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.

Risk factors of preterm birth in Lanzhou area

Objective To explore the risk factors of preterm birth , spontaneous preterm birth and iatrogenic preterm birth .Methods A retrospective study was conducted on medical data of pregnant women with full term birth or preterm birth hospitalized in Gansu Maternal and Child Health Care Hospital from January 2010 to December 2012.There were 5639 full-term births and 540 preterm births, and they were divided into full term group (≥37 gestational age ) and preterm group ( <37 gestational age ) .Risk factors of preterm birth were compared between two groups , and relevant risk factors of spontaneous preterm birth and iatrogenic preterm birth were analyzed .Results Logistic regression analysis showed that education duration (≥16 years) (OR=0.61, 95%CI:0.48-0.78) and average family monthly income (>3000 yuan) (OR=0.62, 95%CI:0.50-0.78) were protective factors of preterm birth .However, pregnancy complications such as gestational diabetes mellitus (GDM) (OR=3.97, 95%CI:1.70-9.25), hypertensive disorders in pregnancy (HDP) (OR=4.43, 95%CI:3.35-5.87) and intrahepatic cholestasis of pregnancy (ICP) (OR=4.88, 95%CI:3.25-7.32) were independent high risk factors of preterm birth .There were 340 cases of spontaneous preterm birth and 200 cases of iatrogenic preterm births in this study divided by causes .Stratified multivariate unconditional logistic regression analysis revealed that compared with full term births , iatrogenic preterm delivery was more common among multipara (OR=2.66,95%CI:1.87-3.76), GDM (OR=4.52,95%CI:1.42-14.38) and especially HDP puerpera (OR =14.19,95%CI:10.10 -19.93) , and spontaneous preterm birth happened more frequently in ICP puerpera (OR=12.875, 95%CI:12.75 -13.00).Conclusion Potential risk factors of preterm birth should be identified earlier and perinatal management should be strengthened to reduce incidence of preterm birth and improve outcomes of perinatal infants .