广西桂平市2016—2020年活产新生儿不良出生结局影响因素

张相明; 赵鹏; 陈思成; 李开娟; 陈柳萍; 辛衍健; 冯柱梅; 石萌萌; 钟延旭

doi:10.16462/j.cnki.zhjbkz.2022.09.011

广西桂平市2016—2020年活产新生儿不良出生结局影响因素

doi: 10.16462/j.cnki.zhjbkz.2022.09.011

1.
537200 桂平，桂平市人民医院产科
2.
530000 南宁，广西壮族自治区疾病预防控制中心
3.
530000 南宁，广西壮族自治区疾病预防控制中心食品安全风险监测与评价所

基金项目:

广西壮族自治区疾病预防控制中心青年科技工作者科研课题 202005

详细信息

通讯作者:
钟延旭，E-mail：gxcdczyx@163.com

中图分类号: R181;R174
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- 被引次数: 0
出版历程
- 收稿日期: 2021-11-14
- 修回日期: 2022-05-18
- 网络出版日期: 2022-09-17
- 刊出日期: 2022-09-10

Analysis of related factors of adverse birth outcomes of living newborns from 2016 to 2020 in Guiping County, Guangxi, China

1.
Department of Obstetrics, Guiping People Hospital, Guiping 537200, China
2.
Guangxi Center for Disease Control and Prevention, Nanning 530000, China
3.
Department of Food Safety Risk Monitoring and Evaluation, Guangxi Center for Disease Control and Prevention, Nanning 530000, China

Funds:

Youth Scientific Research Project of Guangxi Center for Disease Control and Prevention 202005

