLR or PSM. With PSM, after adjusting for risk factors, we observed protective associations between influenza vaccination in the second and third trimester and preterm birth (aOR: 0.87; 95% confidence interval (CI): 0.75–0.99 and aOR: 0.66; 95% CI: 0.45–0.96, respectively) and between influenza vaccination in the second trimester and low birth weight (aOR: 0.80; 95% CI: 0.64–0.97).Conclusions: We found evidence to support an association between influenza vaccination and birth outcomes by trimester of receipt with data from an urban population in Nicaragua. The study had significant selection and recall biases. Prospective studies are needed to minimize these biases.     

接尘、吸烟者死亡危险度比较的前瞻性队列研究

目的 比较接尘、吸烟对死亡的影响。方法 以1989～1992年广州市实施并建立的职工职业健康监护档案为基础资料，选年龄≥30岁的80987名接尘和无接尘职工为研究对象，进行前瞻性队列研究。结果 (1)队列平均43．5岁，主要为工人、中学文化程度、已婚，接尘率16．3％，吸烟率43．7％，饮酒率335%。(2)队列平均随访8年，失访35人，死亡1539人，以恶性肿瘤死亡为主。(3)调整相关混杂因素后，全死因、恶性肿瘤、心脑血管疾病等死亡相对危险度(RR)，接尘者和吸烟者基本一致，但鼻咽癌、呼吸系统疾病死亡RR值，接尘者高于吸烟者，而肺癌、胃癌死亡RR值，吸烟者分别是接尘者的2．2倍和1．5倍；接尘可协同吸烟致死亡危险性明显增加。(4)男性总死因、恶性肿瘤和呼吸系统疾病死亡RR值，矽尘接触者高于吸烟者，心脑血管疾病死亡RR值，木尘接触者也高于吸烟者。(5)人群死亡归因危险度百分比(PARP)吸烟者是接尘者的2．5倍。(6)男吸烟者全死因、恶性肿瘤、肺癌、胃癌的死亡危险随日吸烟量、烟龄的增加而明显递增，冠心病、呼吸系统疾病的死亡危险则分别随日吸烟量、烟龄的增加而增加。结论 接尘、吸烟者死亡RR值基本一致，接尘与吸烟存在协同作用，某些死因死亡危险吸烟者较明显，某些接尘者较明显；吸烟者PARP较接尘者高；吸烟与死亡危险存在明显的剂量效应关系。     

职业健康监护评价与死亡相关的队列研究

目的 探讨广州市职业健康监护评价结果与死亡的相关性。方法 利用１９８９～１９９２年广州市实施职业健康监护（ＯＨＳ）系统中建立的３９９家工厂中≥３５岁的７８７８５名职工的个体健康档案为基础资料,皖前瞻性队列研究方法,随访至１９９８年１２月３１日,了解队列中职工的生存状态和死亡情况,并进行χ＾２检验和Ｃｏｘ模型分析。结果 （１）队列中７８７８５名职工随访８年,共６２７６３５人年（男性３８９２４０人年）,总死亡人数为１５２５人,总死亡率为２４０．０／１０万人年（男３３０．４／１０万人年、女１００．３／１０万人年）。（２）队列中男女职工有职业接触史者分别为４６．１％和３４．４％,建档时有吸烟史男女职工分别占７０．３％和１．５％。（３）无论男性或女性,总死亡率与ＯＨＳ评价结果均有明显相关,调整年龄、文化程度、吸烟与职业接     

Impact of maternal characteristics on the effect of maternal influenza vaccination on fetal outcomes

Background

Maternal infections during pregnancy have been associated with adverse fetal and infant health outcomes, and vaccination against influenza is the most effective tool to prevent morbidity and mortality due to seasonal and pandemic influenza. We evaluated the association between receipt of the inactivated seasonal influenza vaccine on preterm and small for gestational age (SGA) births, with the aim to assess racial and socioeconomic variations in vaccine effect.

Methods

We conducted a retrospective analysis of state-wide surveillance data from Georgia for the most recent four years available at the beginning of the study, a total of 8393 live births in Georgia from January 1, 2005 through December 31, 2008. We constructed multivariable logistic regression models and calculated odds ratios (OR) estimates with corresponding 95% confidence intervals (CI) to evaluate the effect of maternal influenza vaccination on SGA (birth weight <10th percentile for gestational age) and preterm (gestational age at birth <37 weeks) births while controlling for potential confounders.

Results

Among all women, we found significant strong associations between maternal influenza vaccination and reduced odds of a preterm birth during the widespread influenza activity period [OR = 0.39, 95% CI: 0.18, 0.83]. In this period, vaccination was protective against SGA births among women at higher risk for influenza related morbidity – women enrolled in the Women, Infant and Child (WIC) program [OR = 0.20, 95% CI: 0.04, 0.98] and Black women [OR = 0.15 95% CI: 0.02, 0.94]; maternal influenza vaccination was associated with reduced odds of a preterm birth among white women [OR = 0.34, 95% CI: 0.12, 0.91] and women of higher socio-economic status [OR = 0.30, 95% CI: 0.12, 0.74].

Conclusion

Influenza vaccination during pregnancy was significantly associated with reduced odds of small for gestational age and preterm births during the widespread influenza activity period. Vaccination effects varied by socio-demographic characteristics.