孕期增重与早产关联的流行病学分析

妊娠期孕妇的睡眠模式发生明显改变,睡眠时间异常、睡眠质量差等问题尤为突出。不健康的睡眠模式增加了不良妊娠结局的发生风险,早产作为最常见的不良妊娠结局,是导致新生儿患病和死亡的最主要原因。笔者通过文献复习,对孕妇睡眠现状进行简述,同时从睡眠时间和睡眠质量2个方面概述睡眠与早产之间的关系。在未来研究中,应加强对孕妇睡眠情况的关注,制定有效的干预措施,指导孕妇进行健康睡眠。     

兰州地区早产影响因素的研究

目的 探讨早产、自发性早产和医源性早产的相关高危因素.方法 回顾性调查2010年1月至2012年12月在甘肃省妇幼保健院住院分娩足月儿和早产儿的孕妇的住院资料,分娩足月活产儿5639例、早产儿540例,分为足月产组(≥37周孕龄)和早产组(<37周孕龄),比较早产组和足月产组发生早产的相关危险因素,以及自发性早产和医源性早产的相关高危因素.结果 ①Logistic回归分析发现教育年限(≥16年)(OR=0.61,95%CI:0.48~0.78)、家庭平均月收入(>3000元)(OR=0.62,95%CI:0.50~0.78)是早产发生的保护因素,而母亲妊娠合并症,比如妊娠期糖尿病(GDM)(OR=3.97,95%CI:1.70~9.25)、妊娠期高血压疾病(HDP)(OR=4.43,95%CI:3.35~5.87)、妊娠期胆汁淤积症(ICP)(OR=4.88,95%CI:3.25~7.32)是早产发生的独立高危因素.②按早产的病因分类,本研究中340例为自发性早产儿,余200例为医源性早产.经分层多因素非条件Logistic回归分析表明,与足月产相比,经产妇(OR=2.66,95%CI:1.87~3.76)、GDM(OR=4.52,95%CI:1.42~14.38),尤其是HDP孕妇(OR=14.19,95%CI:10.10~19.93)更易发生医源性早产,而ICP孕妇更多出现自发性流产(OR=12.875,95%CI:12.75~13.00).结论 应及早识别早产潜在的高危因素,加强围生期管理,以减少早产的发生,改善围生儿结局.     

妊娠期肝内胆汁淤积症对早产发生率的影响

目的 探讨妊娠期肝内胆汁淤积症（ICP）对早产发生率的影响。方法 采用前瞻性队列研究,以2014年1月1日至2015年3月31日安庆市立医院所有住院分娩的单胎活产孕妇为研究对象。通过调查问卷和医院电子病历系统,收集孕妇人口学信息等资料,采用单因素和多因素统计方法分析ICP对早产发生率的影响。结果 2 758例孕妇ICP发生率为7.25%,早产发生率为16.28%。ICP增加早产和医源性早产的风险,分别为RR=2.33,95% CI：1.67~3.25和RR=8.46,95% CI：5.45~13.12,但对自发性早产的发生无影响（RR=0.94,95% CI：0.57~1.54）。结论 ICP增加医源性早产的发生风险,与自发性早产的发生无明显相关。     

Alteration in vaginal microflora,douching prior to pregnancy,and preterm birth

We aimed to determine the relationship of douching prior to pregnancy and bacterial vaginosis (BV) during pregnancy on preterm birth, addressing individual and joint effects. We used a prospective cohort study and assessed vaginal microflora using gram stains and Nugent's criteria. Douching behaviour was based on self‐report about the 12 months prior to pregnancy. Preterm births were categorised as spontaneous or medically indicated. A total of 2561 women provided vaginal specimens and 1492 provided self‐reports on douching behaviour. Bacterial vaginosis assessed at 24–28 weeks' gestation in the absence of douching prior to pregnancy was associated with spontaneous preterm birth (odds ratio = 2.74 [95% confidence interval 1.13, 6.66]) as was douching in the absence of BV (OR = 2.20 [1.29, 3.75]). The combination of BV and douching was unrelated to spontaneous or medically indicated preterm birth. We concluded that acute alterations in vaginal microflora at mid‐pregnancy or douching prior to pregnancy were associated with an increased risk of preterm birth, but the combination did not appear to increase the risk further than would be expected.     

