高海拔地区藏族育龄妇女自然流产的流行病学特点

目的 了解中国高海拔地区15～49岁藏族育龄妇女自然流产状况。方法 采用横断面调查设计和分层多阶段抽样法获得样本，采用问卷调查西藏地区15～49岁藏族育龄妇女的生育史。结果 共调查3741名15～49岁的藏族育龄妇女，共计10245次妊娠，报告的自然流产386次，自然流产发生率为3墙％，城市妇女显著高于农村妇女，农牧区之间差异无统计学意义，育龄妇女发生自然流产的风险在控制了可能的影响因素后随着海拔高度的增加而增高。居住在海拔4500m以上的育龄妇女发生自然流产的风险是居住在海拔3500m以下妇女的近2倍多。年龄和妊娠的次数显著与自然流产的发生有正相关关系，35岁以上的育龄妇女和多次妊娠的妇女发生自然流产的风险增大。结论 高海拔可能独立的影响藏族妇女自然流产的发生，在高海拔地区更应加强健康教育和育龄妇女孕产期保健与营养，减少妊娠次数，延长生育间隔，以减少自然流产的发生。此外，回顾性的生育史调查可能会因回忆偏性等因素而低估了自然流产的发生，但西藏地区育龄妇女的自然流产水平不一定比平原地区高很多。

Epidemiological f eatures of spontaneous abortion among reproductive Tibetan women living at high altitudes areas

OBJECTIVE: To study the status of spontaneous abortion among reproductive Tibetan women aged 15 - 49 years. METHODS: A cross-sectional survey was conducted on reproductive history of Tibetan women and the sample was chosen under the stratified multistage cluster random sampling technique. RESULTS: A total number of 3741 women were studied with a total number of 10,245 pregnancies. There were 386 spontaneous abortions reported with an incidence rate of 3.9%. Women living in the urban area had a higher rate than living in the rural areas. Women living in area where altitudes were above 4500 m, had a 2-time risk of having spontaneous abortion than those living in areas below 3500 m. The risk of having spontaneous abortion increased among women aged > or = 35 and those with more than 3 pregnancies. CONCLUSIONS: High altitude could contribute to the increase of spontaneous abortions incidence, suggesting that improvement of maternal care and nutrition and reduction of the frequency of pregnancy had important roles to play in reducing the incidence of spontaneous abortion among Tibetan women. Despite the fact that retrospective study on reproductive history could underestimate the incidence of spontaneous abortion, the incidence rate among Tibetan women might not be much higher than women living in the lowland areas.