武汉市新生儿低出生体重危险因素分析及与孕期铝暴露的关联分析

发布时间：2018-06-22 22:34

本文选题：低出生体重 + 影响因素　；参考：《华中科技大学》2016年硕士论文

【摘要】：目的:低出生体重(LBW)是一种全球性公共卫生问题,其涉及范围广泛,对个体早期的生长发育以及青少年和成年期的慢病发生均会造成长远影响,严重制约人口健康和经济文化的发展,给医药卫生系统增添了沉重的负担。胚胎期是个体生命的起源阶段,母体孕期的生活习惯以及接触的各种暴露因素都会对胚胎发育造成影响,而铝元素是生活中常见的一种重金属,研究报道铝元素具有生殖毒性,会导致胚胎宫内发育受损,然而目前关于孕期铝暴露与新生儿出生体重的流行病学证据尚不足。因此,此次调查深入研究孕期各暴露因素以及铝暴露与新生儿低出生体重的关系,为防止产前不良因素和不良妊娠结局的发生提供科学的指导意见。方法:以健康宝贝队列(healthy baby cohort)为基础,采用病例对照研究,从队列中选取低出生体重新生儿158例,按照孕妇年龄以及新生儿性别进行1:3配比,再从队列中选取正常体重新生儿474例,病例和对照均为2012年11月1日至2014年4月1日在武汉市妇幼保健院出生且无明显出生缺陷的单胎活产儿;低出生体重儿的出生体重2500g,正常新生儿为体重在2500g-4000g(包括2500g)。在孕妇分娩住院时填写问卷,收集父母的基本信息、生活工作状况、家庭经济条件、母亲孕期营养等情况;新生儿信息来自于医院资料的搜集整理。选择Epidata3.1对问卷实行双录入并创建数据库,孕妇尿液样本则由受过专业培训的实验员收集,使用电感耦合等离子体质谱仪(ICP-MS)检测尿样中铝元素的含量,将尿铝浓度按三分位数分为高中低三个等级,运用SPSS17.0分析软件,描述基本信息,并选用二分类logistic单因素和多因素回归进行因素分析,以及符号秩和检验和条件logistic回归,统计低出生体重组与对照组的尿铝浓度差异以及铝暴露与低出生体重的关联。结果:1、632个孕妇的平均年龄为28.7岁;新生儿性别比为0.95(男孩:女孩);病例组平均分娩孕周为36.1周,对照组为38.9周;病例组和对照组的平均出生体重分别为2252g和3310g。2、多因素logistic回归分析结果显示,孕期增重多(OR=1.073,P0.01),怀孕周期长(OR=2.707,P0.01)是低出生体重的保护因素;孕期阴道流血(OR=1.981,P0.05),妊娠期高血压(OR=5.271,P0.01),羊水过少(OR=9.175,P0.01)是低出生体重的危险因素。3、在低出生体重与孕期铝暴露的病例对照研究中,Wilcoxon秩和检验结果为:Z=3.2715,P=0.0011,说明病例组和对照组的尿铝浓度有显著性差别,且提示病例组浓度要高于对照组。4、将尿铝高浓度组、中浓度组分别与低浓度组进行比较,logistic回归分析结果显示,中浓度尿铝对新生儿低出生体重的影响分析结果为OR=1.55,P0.05,高浓度尿铝对低出生体重的影响分析结果为OR=2.24(95%CI:1.40-3.60),P0.01。5、将低出生体重危险因素分析得出的影响因素作为校正因素,logistic回归分析结果显示,中浓度尿铝对新生儿低出生体重的影响分析结果为OR=1.27,P0.05,高浓度尿铝对低出生体重的影响分析结果为OR=1.31(95%CI:1.02-2.03),P0.05。6、按母亲年龄的中位数分为两组:≤28岁组和28岁组,两组中铝暴露对低出生体重的影响表现一致:校正其他因素前,尿铝中浓度组与低出生体重无显著性关联,高浓度组对低出生体重有显著性影响(P0.05),校正其他影响因素后,无论暴露浓度高低,胚胎期铝暴露对低出生体重均无显著性影响。7、按新生儿性别分组,男孩组与女孩组的结果一致,均显示为:校正其他因素前,尿铝中浓度组与低出生体重无显著性关联,高浓度组对低出生体重有显著性影响(P0.05),校正其他影响因素后,无论暴露浓度高低,胚胎期铝暴露对低出生体重均无显著性影响。结论:1、孕期增重多、怀孕周期长是低出生体重的保护因素,因此,应加强孕妇对孕期保健的认知,并保证孕妇孕期的营养充足,防止母体营养不良所致的胎儿发育受损的现象;此外,孕期还要预防流产和早产的发生,使得分娩孕周处于正常范围内。羊水过少、阴道流血、妊娠高血压是低出生体重的危险因素,故应在孕期加强警惕,采取有效措施加以预防。2、低出生体重与孕期铝暴露的关联表现为,暴露程度较低时,可认为关联无统计学意义;暴露程度较高时,具有显著性关联,说明高浓度铝暴露是低出生体重的危险因素。因此,妊娠期妇女应识别环境中的铝制产品或者含铝产品,减少该类产品的使用,将不良影响降至最低。
[Abstract]:Objective: low birth weight (LBW) is a global public health problem. It is a global public health problem. It has a wide range of problems. It has a long-term impact on the growth and development of individuals and the occurrence of slow diseases in adolescents and adults. It seriously restricts the health of the population and the development of economy and culture, and adds a heavy burden to the medical and health systems. The embryo period is an individual student. In the origin stage of life, the life habits of the maternal pregnancy and various exposure factors in contact will affect the development of embryos, and aluminum is a common heavy metal in life. It is reported that the reproductive toxicity of aluminum elements can lead to the damage to the intrauterine development of the embryo, but the flow of aluminum exposure and the birth weight of the newborn during pregnancy The evidence is still inadequate. Therefore, the survey studies the relationship between exposure factors in pregnancy and the relationship between aluminum exposure and neonatal low birth weight, and provides scientific guidance for preventing prenatal adverse factors and adverse pregnancy outcomes. Method: Based on the healthy baby cohort, a case control study was used. 158 cases of low birth weight newborns were selected from the cohort, according to the age of pregnant women and the sex of the newborn 1:3, and then 474 cases of normal weight newborn were selected from the cohort. The cases and the control were all single born babies born in Wuhan maternal and child health care hospital from November 1, 2012 to April 1, 2014 without obvious birth defects; low birth weight was low. The birth weight of the infant was 2500g, and the normal newborn was 2500g-4000g (including 2500g). The questionnaire was filled in when the pregnant women were in hospital. The basic information of the parents, the living conditions, the family economic conditions, the maternal nutrition and so on. The information of the newborns came from the collection and arrangement of the hospital data. The questionnaire was selected by Epidata3.1 to carry out a double entry into the questionnaire. And the database was created. The urine samples of pregnant women were collected by the trained experimenters. The content of aluminum in urine samples was detected by inductively coupled plasma mass spectrometry (ICP-MS). The urine aluminum concentration was divided into three grades in high school by three digits. The basic