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摘要:
目的 分析中国早产的流行现状及危险因素，为早产的预防提供参考依据。 方法 本研究数据来源于中国孕产妇队列研究·协和项目(Chinese Pregnant Women Cohort Study, CPWCS)，通过问卷调查和医院信息系统(hospital information system, HIS)收集孕妇基本情况和分娩结局。采用SPSS 26.0软件进行χ2检验和多因素Logistic回归分析模型分析。 结果 5 671名孕妇中发生早产的例数为295例，占5.2%，不同地区早产率差异无统计学意义(χ2 =0.591, P=0.771)。多因素分析结果显示：高龄、糖尿病史、早产史、胎盘早剥、胎膜早破、胎儿宫内窘迫、妊娠期高血压以及双胎是早产的危险因素(均有P < 0.05)，而在自然分娩的孕妇中，高龄(OR=2.90, 95% CI: 1.67~5.06, P < 0.001)、胎膜早破(OR=6.17, 95% CI: 4.21~9.06, P < 0.001)、双胎(OR=17.72, 95% CI: 3.23~97.25, P=0.001)是早产的主要危险因素。 结论 早产的影响因素较多，准确识别危险因素，为孕妇提供科学合理的健康教育和个性化的防治措施是预防早产的重要手段。 Abstract:Objective To analyze the prevalence and risk factors of preterm birth in China and to provide reference for the prevention of preterm birth. Methods Data was from the Chinese Pregnant Women Cohort study (CPWCS). The basic information and delivery outcomes of pregnant women were collected through questionnaire surveys and hospital information system. The chi-square test and multivariate logistic regression analysis were conducted by SPSS 26.0 software. Results The prevalence of preterm birth among 5 671 pregnant women was 5.2%, and there was no significant difference in the prevalence of preterm birth among different regions (χ2 =0.591, P=0.771). The results of multivariate logistic regression analysis showed that advanced age, history of diabetes, history of premature birth, placental abruption, premature rupture of membranes, fetal distress, hypertension during pregnancy, and twins were risk factors for preterm birth (all P < 0.05), while among pregnant women who give birth naturally, advanced age (OR=2.90, 95% CI: 1.67-5.06, P < 0.001), premature rupture of membranes (OR=6.17, 95% CI: 4.21-9.06, P < 0.001), and twins (OR=17.72, 95% CI: 3.23-97.25, P < 0.001) were risk factors for preterm birth. Conclusions There are many influencing factors of preterm birth. Accurately identifying risk factors and providing pregnant women with scientific and reasonable health education and individualized prevention and control measures are important means to prevent preterm birth. -
Key words:
- Pregnant women /
- Preterm birth /
- Risk factors /
- Cohort study
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表 1 孕妇的人口学特征对早产影响的单因素分析[n (%)]
Table 1. Univariate analysis of the influence of demographic characteristics on preterm birth [n (%)]
变量 总人数 早产 χ2值 P值 是 否 年龄(岁) 34.307 < 0.001 ＜35 5 089(89.7) 235(79.7) 4 854(74.4) ≥35 582(10.3) 60(20.3) 522(25.6) 民族 0.087 0.768 汉族 5 347(94.3) 277(93.9) 5 070(94.3) 少数民族 324(5.7) 18(6.1) 306(5.7) 文化程度 4.483 0.106 高中及以下 2 129(37.5) 99(33.6) 2 030(37.8) 大学本科 3 198(56.4) 183(62.0) 3 016(56.1) 硕士及以上 344(6.1) 13(4.4) 331(6.1) 职业 3.987 0.136 无业 1 647(29.0) 75(25.4) 1 572(29.2) 脑力劳动 1 994(35.2) 119(40.3) 1 875(34.9) 体力劳动 2 030(35.8) 101(34.3) 1 929(35.9) 户籍所在地 0.104 0.747 城镇 2 582(45.5) 137(46.4) 2 445(45.5) 农村 3 089(54.5) 158(53.6) 2 931(54.5) 地域 0.032 0.857 南 2 701(47.6) 139(47.1) 2562(47.7) 北 2 970(52.4) 156(52.9) 2814(52.3) 地区 0.519 0.771 东 2 053(36.2) 106(35.9) 1947(36.2) 中 2 024(35.7) 101(34.2) 1923(35.8) 西 1 594(28.1) 88(29.9) 1506(28.0) 家庭人均年收入(万元) 0.289 0.865 ＜2 1 275(22.5) 70(23.7) 1205(22.4) 2~ 2 818(49.7) 145(49.2) 2673(49.7) ≥6 1 578(27.8) 80(27.1) 1498(27.9) 孕前BMI(kg/m2) 1.518 0.468 ＜18.5 769(13.6) 37(12.5) 732(13.6) 18.5~ 3 640(64.2) 184(62.4) 3456(64.3) ≥24.0 1 262(22.2) 74(25.1) 1188(22.1) 
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表 2 疾病史和生育史对早产影响的单因素分析[n (%)]