北京市通州区单胎孕妇2013-2017年早产发生情况及危险因素研究

目的 了解北京市通州区2013-2017年单胎妊娠孕妇的早产发生情况及影响因素,为降低早产的发生提供科学依据。方法 采用回顾性队列研究的方法,通过医院电子信息系统获得2013-2017年单胎孕妇的社会人口学资料、孕产史及本次妊娠情况,分析早产发生率以及不同因素对早产发生率的影响,采用多因素Logistic回归分析早产的危险因素。结果 2013-2017年通州区单胎孕妇的早产发生率为4.1%(1 418/34 726)。其中,自发性早产和治疗性早产分别占68.8%(975/1 418)和31.2%(443/1 418)。产妇年龄≥35岁(OR=1.314,95%CI:1.113～1.551)、经产妇(OR=1.399,95%CI:1.223～1.600)、男胎(OR=1.237,95%CI:1.100～1.390)、前置胎盘(OR=10.162,95%CI:7.100～14.546)、胎盘早剥(OR=9.201,95%CI:6.596～12.837)、胎膜早破(OR=3.328,95%CI:2.953～3.750)、妊娠期糖尿病(OR=1.232,95%CI:1.082～1.403)、妊娠期高血压疾病(OR=3.283,95%CI:2.755～3.911)是早产的危险因素。其中,产妇失业或待业(OR=1.159,95%CI:1.003~1.339)、丈夫年龄≥35岁(OR=1.243,95%CI:1.036~1.490)、初次妊娠(OR=1.407,95%CI:1.157~1.710)、经产妇(OR=1.295,95%CI:1.049~1.598)、男胎(OR=1.273,95%CI:1.109~1.462)是自发性早产的危险因素。结论 对于年龄≥35岁,经产妇,男胎、前置胎盘、胎盘早剥、胎膜早破、妊娠期糖尿病及高血压疾病的孕妇,应及早采取预防措施以降低早产发生率。     

孕期大气细颗粒物PM2.5暴露及对早产的影响研究

目的 探讨空气中粒径≤2.5μm的颗粒物(PM_2.5)对早产的影响情况。方法 以受孕日期在2013年1月1日至12月31日之间、山西医科大学第一医院妇产科分娩的太原市区1882例产妇作为研究对象。按照WHO对早产的定义,将研究对象分为早产组和足月产组,关联性分析时再将早产组分为轻度早产组、早期早产和极早早产组。收集其一般人口学特征资料、健康状况、分娩情况、家庭准确住址等资料;收集太原市8个监测点2013年1月1日至2014年10月10日PM_2.5日平均浓度,根据反距离加权法计算孕妇孕期每天PM_2.5暴露浓度,通过多因素非条件logistic回归模型分析PM_2.5对早产的影响情况。结果 1839例产妇的早产发生率为8.21%(151/1839)。调整孕妇年龄、孕妇文化程度、孕前BMI等因素后结果显示,在分娩前第2周PM_2.5浓度暴露值每增加10μg/m³,早产风险增加8.7%(OR=1.087,95%CI:1.001~1.182),轻度早产风险增加9.9%(OR=1.099,95%CI:1.007~1.200)。分娩前第2周孕妇处于PM_2.5高水平环境(≥75μg/m³)中,早产风险增加0.8%(OR=1.008,95%CI:1.000~1.017),轻度早产风险增加1.0%(OR=1.010,95%CI:1.001~1.018)。结论 孕妇在孕晚期尤其是在分娩前半个月,PM_2.5高浓度暴露会导致早产风险增加。     

Institutional racism,neighborhood factors,stress, and preterm birth

Objective. Racial/ethnic disparities in the risk of preterm birth may be explained by various factors, and previous studies are limited in examining the role of institutional racism. This study focused on the following questions: what is the association between preterm birth and institutional racism as measured by residential racial segregation (geographic separation by race) and redlining (black–white disparity in mortgage loan denial); and what is the association between preterm birth and reported stress, discrimination, and neighborhood quality.

