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摘要:
目的 探索孕期环境因素和行为因素暴露与农村高出生体重（high birth weight，HBW）发生风险之间的关联。 方法 从2007-2012年期间山西省平定县出生人口及不良出生结局监测系统随访到204例对照、125例≥ 4 200 g HBW病例和171例4 000~4 200 g HBW病例。采用病例对照研究探索HBW风险因素。 结果 2007-2012年期间，总出生数为18 749人，高出生体重1 177例，发生率为6.28%。HBW<4 200 g组病例对照研究结果显示，调整了父母亲生育年龄、产次后，分娩孕周≥ 42孕周生育HBW的风险是<42孕周的3.10倍（95%CI：1.67~5.76），生育男孩发生HBW风险是生育女孩的2.30倍（95%CI：1.46~3.63），孕前BMI与HBW发生风险无统计学关联；HBW ≥ 4 200 g组病例对照研究结果显示，调整了母亲生育年龄、产次后，分娩孕周≥ 42孕周生育HBW的风险是<42孕周的3.01倍（95%CI：1.49~6.08），母亲孕前BMI ≥ 24生育HBW的风险是BMI<24者的1.91倍（95%CI：1.15~3.16），母亲孕期每周食用豆制品次数为4~7次，生育HBW的风险是每周食用豆制品次数≤ 1次者的2.59倍（95%CI：1.06~6.32）。 结论 降低高出生体重的发生风险可从育龄人群的孕前体重、孕期饮食和分娩孕周管理入手。 Abstract:Objective To estimate the association between the risk of high birth weight(HBW) and maternal environmental and behavioral factors exposure during pregnancy in rural areas. Methods Data were collected from the surveillance system of birth population and adverse pregnancy outcome in Pingding County, Shanxi Province during 2007 and 2012, where we followed up 204 controls with normal birth weight, 125 cases with HBW ≥ 4 200 g and 171 cases with HBW 4 000-4 200 g. Case control study was performed to explore the potential risk factors of HBW. Results The total number of births was 18 749, including 1 177 cases of high birth weight, with an incidence rate of 6.28% between 2007 and 2012. Concerning the case control study on HBW<4 200 g, after adjusting parental reproductive age and parity, the risk of HBW was 3.10 (95% CI: 1.67-5.76) times higher among women with gestational weeks ≥ 42 than that of women with gestational weeks < 42. The risk of HBW in boys was 2.30 (95% CI: 1.46-3.63) times higher than that in girls. No significant association was observed between maternal BMI before pregnancy and the risk of HBW; Regarding the case control study on HBW ≥ 4200 g, after adjusting maternal reproductive age and parity, the risk of HBW was 3.01(95% CI: 1.49-6.08) times higher among women with gestational weeks ≥ 42 than that of those with gestational weeks <42. The risk of HBW was 1.91 (95% CI: 1.15-3.16) times higher among women with pre-pregnancy BMI ≥ 24 than that of those with pre-pregnancy BMI< 24. The risk of HBW was 2.59 (95% CI: 1.06-6.32) times higher in women who ate soybean products ≥ 4 times a week than that of those who ate soybean products less than once a week. Conclusion It would be of public health significance to reduce the risk of high birth weight, which can be reduced by managing pre-pregnancy BMI, diet during pregnancy and controlling gestational week. -
Key words:
- Rural area /
- High birth weight /
- Risk factors
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表 1 HBW病例组和对照组人口学孕产史分布特征
Table 1. The demographic distribution of HBW case group and control group