More Information

Corresponding author: ZHONG Yan-xu, E-mail: gxcdczyx@163.com

摘要

摘要: 目的了解广西壮族自治区(简称广西)桂平市新生儿出生体重变化、不良出生结局流行特征以及相关影响因素，为下一步促进新生儿健康提供科学依据。方法收集2016年1月1日—2020年12月31日所有在桂平市人民医院出生活产新生儿数据，通过R 4.1.2统计软件，采用ggplot2、χ²检验、趋势χ²检验、t检验和logistic回归分析模型进行描述及统计分析。结果共有25 958名新生儿纳入研究，平均出生体重为(3 054±515) g，低出生体重率为10.38%，巨大儿率为2.07%，早产率为11.09%。女婴、农村地区、高危妊娠是低出生体重危险因素(OR=1.81, 95% CI：1.61~2.04; OR=1.56, 95% CI: 1.27~1.90; OR=1.70，95% CI：1.44~2.00)，冬天出生、二胎、三胎及以上、产检次数≥8次是低出生体重保护因素(OR=0.77，95% CI：0.65~0.92；OR=0.55，95% CI：0.48~0.62; OR=0.50, 95% CI：0.42~0.59; OR=0.78, 95% CI：0.67~0.91)；冬天出生、母亲年龄为20~ < 35岁和≥35岁、二胎、三胎及以上、高危妊娠是巨大儿发生危险因素(OR=1.59, 95% CI：1.21~2.08; OR=2.94, 95% CI：1.29~6.71; OR=3.16, 95% CI：1.35~7.38; OR=1.74, 95% CI：1.37~2.22; OR=1.73, 95% CI：1.31~2.29; OR=3.53, 95% CI：2.66~4.96)；农村地区、父亲为其他少数民族、高危妊娠、多胎儿是新生儿早产的危险因素(OR=1.18, 95% CI：1.01~1.37; OR=1.53, 95% CI：1.03~2.28; OR=10.20, 95% CI：8.29~12.55; OR=7.05, 95% CI：6.17~8.05)，女婴、二胎、三胎及以上、产检次数≥8次是早产保护因素(OR=0.91, 95% CI：0.83~0.99; OR= 0.86, 95% CI：0.77~0.95; OR=0.87, 95% CI：0.77~0.98; OR=0.37, 95% CI：0.33~0.42)。结论广西桂平市新生儿早产率具有下降趋势，但是低出生体重率及巨大儿率仍然平稳甚至上升，应加强影响因素因果关联的深入研究并及早干预，促进新生儿健康。
- 低出生体重 /
- 早产 /
- 巨大儿 /
- 影响因素
Abstract: Objective To understand the changing of newborns' birth weight, the characteristics and the related factors of adverse birth outcomes in Guiping County, providing scientific evidence to promote newborns' health in the future. Methods The data of newborns were collected from Guiping People's hospital from January first, 2016 to December 31st, 2020. R 4.1.2 version software was used for data description and statistic testing, which included ggplot2, chi-square test, trend chi-square test, t-test, and logistic regression. Results There were 25 958 newborns included in the study, with a mean birth weight of (3 054±515) g. The incidence of low birth weight was 10.38%, while the incidence of macrosomia was 2.07%, and the incidence of preterm birth was 11.09%, respectively. Female infants, living in rural areas, and having a high-risk pregnancy were risk factors for low birth weight(OR=1.81, 95% CI: 1.61-2.04; OR=1.56, 95% CI: 1.27-1.90; OR=1.70, 95% CI: 1.44-2.00, respectively); while birth in winter, the second or third parity, and frequent obstetric examinations were protective factors for low birth weight (OR=0.77, 95% CI: 0.65-0.92; OR=0.55, 95% CI: 0.48-0.62; OR=0.50, 95% CI: 0.42-0.59; OR=0.78, 95% CI: 0.67-0.91, respectively). In addition, birth in winter, maternal age 20- < 35 years old and ≥35 years old, the second or third parity, and having high-risk pregnancy were risk factors for macrosomia (OR=1.59, 95% CI: 1.21-2.08; OR=2.94, 95% CI: 1.29-6.71; OR=3.16, 95% CI: 1.35-7.38; OR=1.74, 95% CI: 1.37-2.22; OR=1.73, 95% CI: 1.31-2.29; OR=3.53, 95% CI: 2.66-4.96, respectively). Besides, living in rural areas, paternal ethnicity are other ethnic minorities, having a high-risk pregnancy and multiple fetuses were risk factors for neonatal preterm birth (OR=1.18, 95% CI: 1.01-1.37; OR=1.53, 95% CI: 1.03-2.28; OR=10.20, 95% CI: 8.29-12.55; OR=7.05, 95% CI: 6.17-8.05, respectively), while female infants, the second or third parity, and the number of obstetric examinations were protective factors for preterm birth (OR=0.91, 95% CI: 0.83-0.99; OR= 0.86, 95% CI: 0.77-0.95; OR=0.87, 95% CI: 0.77-0.98; OR=0.37, 95% CI: 0.33-0.42, respectively). Conclusions The incidence of preterm birth has decreased during these five years. However, the incidence of low birth weight and macrosomia was still stable or even increasing. It is necessary to carry out high-quality studies to access the causality of related factors and intervention measures to promote newborn health in the future.
- Low birth weight /
- Preterm birth /
- Macrosomia /
- Related factors

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图 1 2016—2020年广西桂平市新生儿出生结局变化趋势

Figure 1. The trend of adverse birth outcomes of newborns in Guiping County, Guangxi, 2016-2020

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表 1 2016—2020年广西桂平新生儿一般人口学特征[n(%)]

Table 1. The demographic distribution of newborns in Guiping County, Guangxi, 2016-2020 [n(%)]