Design. We used data from a clinic-based sample of pregnant women (n = 3462) participating in a stress and pregnancy study conducted from 1999 to 2004 in Philadelphia, PA (USA). We linked data from the 2000 US Census and Home Mortgage Disclosure Act (HMDA) data from 1999 to 2004 and developed measures of residential redlining and segregation.

Results. Among the entire population, there was an increased risk for preterm birth among women who were older, unmarried, tobacco users, higher number of previous births, high levels of experiences of everyday discrimination, owned their homes, lived in nonredlined areas, and areas with high levels of segregation measured by the isolation index. Among black women, living in a redlined area (where blacks were more likely to be denied mortgage loans compared to whites) was moderately associated with a decreased risk of preterm birth (aRR = 0.8, 95% CI: 0.6, 0.99).

Conclusion. Residential redlining as a form institutional racism and neighborhood characteristic may be important for understanding racial/ethnic disparities in pregnancy and preterm birth.     

孕期多环芳烃暴露对早产影响的研究进展

多环芳烃（PAH）是广泛存在于环境中的有毒污染物,可以通过呼吸道、消化道等多种方式进入人体。孕妇和新生儿是重要的敏感人群,相关的研究证据表明孕期PAH暴露可能是早产发生的重要原因,但具体的作用机制不是十分明确,可能与DNA损伤、氧化应激、全身炎症反应、内分泌干扰等有关。本文就孕期PAH暴露的影响因素和评价方法、孕期PAH暴露可增加早产的发生风险和可能的作用机制进行了综述。     

Modelling sequence of prior pregnancies on subsequent risk of very preterm birth

Watson LF, Rayner J‐A, King J, Jolley D, Forster D, Lumley J. Modelling sequence of prior pregnancies on subsequent risk of very preterm birth. Paediatric and Perinatal Epidemiology 2010. The prevalence and intractability of preterm birth is known as is its association with reproductive history, but the relationship with sequence of pregnancies is not well studied. The data were from a population‐based case–control study, conducted in Victoria, Australia. The study recruited women giving birth between April 2002 and April 2004 from 73 maternity hospitals. Detailed reproductive histories were collected by interview a few weeks after the birth. The cases were 603 women having a singleton birth between 20 and <32 weeks gestation (very preterm births including terminations of pregnancy). The controls were 796 randomly selected women from the population having a singleton birth of at least 37 completed weeks gestation. Unconditional logistic regression was used to assess the association of very preterm birth with sequence of pregnancies defined by their outcome (prior abortion – spontaneous or induced, and prior preterm or term birth) with adjustment for sociodemographic factors. The outcomes of each prior pregnancy, stratified by pregnancy order, and starting with the pregnancy immediately before the index or control pregnancy, were categorised as one of abortion, preterm birth or term birth. We showed that each of these prior pregnancy events was an independent risk of very preterm birth. This finding does not support the hypothesis of a neutralising effect of a term birth after an abortion on the subsequent risk for very preterm birth and is further evidence for the cumulative or increasing risk associated with increasing numbers of prior abortions or preterm births.     

