中国三省六县出生人口质量及其影响因素分析

发布时间：2018-06-04 03:07

本文选题：出生人口质量 + 早产　；参考：《北京协和医学院》2011年硕士论文

【摘要】：[研究目的] 总目的：了解中国农村地区出生人口质量现状并探讨其影响因素具体目标： 1.调查四川、安徽、河南三省六县早产、低出生体重、巨大儿的发生率 2.了解农村地区早产率,低出生体重率和巨大儿率的人群和时间分布特点 3.比较六县标准化的早产率,低出生体重率和巨大儿率 4.了解不同胎龄新生儿体重身长体格发育情况 5.探讨妇女人口学特征、婚育情况、妊娠期疾病及孕期保健因素对早产和巨大儿的影响 [研究方法] 本研究为现况研究。在四川省(射洪县和乐至县)、安徽省(蚌埠和蒙城县)和河南省(南乐县和泌阳县)分层抽取25个医疗机构,随机和整群相结合的抽样方法抽取2008年1月1日至2008年12月31日内分娩的活产儿的产科病案,采用自制调查问卷摘录相关变量。运用描述性研究法和标准化的思想描述早产、低出生体重、巨大儿的发生率的三间分布特点,运用t检验,卡方检验进行单因素分析,运用非条件Logistic回归检验进行多因素分析。 [结果] 本次调查共获得17805份合格调查表,最终合格率为98.9%。 1.率的三间分布本次调查中,三省六县农村地区早产儿共829例,发生率为4.66%。低出生体重儿共823例,发生率为4.62%。巨大儿共1765例,发生率为9.91%。四川省乐至县的早产和低出生体重率比较高,分别为8.16%和10.54%。安徽省蚌埠早产率和巨大儿率较高,分别为6.20%和10.96%。安徽省蒙城县和河南省泌阳县巨大儿率较高,两者均高达15%以上。男婴早产率和巨大儿率高于女婴,女婴低出生体重率高于男婴。安徽省蒙城县和河南省泌阳县男性巨大儿率高达18%以上。春季巨大儿发生率高于其它三季。早产和低体重率暂未发现季节差异。 2.新生儿体格发育情况新生儿平均出生体重为3308.2克,男婴3360.9克,女婴3249.0克,男婴高于女婴,两者具有统计学差异(t'=14.86,P=0.000)。男女婴的胎龄别曲线图在34周以前的曲线均不规则,34-42周之前曲线走向较平稳,P50曲线表现为男性在40周达到峰值,女性在41周达到峰值,之后有回落趋势,表明胎儿在胎龄达到41周后体重的发育速度可能有所减缓或停止。仅有男婴体重超过4500克。新生儿平均身长为49.6厘米,男婴498厘米,女婴49.5厘米,男婴长于女婴,差异具有统计学意义(t=8.17,P=0.000)。男婴身长的区间带宽于女性,男婴的身长发育变异相对较大,40周后基本停止发育。女婴身长的变异相对较小,身长在39周时基本停止发育,仅有男性身长超过55厘米。 3.早产的影响因素单因素分析表明妇女分娩年龄与早产率呈J型关系,35岁组的早产率为8.9%,小于20岁组的早产率为5.7%,25岁组分娩年龄早产率为4.0%；有早产史的妇女早产率为18.18%,远高于无早产史妇女的早产率(4.77%)；早产组中40.5%的妇女存在妊娠期疾病,高于足月产的24.2%；早产组中高危妊娠的比例为36.6%,足月产为15.5%；胎膜早破者中早产发生率为13.4%,高于未发生胎膜早破者的早产率(3.5%)；孕前消瘦的妇女早产率为8.0%,高于正常体重的妇女,也高于孕前超重和肥胖的妇女的早产率(5.5%左右)；孕期增重小于6千克的产妇,早产率为9.0%,而孕期增重在21千克以上者,早产率为2.9%,孕期增重越低,早产率越高。产妇分娩前BMI指数偏低者(BMI21),早产率高达15.3%,分娩前BMI指数在25-33之间者,早产率为4.2%。孕检次数过少者的早产率为5.9%,高于孕检次数在8次及以上的妇女的早产率(2.8%)。多因素分析结果表明分娩年龄≥35岁,有妊娠期疾病,胎膜早破,产检次数少,男婴是早产的危险因素(P0.05),优势比分别是：2.32,2.24,4.37,2.7,1.45。孕期增重高是早产的保护性因素,孕期增重≥21kg的妇女早产的风险只有孕期增重6kg的1/5。 4.巨大儿的影响因素单因素分析结果表明男婴巨大儿发生率为12.01%,女婴为7.54%；20-24岁年龄组巨大儿率为7.63%,25-29岁组上升至11.33%,30-34岁组上升至12.73%。孕周超过42周的妇女巨大儿发生率显箸上升至17.16%,而42周以内的妇女巨大儿发生率仅为9.69%。孕前BMI达到28的妇女巨大儿发生率高达18.45%,孕期增重超过18千克的妇女巨大儿发生率高达12.27%,产前保健较缺乏的妇女巨大儿发生率在12%以上。多因素分析结果表明男婴、产妇年龄在25岁及以上、过期产、孕前超重和肥胖,孕期增重超过18kg、孕20周后才进行首次产前检查、产检次数不详是巨大儿的危险因素,优势比分别1.81,1.33,1.91,1.98,3.20,1.80,3.60,1.85。 [结论] 1.三省六县农村地区出生人口质量不好,仅据孕周和出生体重两项客观指标计算,不良出生人口质量者占到总出生人口的15%以上。 2.欠发达、贫困农村地区巨大儿发生率高,10%的新生儿为巨大儿,且轻度巨大儿少,近20%的巨大儿体重超过4400克。 3.