变量	新生儿	性别		t/χ²值	P值
变量	新生儿	男	女	t/χ²值	P值
人数	25 958(100.00)	13 794(53.14)	12 163(46.86)
出生体重(x±s, g)	3 054±515	3 108±520	2 992±502	18.15	< 0.001
出生孕周(x±s, 周)	38.34±1.90	38.26±1.90	38.43±1.88	-7.26	< 0.001
母亲年龄(x±s, 岁)	29.11±5.87	29.25±5.86	28.95±5.88	4.13	< 0.001
产前血红蛋白	106.91±5.74	106.91±5.67	106.92±5.82	-0.12	0.900
是否早产				8.98	0.003
否	23 080(88.91)	12 189(88.36)	10 891(89.54)
是	2 878(11.09)	1 605(11.64)	1 272(10.46)
出生体重类型				80.26	< 0.001
正常体重	22 726(87.55)	12 133(87.96)	10 593(87.09)
低出生体重	2 695(10.38)	1 293(9.37)	1 401(11.52)
巨大儿	537(2.07)	368(2.67)	169(1.39)
胎次				25.50	< 0.001
首胎	10 268(39.55)	5 295(38.39)	4 972(40.88)
二胎	10 590(40.80)	5 650(40.96)	4 940(40.61)
三胎及以上	5 100(19.65)	2 849(20.65)	2 251(18.51)
产检次数(次)				0.86	0.354
< 8	4100(15.80)	2 206(15.99)	1 894(15.57)
≥8	21857(84.20)	11 588(84.01)	10 269(84.43)
是否多胎				0.28	0.594
否	24 728(95.27)	13 150(95.33)	11 578(95.19)
是	1 229(4.73)	644(4.67)	585(4.81)
母亲民族				0.40	0.817
汉族	23 912(92.12)	12 702(92.08)	11 209(92.16)
壮族	1 768(6.81)	939(6.81)	829(6.82)
其他	278(1.07)	153(1.11)	125(1.03)
父亲民族				0.53	0.768
汉族	23 680(91.23)	12 587(91.25)	11 093(91.2)
壮族	1 971(7.59)	1 039(7.53)	932(7.66)
其他	307(1.18)	168(1.22)	138(1.13)
母亲常住地				0.23	0.893
桂平市	24 142(93.06)	12 826(93.02)	11 315(93.10)
广西非桂平市	1 218(4.70)	647(4.69)	571(4.70)
外省	582(2.24)	315(2.28)	267(2.20)
居住地类型				10.61	0.001
城市	2 628(10.13)	1 476(10.70)	1 152(9.47)
农村	23 322(89.87)	12 313(89.30)	11 008(90.53)

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表 2 2016—2020年广西桂平市新生儿低体重率、巨大儿率影响因素

Table 2. The related factors of newborn's low birth weight and macrosomia in Guiping County, Guangxi, 2016-2020