孕前及孕期细颗粒物PM2.5对早产效应的因素分析

目的 分析细颗粒物PM2.5暴露与早产的相关性.方法 以河源市全市范围内2014年12月1日至2015年11月30日分娩的单胎活产儿和2013年12月1日至2015年11月30日河源市的细颗粒物PM2.5逐日浓度为研究对象.考虑到孕期的空气污染暴露是一个慢性的、累积的过程,并且每个产妇的孕程不同,首先以新生儿出生时的孕周为起点向后计算,将暴露时间分为4个阶段:孕前3个月,孕早期(1~13周末)、孕中期(14~27周末)和分娩前4周,分别计算PM2.5早产效应的组间差异.以某日为起点向后求和12个月的逐日暴露量作为该日分娩孕妇过去1年的PM2.5暴露总量,建立该日过去1年PM2.5累积暴露量在当日及滞后1~10d内早产例数的回归模型,并计算相对危险度.结果 河源市单胎活产儿的早产发生率为4.25%.逐日PM2.5浓度波动区间为7~108μg/m3,均值37.88μg·(m3)-1·d-1.研究对象孕前3个月、孕早期、孕中期的PM2.5合计暴露水平区间为12470~14960μg/m3,平均值为13700μg/m3.孕前3个月、孕早期、孕中期的PM2.5暴露水平在早产组与足月组间的差异无统计学意义(t值分别为2.199、2.343、0.947,均P>0.05),早产组与足月组间的PM2.5暴露水平在孕晚期的差异有统计学意义(t=4.818,P<0.05).以PM2.5累积暴露量下四分位数及其早产例数为参照(即RR=1),暴露于PM2.5累积量中位数,在滞后的10日内有意义的效应表现在滞后的第8、9、10日,RR值分别为1.49(1.01~2.21)、1.63(1.01~2.63)、1.06(1.01~1.11);暴露于PM2.5累积量中位数在滞后的10日内有意义的效应表现在滞后的第8、9、10日,RR值分别为2.05(1.02~4.15)、2.41(1.02~5.70)、1.11(1.03~1.21),累积暴露量的变化幅度与其对早产的效应呈正比,累积暴露量升高越大,在滞后期内对早产的影响也越大.结论 河源市孕期PM2.5暴露与早产有关,PM2.5暴露对早产存在非线性的滞后影响.     

早产低出生体重儿婴儿期追赶生长情况分析

目的 分析早产低出生体重儿1岁以内的追赶生长特点,研究其追赶生长规律。方法 按照纳入和剔除标准,选择2013年1月-2016年12月在本院儿童保健门诊体检的252名早产低出生体重儿为研究对象。根据1岁时体重、身长Z评分与出生时Z评分之差(△Z)的大小,△Z>0.67定义为婴儿期出现追赶生长;并分析比较不同性别之间追赶生长的差异。结果 纳入252名早产低出生体重儿,其中男婴118名(46.8%),女婴134名(53.2%);早产低出生体重儿婴儿期体重(kg)增长(Z评分为1.41±0.83)、身长(cm)增长(Z评分为0.82±0.76);80.5%在婴儿期出现体重追赶生长,62.7%出现身长追赶生长;不同性别之间的体重和身长的追赶生长情况比较,差异无统计学意义(χ²=1.583、1.082,P>0.05);适于胎龄儿体重追赶生长较小于胎龄儿和大于胎龄儿比例高(χ²=8.552,P=0.014)。结论 大部分早产低出生体重儿在第一年出现追赶生长,积极的营养支持策略和生长发育监测,对早产低出生体重儿的生长发育至关重要。     