information was described by SPSS17.0 analysis, and the two classification of logistic single causes was selected. Factor analysis, factor analysis, symbolic rank sum test and conditional logistic regression, and the correlation between aluminum concentration and low birth weight in the low birth weight group and the control group, and the correlation between aluminum exposure and low birth weight. Results: the average age of 1632 pregnant women was 28.7 years; the neonatal sex ratio was 0.95 (boys: girls); the average childbirth in the case group. The pregnancy week was 36.1 weeks and the control group was 38.9 weeks. The average birth weight of the case group and the control group was 2252g and 3310g.2 respectively. The multiple factor Logistic regression analysis showed that the weight gain during pregnancy was more (OR=1.073, P0.01), the long pregnancy cycle (OR=2.707, P0.01) was the protection factor of low birth weight; vaginal bleeding (OR=1.981, P0.05), pregnancy hypertension (OR). =5.271, P0.01), OR=9.175 (P0.01) is a risk factor for low birth weight.3. In a case-control study of low birth weight and prenatal exposure to aluminum, Wilcoxon rank and test results are: Z=3.2715, P=0.0011, indicating a significant difference in the urinary aluminum concentration between the case group and the control group, suggesting that the concentration of the case group is higher than that of the control group, and the urine is higher than that of the control group. The results of logistic regression analysis showed that the effect of middle concentration of urine aluminum on low birth weight of newborn was OR=1.55, P0.05, and the effect of high concentration of urine aluminum on low birth weight was OR=2.24 (95% CI:1.40-3.60), P0.01.5, and the risk factors of low birth weight were divided. Logistic regression analysis showed that the effect of medium concentration of urine aluminum on the low birth weight of newborn was OR=1.27, P0.05, and the result of high concentration of urine aluminum was OR=1.31 (95%CI:1.02-2.03) and P0.05.6, which was divided into two groups according to the median age of mother: group less than 28 years old. The effect of aluminum exposure on low birth weight in the two groups was consistent with the 28 year old group. Before the correction of other factors, there was no significant association between the concentration group in the urinary aluminum and the low birth weight. The high concentration group had a significant effect on the low birth weight (P0.05). After the correction of other factors, no matter the exposure concentration was high and low, the aluminum exposure of the embryo to low birth weight was no more. The significant effect of.7, according to the neonatal sex group, the boys group and the results of the girls group, all showed that before the correction of other factors, there was no significant association between the concentration group in the urine and the low birth weight, and the high concentration group had a significant effect on the low birth weight (P0.05). After correcting the factors of his influence, no matter the exposure concentration was high or low, the aluminum exposure stage in the embryo period was exposed. There is no significant effect on low birth weight. Conclusion: 1, more weight increases during pregnancy and long pregnancy cycle is a protective factor for low birth weight. Therefore, it is necessary to strengthen the cognition of pregnant women's health care during pregnancy, ensure adequate nutrition of pregnant women during pregnancy and prevent fetal malnutrition caused by maternal malnutrition, and also prevent abortion and premature birth during pregnancy. The incidence of childbirth is in the normal range. Oligohydramnios, vaginal bleeding, pregnancy induced hypertension are the risk factors of low birth weight. Therefore, we should strengthen vigilance during pregnancy and take effective measures to prevent.2. The association between low birth weight and pregnant aluminum exposure is that when the exposure degree is low, there is no statistical significance; violence is not significant. When exposure is high, there is a significant correlation, indicating that high concentration of aluminum exposure is a risk factor for low birth weight. Therefore, pregnant women should identify the aluminum products or aluminum products in the environment, reduce the use of such products and minimize the adverse effects.
【学位授予单位】：华中科技大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R17

【参考文献】