变量	正常(N=22 726)	低体重儿			巨大儿
变量	正常(N=22 726)	例数(n=2 695)	OR (95% CI)值	P值	例数(n=537)	OR (95% CI)值	P值
年份(年)
2016—2017	9 174(40.37)	1 131(41.97)	1.00		221(41.15)	1.00
2018—2019	9 140(40.22)	1 025(38.03)	1.05(0.91~1.21)	0.507	191(35.57)	0.89(0.71~1.11)	0.300
2020	4 412(19.41)	539(20.00)	1.23(1.04~1.45)	0.016	125(23.28)	1.31(1.01~1.69)	0.039
出生季节
春	4 772(21.00)	595(22.08)	1.00		114(21.23)	1.00
夏	5 613(24.70)	686(25.45)	0.89(0.75~1.05)	0.165	103(19.18)	0.89(0.66~1.19)	0.417
秋	6 648(29.25)	803(29.80)	1.04(0.88~1.22)	0.642	143(26.63)	0.95(0.72~1.26)	0.738
冬	5 693(25.05)	611(22.67)	0.77(0.65~0.92)	0.004	177(32.96)	1.59(1.21~2.08)	0.001
性别
男	12 133(53.39)	1 293(48.00)	1.00		368(68.53)	1.00
女	10 593(46.61)	1 401(52.00)	1.81(1.61~2.04)	< 0.001	169(31.47)	0.50(0.41~0.61)	< 0.001
母亲年龄(岁)
< 20	1 099(4.84)	161(5.97)	1.00		8(1.49)	1.00
20~ < 35	17 513(77.06)	1 922(71.32)	0.97(0.74~1.26)	0.809	390(72.63)	2.94(1.29~6.71)	0.010
≥35	4 114(18.10)	612(22.71)	1.00(0.75~1.35)	0.989	139(25.88)	3.16(1.35~7.38)	0.008
胎次
首胎	8 939(39.33)	1 192(44.23)	1.00		137(25.51)	1.00
二胎	9 403(41.38)	938(34.81)	0.55(0.48~0.62)	< 0.001	249(46.37)	1.74(1.37~2.22)	< 0.001
三胎及以上	4 384(19.29)	565(20.96)	0.50(0.42~0.59)	< 0.001	151(28.12)	1.73(1.31~2.29)	< 0.001
产检次数(次)
< 8	3 386(14.90)	642(23.82)	1.00		73(13.59)	1.00
≥8	19 340(85.10)	2 053(76.18)	0.78(0.67~0.91)	0.002	464(86.41)	1.21(0.89~1.64)	0.235
居住地类型
城市	2 365(10.41)	216(8.02)	1.00		47(8.75)	1.00
农村	20 355(89.59)	2 477(91.98)	1.56(1.27~1.90)	< 0.001	490(91.25)	1.08(0.79~1.49)	0.620
高危妊娠
否	6 577(34.72)	229(10.02)	1.00		60(12.96)	1.00
是	12 365(65.28)	2 056(89.98)	1.70(1.44~2.00)	< 0.001	403(87.04)	3.53(2.66~4.69)	< 0.001
注：模型矫正了孕周和多胎妊娠2个因素；母亲民族、父亲民族、母亲常住地、产前血红蛋白差异无统计学意义，未纳入最终模型。

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表 3 2016—2020年广西桂平市新生儿早产率影响因素

Table 3. The related factors of newborn's preterm birth in Guiping County, Guangxi, 2016-2020

变量	足月儿(N=23 080)	早产儿
变量	足月儿(N=23 080)	例数(n=2 878)	OR (95% CI)值	P值
年份(年)
2016—2017	9 208(39.90)	1 318(45.80)	1.00
2018—2019	9 282(40.21)	1 074(37.32)	0.76(0.68~0.85)	< 0.001
2020	4 590(19.89)	486(16.88)	0.62(0.54~0.71)	< 0.001
性别
男	12 189(52.81)	1 605(55.79)	1.00
女	10 891(47.19)	1 272(44.21)	0.91(0.83~0.99)	0.034
胎次
首胎	9 203(39.87)	1 065(37.01)	1.00
二胎	9 469(41.03)	1 121(38.95)	0.86(0.77~0.95)	0.004
三胎及以上	4 408(19.10)	692(24.04)	0.87(0.77~0.98)	0.021
产检次数(次)
< 8	3 387(14.68)	714(24.81)	1.00
≥8	19 693(85.32)	2 164(75.19)	0.37(0.33~0.42)	< 0.001
父亲民族
汉族	21 067(91.28)	2 613(90.79)	1.00
壮族	1 756(7.61)	215(7.47)	1.04(0.88~1.23)	0.640
其他	257(1.11)	50(1.74)	1.53(1.03~2.28)	0.037
居住地类型
城市	2 369(10.27)	259(9.01)	1.00
农村	20 706(89.73)	2 616(90.99)	1.18(1.01~1.37)	0.038
高危妊娠^a
否	6 768(35.09)	98(4.08)	1.00
是	12 522(64.91)	2 302(95.92)	10.20(8.29~12.55)	< 0.001
多胎妊娠
否	22 466(97.34)	2 263(78.63)	1.00
是	614(2.66)	615(21.37)	7.05(6.17~8.05)	< 0.001
注：^a高危妊娠包括妊娠并发症(心血管病、肝肾病、内分泌病、肿瘤及其他)；出生季节、母亲年龄、母亲民族、母亲常住地和产检血红蛋白差异无统计学意义，未纳入最终模型。

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