男婴巨大儿率显著高于女婴,尤其是在安徽省蒙城县和河南省泌阳县,男婴巨大儿率接近20%。 4.分娩年龄≥35岁,有妊娠期疾病,胎膜早破,产检次数少,男婴是早产的危险因素。孕期增重多是早产的保护性因素 5.男婴、产妇年龄在25岁及以上、过期产、孕前超重和肥胖,孕期增重超过18kg、孕20周后才进行首次产前检查、产检次数不详是巨大儿的危险因素。 [政策建议] 1.鼓励妇女在最佳生育年龄段生育,降低低龄产妇(20岁)和高龄产妇(35岁)的比例。 2.孕前健康状况的监测：通过公共卫生监测和相关研究机制,对妇女的孕前健康状况进行监测。将孕前保健服务和业已存在的地方公共卫生和相关领域的项目有机结合,既有普通人群干预策略又有高危人群干预策略。如计划怀孕的夫妇双方应当进行一次体检；调控好妇女BMI指数使其保持在理想范围后再计划怀孕；妊娠期控制血糖；开展疾病筛查,减少妊娠期疾病发生率。 3.两次怀孕之间的保健：对有不良妊娠结局(流产、死产、早产、低出生体重儿等)的妇女提供高危人群特别的干预措施。 4.开展深入研究,科学制定孕期适宜增重标准,提高孕产期保健水平,强调科学合理指导膳食的可操作性,并力争提供个性化的优生优育的指导。 5.提倡自然分娩,降低巨大儿,尤其是轻度巨大儿的剖宫产率。
[Abstract]:[research purposes]
General purpose: to understand the quality of birth population in rural areas of China and to explore its influencing factors.
Specific objectives:
1. to investigate the incidence of premature birth, low birth weight and macrosomia in six counties of Sichuan, Anhui and Henan provinces.
2. understand the characteristics of population and time distribution of premature birth rate, low birth weight rate and macrosomia rate in rural areas.
3. compare the standardized premature birth rate, low birth weight rate and macrosomia rate in six counties.
4. to understand the physical development of newborns with different gestational age.
5. to explore the effects of demographic characteristics, marital status, pregnancy diseases and prenatal care on preterm labor and macrosomia.
[research methods]
In this study, 25 medical institutions were selected in Sichuan (Shehong county and Lezhi county), Anhui province (Bengbu and Mengcheng county) and Henan province (Nanye county and Biyang county). The obstetric case of childbirth in January 1, 2008 to December 31, 2008 was sampled by random and cluster sampling method, and the self-made questionnaire was used to pick out the medical records. Descriptive research and standardized ideas were used to describe the three distribution characteristics of preterm birth, low birth weight, and the incidence of gigantic infants. Single factor analysis was performed by t test, chi square test was performed, and multivariate analysis was carried out by non conditional Logistic regression test.
[results]
A total of 17805 qualified questionnaires were obtained from the survey, with a final pass rate of 98.9%.