妊娠期糖尿病与早产亚型之间的关联研究

目的 探讨妊娠期糖尿病（GDM）与早产亚型之间的关联。方法 招募孕早、中期在安徽省安庆市立医院产前筛查的孕妇,进行基线调查和生物标本采集,随访孕妇至分娩或妊娠终止,通过医院电子病历系统、问卷调查等获取孕妇孕期情况、妊娠结局等信息,建设孕妇队列。采用log-binomial回归模型探讨GDM与早产［医源性早产和自发性早产（未足月胎膜早破和早产临产）］之间的关联;对于多个混杂因素,采用倾向性评分校正法构建模型计算调整后的关联。结果 在2 031例分娩单胎的孕妇中,GDM和早产的发生比例分别为10.0%（204例）和4.4%（90例）;其中,GDM组（n=204）孕妇发生医源性早产和自发性早产的比例分别为1.5%和5.9%,非GDM组（n=1 827）孕妇发生医源性早产、自发性早产的比例分别为0.9%和3.2%,两组自发性早产的比例差异有统计学意义（P=0.048）。进一步细化自发性早产亚型,结果显示GDM组发生未足月胎膜早破、早产临产的比例分别为4.9%和1.0%,非GDM组发生未足月胎膜早破、早产临产的比例分别为2.1%和1.1%。GDM孕妇发生未足月胎膜早破的风险是非GDM孕妇的2.34倍（aRR=2.34,95%CI：1.16~4.69）。结论 GDM可能增加未足月胎膜早破的发生风险,未发现GDM孕妇早产临产发生比例显著增加。     

兰州市低出生体重儿妊娠期危险因素的病例对照研究

目的:了解甘肃省兰州市低出生体重儿妊娠期的危险因素。方法:采取整群抽样的方法获取研究对象,以2010年6月～11月在兰州大学第一医院,兰州大学第二医院和甘肃省妇幼保健院29例低体重儿的产妇为病例组,以基线资料相同的41例分娩正常体重儿的产妇为对照组,采用病例对照研究方法对兰州市低出生体重儿妊娠期危险因素进行非条件Logistic多元逐步回归分析。结果:孕周小于37周(OR=22.162,P<0.05)、妊娠期每日餐数≤3次(OR=20.907,P<0.05)和妊娠期间较少摄入鸡蛋(OR=47.357,P<0.05)均是低出生体重儿发生的危险因素。结论:兰州市低出生体重儿妊娠期危险因素较多,预防早产和提高产妇孕期营养可能是减少低体重儿出生的有效手段。     

早产危险因素的Logistic回归及分类树分析

目的应用分类树模型和Logistic回归模型进行对比分析,探索北京地区早产发生的影响因素。方法对北京地区5家妇幼保健院的1323例早产进行1：1病例对照研究,应用分类树模型和Logistic回归模型分析早产的影响因素。结果Logistic回归模型显示均衡饮食（OR=0．509）、产前检查（OR=0．233）、常住址为城镇（OR=0．555）是早产的保护性因素,受教育程度低（OR=1．674）、负性生活事件（OR=6．086）、性生活（OR=1．704）、前置胎盘（OR=11．834）、妊娠期糖尿病（OR=3．170）、妊娠期高血压疾病（OR：5．024）、早产史（OR=17．574）和胎膜早破（OR=4．083）是早产的危险因素。利用卡方自动交互检测法建立的分类树模型,共筛选出5个早产高危因素,其中胎膜早破是最重要的影响因素,其他包括妊娠期高血压疾病、膳食结构不均衡、无产前检查、文化程度低。结论孕期应进行定期的产前检查可及早发现高危妊娠,避免各种不良刺激,保持良好心态,积极预防胎膜早破。Logistic回归模型可以提供变量影响的定量解释,分类树模型可以更好地展现变量间的复杂相互作用。二者结合可更好地服务于流行病学的研究。     

Modelling prior reproductive history to improve prediction of risk for very preterm birth

