Association of physical activity and cesarean section in the second trimester of pregnancy:a cohort study
Feng YH and Shi YJ contributed equally to this article
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摘要:
目的 探究孕中期妇女不同类型和强度的身体活动对剖宫产的影响。 方法 以中国孕产妇队列研究协和项目中的672名孕妇为研究对象, 采用孕期身体活动问卷(pregnancy physical activity questionnaire, PPAQ)调查孕中期妇女身体活动情况, 随访获得研究对象的分娩方式。采用多因素非条件Logistic回归分析模型对数据进行统计分析。 结果 273名孕妇(40.63%)的分娩方式为剖宫产。调整年龄、孕前体重指数(body mass index, BMI)、产史等因素后, 相比于不参加运动锻炼的孕妇, 运动锻炼较高水平的孕妇剖宫产发生风险较低(OR=0.564, 95% CI:0.338~0.941);相对于参加低水平中重度身体活动的孕妇, 参与较高水平中重度身体活动的孕妇剖宫产发生风险较低(OR=0.652, 95% CI:0.437~0.972)。 结论 运动锻炼和中重度身体活动是剖宫产的保护因素, 应进一步加强孕期运动的健康教育, 鼓励孕妇在孕期进行适宜的身体活动。 Abstract:Objective To explore the associations between cesarean section with different types and intensity of physical activity in the second trimester pregnant women. Methods Six hundred and seventy-two participants from the Chinese pregnant women cohort study(CPWCS) were analyzed. The pregnancy physical activity questionnaire(PPAQ) was used to collect the status of physical activities in pregnant women. The participants were followed up and the data of delivery way was collected. Logistic regression model was conducted to analyze the associations. Results A total of 273 pregnant women(40.63%) were delivered by cesarean section. After adjusting age, pre-pregnancy BMI and history of childbirth, results of Logistic regression model showed that pregnant women with higher levels of exercise had a lower risk of cesarean section than those who did not participate in exercise(OR=0.564, 95% CI: 0.338-0.941). In terms of physical activity intensity, pregnant women who participated in the higher level of moderate to vigorous physical activity had a lower risk of cesarean section than those who participated in the lower level(OR=0.642, 95% CI:0.437-0.972). Conclusions Exercise and moderate to vigorous physical activity are protective factors for cesarean section. Health education should be further strengthened to encourage pregnant women to carry out appropriate physical activity during pregnancy. -
Key words:
- Gestation /
- Physical activity /
- Cesarean section /
- Cohort study
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表 1 研究对象基本信息
Table 1. Sample characteristics of participants
变量 人数(人) 百分比(%) 年龄(岁) 20~ 56 8.33 25~ 311 46.28 30~ 238 35.42 ≥35 67 9.97 民族 汉族 622 92.56 少数民族 50 7.44 文化程度 初中及以下 44 6.55 高中 154 22.92 本科 425 63.24 硕士及以上 49 7.29 职业 无业 118 17.56 脑力劳动为主 353 52.53 体力劳动为主 201 29.91 家庭年收入(元) < 100 000 140 20.83 100 000~ 363 54.02 ≥240 000 169 25.15 孕前BMI 偏瘦 59 8.78 正常 440 65.48 超重 137 20.39 肥胖 36 5.36 产史 初产妇 416 61.90 经产妇 256 38.10 
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表 2 不同特征孕妇剖宫产发生率[n(%)]
Table 2. Incidence of cesarean section in pregnant women with different characteristics [n(%)]