Table 2. Univariate analysis of the influence of disease history and birth history on preterm birth [n (%)]
变量 总人数 早产 χ2值 P值 是 否 高血压 3.075 0.080a 无 5 619(99.1) 289(98.0) 5330(99.1) 有 52(0.9) 6(2.0) 46(0.9) 糖尿病 10.926 0.001a 无 5 582(98.4) 283(96.0) 5299(98.6) 有 89(1.6) 12(4.0) 77(1.4) 贫血 0.164 0.685 无 5 537(97.6) 287(97.3) 5250(97.7) 有 134(2.4) 8(2.7) 126(2.3) 孕次 4.754 0.093 0 1 733(30.6) 91(30.8) 1642(30.5) 1~ 3 062(54.0) 146(49.5) 2916(54.2) ≥3 876(15.4) 58(19.7) 818(15.3) 产次 1.538 0.463 0 3 192(56.3) 160(54.2) 3032(56.4) 1 2 310(40.7) 123(41.7) 2187(40.7) ≥2 169(3.0) 12(4.1) 157(2.9) 剖宫产史 2.508 0.113 无 4 673(82.4) 233(80.0) 4440(82.6) 有 998(17.6) 62(20.0) 936(17.4) 流产史 0.007 0.935 无 3 794(66.9) 198(67.1) 3596(66.9) 有 1 877(33.1) 97(32.9) 1780(33.1) 早产史 0.008b 无 5 655(99.7) 291(98.6) 5364(99.8) 有 16(0.3) 4(1.4) 12(0.2) 注：孕次、产次均不包括本次；a：连续性校正法；b：Fisher精确概率法。
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表 3 妊娠期并发症对早产影响的单因素分析[n (%)]
Table 3. Univariate analysis of the influence of gestational complications on preterm birth [n (%)]
变量 总人数 早产 χ2值 P值 是 否 胎膜早破 12.116 < 0.001 是 813(14.3) 106(35.9) 707(13.2) 否 4 858(85.7) 189(64.1) 4669(86.8) 胎盘早剥 35.829 < 0.001 是 37(0.7) 10(3.4) 27(0.5) 否 5 634(99.3) 285(96.6) 5349(99.5) 胎儿宫内窘迫 10.645 0.001 是 207(3.7) 21(7.1) 186(3.5) 否 5 464(96.3) 274(92.9) 5190(96.5) 妊娠期糖尿病 118.180 < 0.001 是 834(14.7) 64(21.7) 770(14.3) 否 4 837(85.3) 231(78.3) 4606(85.7) 妊娠期高血压 35.975 < 0.001 是 161(2.8) 25(8.5) 136(2.5) 否 5 510(97.2) 270(91.5) 5240(97.5) 妊娠期贫血 5.125 0.024 是 906(16.0) 61(20.7) 845(15.7) 否 4 765(84.0) 234(79.3) 4531(84.3) 分娩方式 28.47 < 0.001 自然分娩 3 103(54.7) 117(39.7) 2 986(55.5) 剖宫产 2 568(45.3) 178(60.3) 2 390(44.5) 胎数 178.385 < 0.001a 单胎 5 617(99.0) 270(91.5) 5 347(99.5) 双胎 54(1.0) 25(8.5) 29(0.5) 注：孕次、产次均不包括本次；a：连续性校正法。
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表 4 早产影响因素的多因素分析
Table 4. Multivariate analysis of the influencing factors of preterm birth
变量 β值 sx Wald χ2值 OR(95% CI)值 P值 年龄(岁)(参照组：＜35) 0.787 0.163 23.274 2.20(1.60~3.03) < 0.001 糖尿病史(参照组：无) 0.832 0.346 5.778 2.30(1.17~4.53) 0.016 早产史(参照组：无) 2.094 0.599 12.226 8.12(2.51~26.24) < 0.001 胎盘早剥(参照组：无) 1.793 0.402 19.863 6.01(2.73~13.22) < 0.001 胎膜早破(参照组：无) 1.364 0.134 103.846 3.91(3.01~5.08) < 0.001 胎儿宫内窘迫(参照组：无) 0.672 0.253 7.052 1.96(1.19~3.22) 0.008 妊娠期高血压(参照组：无) 1.012 0.252 16.069 2.75(1.68~4.51) < 0.001 妊娠期糖尿病(参照组：无) 0.267 0.159 2.817 1.31(0.96~1.78) 0.093 妊娠期贫血(参照组：无) 0.158 0.158 1.001 1.17(0.86~1.60) 0.317 双胎(参照组：单胎) 2.840 0.303 88.079 17.11(9.46~30.96) < 0.001
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表 5 自然分娩和剖宫产孕妇早产影响因素的亚组分析
Table 5. Subgroup analysis of influencing factors of preterm birth in natural delivery and cesarean section
变量 自然分娩组(n=3 103) 剖宫产组(n=2 568) OR(95% CI)值 P值 OR(95% CI)值 P值 年龄(岁)(参照组：＜35) 2.90(1.67~5.06) < 0.001 1.69(1.14~2.50) 0.009 糖尿病史(参照组：无) 1.50(0.43~5.29) 0.526 2.69(1.19~6.09) 0.018 早产史(参照组：无) 3.71(0.40~34.22) 0.248 9.70(2.30~40.92) 0.002 胎盘早剥(参照组：无) 1.61(0.19~13.26) 0.660 7.59(3.07~18.76) < 0.001 胎膜早破(参照组：无) 6.17(4.21~9.06) < 0.001 3.05(2.06~4.53) < 0.001 胎儿宫内窘迫(参照组：无) 0.72(0.17~3.10) 0.663 2.17(1.27~3.73) 0.005 妊娠期高血压(参照组：无) 1.43(0.89~2.31) 0.141 3.28(1.93~5.59) < 0.001 妊娠期糖尿病(参照组：无) 0.26(0.02~3.00) 0.277 1.18(0.78~1.78) 0.430 妊娠期贫血(参照组：无) 0.84(0.49~1.46) 0.543 1.36(0.92~2.00) 0.120 双胎(参照组：单胎) 17.72(3.23~97.25) 0.001 13.60(7.19~25.71) < 0.001
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