影响因素 对照组n(%)(n=204) 4 000~4 200 g HBW组(n=171) ≥4 200 g HBW组(n=125) n(%) OR(95% CI)值 n(%) OR(95% CI)值 母亲分娩年龄(岁) <28 118(57.84) 75(43.86) 1.00 49(39.20) 1.00 ≥28 86(42.16) 96(56.14) 1.76(1.17~2.65) 76(60.80) 2.13(1.35~3.35) 父亲年龄(岁)a <30 113(55.94) 71(41.76) 1.00 61(48.80) 1.00 ≥30 89(44.06) 99(58.24) 1.77(1.17~2.67) 64(51.20) 1.33(0.85~2.08) 孕周 <42 49(24.02) 19(11.11) 1.00 12(9.60) 1.00 ≥42 155(75.98) 152(88.89) 2.53(1.42~4.49) 113(90.40) 2.98(1.51~5.85) 产次b 初产 103(50.99) 69(40.35) 1.00 46(36.80) 1.00 经产 99(49.01) 102(59.65) 1.54(1.02~2.32) 79(63.20) 1.79(1.13~2.82) 孕前BMI(kg/m2)c <24 141(69.46) 95(55.56) 1.00 62(49.60) 1.00 ≥24 62(30.54) 76(44.44) 1.82(1.19~2.78) 63(50.40) 2.31(1.46~3.66) 新生儿性别 女 98(48.04) 51(29.82) 1.00 46(36.80) 1.00 男 106(51.96) 120(70.18) 2.18(1.42~3.34) 79(63.20) 1.59(1.01~2.50) 家庭人均年收入(元)d <3 000 67(33.00) 51(30.00) 1.00 39(31.45) 1.00 3 000~ 48(23.65) 52(30.59) 1.42(0.83~2.43) 41(33.06) 1.47(0.83~2.61) ≥6 000 88(43.35) 67(39.41) 1.00(0.62~1.62) 44(35.48) 0.86(0.50~1.47) 注：a对照组有2例缺失，4 000~4 200 g组有1例缺失；b对照组有1例缺失；c对照组有1个缺失；d对照组、4 000~4 200 g组和≥4 200 g组各有1例缺失。 
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表 2 HBW病例组和对照组孕期行为和环境暴露因素分布特征
Table 2. The distribution of behavior and environment exposure during pregnancy of HBW case group and control group
影响因素 对照组[n(%)](n=204) 4 000~4 200 g HBW组(n=171) ≥4 200 g HBW组(n=125) n(%) OR(95% CI)值 n(%) OR(95% CI)值 吃新鲜蔬菜(次/周) ≤3 17(8.33) 16(9.36) 1.00 15(12.00) 1.00 4~ 109(53.43) 78(45.61) 0.76(0.36~1.60) 48(38.40) 0.50(0.23~1.08) 6~7 78(38.24) 77(45.03) 1.05(0.50~2.22) 62(49.60) 0.90(0.42~1.95) 吃水果次数(次/周)a ≤3 54(26.47) 39(22.81) 1.00 35(28.23) 1.00 4~ 82(40.20) 66(38.60) 1.11(0.66~1.88) 39(31.45) 0.73(0.41~1.30) 6~7 68(33.33) 66(38.60) 1.34(0.79~2.29) 50(40.32) 1.13(0.65~1.99) 吃蛋奶(次/周) ≤1 13(6.37) 11(6.43) 1.00 12(9.60) 1.00 2~ 56(27.45) 49(28.65) 1.03(0.43~2.52) 38(30.40) 0.74(0.30~1.78) 4~7 135(66.18) 111(64.91) 0.97(0.42~2.25) 75(60.00) 0.60(0.26~1.39) 孕期吃肉次数(次/周)b ≤1 120(59.11) 85(49.71) 1.00 67(53.60) 1.00 2~ 68(33.50) 68(39.77) 1.41(0.91~2.18) 43(34.40) 1.13(0.70~1.84) 4~7 15(7.39) 18(10.53) 1.69(0.81~3.55) 15(12.00) 1.79(0.83~3.89) 孕期吃豆制品(次/周)c ≤1 105(51.72) 69(40.59) 1.00 47(37.60) 1.00 2~ 86(42.36) 88(51.76) 1.56(1.02~2.38) 62(49.60) 1.61(1.00~2.59) 4~7 12(5.91) 13(7.65) 1.65(0.71~3.82) 16(12.80) 2.98(1.31~6.79) IAPCC[15] 0 110(53.92) 92(53.80) 1.00 56(44.80) 1.00 1 28(13.72) 22(12.87) 0.94(0.50~1.75) 15(12.00) 1.05(0.52~2.13) ≥2 66(32.35) 57(33.33) 1.03(0.66~1.62) 54(43.20) 1.61(0.99~2.60) 孕期被动吸烟情况d 没有 76(38.19) 68(40.96) 1.00 51(41.80) 1.00 偶尔 77(38.69) 62(37.35) 0.90(0.56~1.44) 43(35.25) 0.83(0.50~1.39) 经常 46(23.12) 36(21.69) 0.88(0.51~1.51) 28(22.95) 0.91(0.50~1.63) 注：a≥4 200 g组存在1例缺失；b对照组存在1例缺失；c对照组和4 000~4 200 g组各有1例缺失；d对照组和4 000~4 200 g组各有5例缺失，≥4 200 g组存在3例缺失。
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表 3 HBW多因素Logistic回归分析
Table 3. Multivariate Logistic regression analysis of high birth weight
影响因素 OR(95% CI)值 4 000~4 200 g HBW组 ≥4 200 g HBW组 父亲年龄(岁) < 30 1.00 - ≥30 1.62(0.82~3.18) - 母亲分娩年龄(岁) <28 1.00 1.00 ≥28 1.41(0.58~2.24) 1.38(0.79~2.41) 产次 初产 1.00 1.00 经产 1.27(0.80~2.01) 1.36(0.78~2.38) 孕周 <42 1.00 1.00 ≥42 3.10(1.67~5.76) 3.01(1.49~6.08) 新生儿性别 女 1.00 1.00 男 2.30(1.46~3.63) 1.49(0.91~2.41) 孕前BMI(kg/m2) <24 1.00 1.00 ≥24 1.85(0.16~2.93) 1.91(1.15~3.16) 孕期吃豆制品(次/周) ≤1 1.00 1.00 2~ 1.46(0.92~2.30) 1.44(0.87~2.39) 4~7 1.33(0.54~3.32) 2.59(1.06~6.32)
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