Watson LF, Rayner J‐A, King J, Jolley D, Forster D, Lumley J. Modelling prior reproductive history to improve prediction of risk for very preterm birth. Paediatric and Perinatal Epidemiology 2010. In published studies of preterm birth, analyses have usually been centred on individual reproductive events and do not account for the joint distributions of these events. In particular, spontaneous and induced abortions have often been studied separately and have been variously reported as having no increased risk, increased risk or different risks for subsequent preterm birth. In order to address this inconsistency, we categorised women into mutually exclusive groups according to their reproductive history, and explored the range of risks associated with different reproductive histories and assessed similarities of risks between different pregnancy histories. The data were from a population‐based case–control study, conducted in Victoria, Australia. The study recruited women giving birth between April 2002 and April 2004 from 73 maternity hospitals. Detailed reproductive histories were collected by interview a few weeks after the birth. The cases were 603 women who had had a singleton birth between 20 and less than 32 weeks gestation (very preterm births including terminations of pregnancy) and the controls were 796 randomly selected women from the population who had had a singleton birth of at least 37 completed weeks gestation. All birth outcomes were included. Unconditional logistic regression was used to assess the association of very preterm birth with type and number of prior abortions, prior preterm births and sociodemographic factors. Using the complex combinations of prior pregnancy experiences of women (including nulligravidity), we showed that a history of prior childbirth (at term) with no preterm births gave the lowest risk of very preterm birth. With this group as the reference category, odds ratios of more than two were associated with all other prior reproductive histories. There was no evidence of difference in risk between types of abortion (i.e. spontaneous or induced) although the risk increased if a prior preterm birth had also occurred. There was an increasing risk of very preterm birth associated with increasing numbers of abortions. This method of data analysis reveals consistent and similar risks for very preterm birth following spontaneous or induced abortions. The findings point to the need to explore commonalities rather than differences in regard to the impact of abortion on subsequent births.     

妊娠期贫血与早产

目的 分析妊娠期贫血及严重程度与早产的关系. 方法 对江苏和浙江省4个县市1995～2000年102 489名孕产妇孕期各个阶段贫血与非贫血及不同贫血程度早产的发生率进行分析;并采用Logistic回归控制年龄、文化程度、孕次、妊娠高血压疾病等因素的影响,估计孕期各阶段贫血严重程度与早产的关联程度. 结果 孕早期贫血组早产发生率高于孕早期非贫血组,孕晚期贫血组早产发生率低于孕晚期非贫血组,差异均有统计学意义(P<0.01),孕中期贫血组与孕中期非贫血组早产率比较,差异无统计学意义(P>0.01).孕早期随着贫血程度的增加,早产的风险逐渐升高,重度贫血孕妇早产风险是非贫血孕妇的5.4倍;孕中期非贫血组、轻度贫血组和中度贫血组早产发生率没有明显差别,重度贫血组早产发生率最高,与非贫血孕妇相比早产风险增加60%;孕晚期轻度贫血组早产发生率最低,重度贫血组早产发生率最高,与非贫血孕妇相比早产风险增加30%. 结论 孕早期轻度以上贫血,孕中、晚期重度贫血与早产风险增加有关;预防孕期贫血应从孕早期开始.     

Maternal psychological distress during pregnancy does not increase the risk for adverse birth outcomes

ABSTRACT

Maternal psychological distress during pregnancy is a potential risk factor for various birth complications. This study aimed to explore psychological factors associated with adverse birth outcomes. Symptoms of psychological distress, individual characteristics, and medical complications were assessed at two time points antenatally in 285 women from Australia and New Zealand; birth outcomes were assessed postpartum, between January 2014 and September 2015. Hierarchical multiple regression analyses were conducted to examine the relation of psychological distress to adverse birth outcomes. Medical complications during pregnancy, such as serious infections, placental problems and preeclampsia, and antenatal cannabis use, were the factors most strongly associated with adverse birth outcomes, accounting for 22 percent of the total variance (p < .001). Symptoms of depression and/or anxiety, low social support, and low sense of coherence were not associated with birth complications. In unadjusted analyses, self-reported diagnosis of anxiety disorder during pregnancy and an orientation toward a Regulator mothering style were associated with adverse birth outcomes; however, after controlling for medical complications, these were no longer associated. Our study results indicate that antenatal depressive and/or anxiety symptoms were not independently associated with adverse birth outcomes, a reassuring finding for women who are already psychologically vulnerable during pregnancy.