变量 剖宫产 例数(%) OR值 95% CI值 χ2值 P值 年龄(岁) 17.087 < 0.001 20~ 11(4.03) 1.000 25~ 122(44.69) 2.641 1.315~5.304 30~ 103(37.73) 3.121 1.539~6.332 ≥35 37(13.55) 5.045 2.230~11.414 民族 2.898 0.089 汉族 247(90.48) 1.000 少数民族 26(9.52) 1.645 0.923~2.930 文化程度 0.518 0.915 初中及以下 16(5.86) 1.000 高中 62(22.71) 1.179 0.589~2.360 本科 176(64.47) 1.237 0.650~2.355 硕士及以上 19(6.96) 1.108 0.478~2.570 职业 0.145 0.930 无业 49(17.95) 1.000 脑力劳动为主 141(51.65) 0.937 0.613~1.430 体力劳动为主 83(30.40) 0.990 0.624~1.571 家庭年收入(元) 0.722 0.697 < 100 000 53(19.41) 1.000 100 000~ 148(54.21) 1.130 0.575~1.687 ≥240 000 72(26.37) 1.218 0.771~1.926 孕前BMI 14.589 0.002 正常 174(63.74) 1.000 偏瘦 13(4.76) 0.432 0.227~0.823 超重 68(24.91) 1.507 1.025~2.215 肥胖 18(6.59) 1.529 0.774~3.020 产史 0.026 0.872 初产妇 168(61.54) 1.000 经产妇 105(38.46) 1.027 0.748~1.409
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表 3 孕中期妇女身体活动的能量消耗(MET-hours/week)
Table 3. Energy expenditure of physical activity of participants in the second trimester (MET-hours/week)
总体
(n=672)
M (P25, P75)剖宫产孕妇
(n=273)
M (P25, P75)阴道分娩
孕妇(n=399)
M (P25, P75)总身体活动 150.40(105.53, 208.50) 150.15(98.70, 203.00) 150.78(110.38, 212.55) 不同类型身体活动 家务照顾 61.08(39.03, 97.83) 61.08(39.20, 92.75) 61.08(38.68, 98.53) 职业活动 59.85(0.00, 76.83) 61.78(0.00, 76.83) 59.85(0.00, 75.25) 运动锻炼 2.40(0.80, 4.80) 2.40(0.00, 5.33) 2.40(0.80, 4.80) 交通活动 24.50(11.81, 40.25) 22.75(11.38, 39.38) 25.38(13.13, 41.13) 不同强度身体活动 静坐行为 76.91(34.56, 105.53) 80.15(36.93, 108.15) 75.95(33.25, 104.13) 轻度身体活动 40.78(25.03, 65.19) 39.38(25.03, 61.60) 41.65(25.03, 70.35) 中重度身体活动 24.28(11.80, 49.65) 23.40(10.69, 44.93) 25.03(12.25, 51.78)
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表 4 孕中期妇女身体活动与剖宫产关系的Logistic回归分析模型分析结果
Table 4. Analysis results of Logistic regression model of physical activity in the second trimester and cesarean
β值 Sx值 Wald/χ2值 P值 OR值 95% CI值 总身体活动 较低水平 1.000 中等水平 -0.152 0.196 0.601 0.438 0.859 0.584~1.262 较高水平 -0.163 0.197 0.686 0.408 0.849 0.577~1.250 不同类别身体活动 家务照顾 较低水平 1.000 中等水平 0.007 0.197 0.001 0.973 1.007 0.685~1.480 较高水平 -0.077 0.196 0.155 0.694 0.926 0.630~1.360 职业活动 较低水平 1.000 中等水平 -0.131 0.208 0.400 0.527 0.877 0.584~1.317 较高水平 0.007 0.192 0.001 0.973 1.007 0.690~1.467 运动锻炼 无 1.000 中等水平 0.366 0.277 1.753 0.186 0.693 0.403~1.192 较高水平 -0.572 0.261 4.808 0.028 0.564 0.338~0.941 交通活动 较低水平 1.000 中等水平 -0.261 0.199 1.712 0.191 0.770 0.521~1.139 较高水平 -0.325 0.206 2.492 0.114 0.723 0.483~1.082 不同强度身体活动 静坐行为 较低水平 1.000 中等水平 -0.221 0.200 1.214 0.270 0.802 0.542~1.187 较高水平 0.163 0.198 0.673 0.412 1.177 0.798~1.735 轻度身体活动 较低水平 1.000 中等水平 0.072 0.198 0.132 0.716 1.075 0.729~1.583 较高水平 -0.198 0.208 0.899 0.343 0.821 0.546~1.235 中重度身体活动 较低水平 1.000 中等水平 -0.231 0.197 1.373 0.241 0.794 0.540~1.168 较高水平 -0.428 0.204 4.417 0.036 0.652 0.437~0.972
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