Three distribution of 1. rates
In this survey, 829 cases of premature infants in three provinces and six counties in six counties had a total incidence of 823 cases of low birth weight infants with a total incidence of 1765 cases of 4.62%. gigantic infants. The incidence of premature birth and low birth weight ratio in Lezhi County, Sichuan province was higher, respectively, 8.16% and 10.54%. Anhui province Bengbu preterm birth rate and large infant rate higher, respectively 6, respectively. .20% and 10.96%. in Mengcheng County of Anhui province and Biyang County of Henan province are high, both of which are higher than 15%. The premature birth rate and the huge infant rate of male baby are higher than that of the female baby. The low birth weight rate of the female baby is higher than that of the male baby. The male rate of male in Mengcheng County of Anhui province and Biyang County of Henan province is up to above 18%. The occurrence rate of large infants in spring is higher than the other three seasons. The seasonal difference was not found at the low weight rate.
2. physical development of newborns
The average birth weight of the newborn was 3308.2 grams, 3360.9 grams of male baby, 3249 gram of female baby, and the male baby was higher than female baby. The difference was statistically different (t'=14.86, P=0.000). The curve of the gestational age of boys and girls was irregular before 34 weeks, and the curve trend was more stable before 34-42 weeks. The P50 curve showed that the male reached the peak at 40 weeks and the female was 41 weeks. After reaching the peak, there was a downward trend, indicating that the fetal body weight development speed may be slowed down or stopped after 41 weeks of fetal age. Only male babies weight more than 4500 grams. The average length of the newborn was 49.6 cm, the male baby was 498 cm, the female baby was 49.5 cm, the male baby was longer than the female baby, the difference was statistically significant (t=8.17, P=0.000). The male baby was long. The length of the length of the male baby is relatively large, and the development of the female baby is relatively small after 40 weeks. The variation of the length of the female baby is relatively small, and the length of the baby is basically stopped at 39 weeks, only the male length exceeds 55 centimeters.
3. factors affecting preterm labor
The single factor analysis showed that the women's birth age and the premature birth rate were J type, the premature birth rate of 35 year old group was 8.9%, the premature birth rate of the group less than 20 years old was 5.7%, the birth rate of the 25 year old group was 4%, the preterm birth rate was 18.18%, which was far higher than that of the women without preterm birth (4.77%); and the women in the premature birth group were pregnant with pregnancy disease. The disease was higher than 24.2% of full term birth; the proportion of high risk pregnancy in premature delivery group was 36.6%, full term was 15.5%, premature rupture of membranes was 13.4%, higher than that of non premature rupture of membranes (3.5%); prematurely pregnant women were 8%, higher than normal weight women, and the preterm birth of women who were overweight and obese before pregnancy. Rate (about 5.5%); pregnant women with weight gain less than 6 kilograms, the rate of premature birth was 9%, and the weight gain in pregnancy was 21 kg, the premature birth rate was 2.9%, the higher the weight gain in pregnancy was, the higher the premature birth rate was, the prelabor BMI index was lower (BMI21), the preterm birth rate was 15.3%, the BMI index before childbirth was 25-33, the premature birth rate was too few 4.2%. pregnancies. The preterm birth rate was 5.9%, which was higher than that of women with 8 times of pregnancy (2.8%). The results of multiple factors analysis showed that the birth age was more than 35 years old, the pregnancy disease, the premature rupture of the membrane, the less frequency of production, the male baby was the risk factor of preterm birth (P0.05), and the advantage ratio was the protective cause of the premature birth in the 2.32,2.24,4.37,2.7,1.45. pregnancy. The risk of premature delivery in pregnant women with weight gain of less than 21kg is only 1/5. during pregnancy and 6kg.
4. influential factors of the giant children
The single factor analysis showed that the incidence of gigantic infants was 12.01% and 7.54% for women, 7.63% in 20-24 years old and 11.33% in 25-29 years old. The incidence of gigantic infants in 30-34 year old groups rose to 17.16% in 12.73%. weeks for more than 42 weeks, and the incidence of giant children in 42 weeks was only BMI before 9.69%. pregnancy. The incidence of gigantic children in 28 was up to 18.45%. The incidence of gigantic infants in women with more than 18 kilograms during pregnancy was 12.27%, and the incidence of huge children was more than 12%. The results of multiple factors analysis showed that the male infant was 25 years old and above, overdue, overweight and obesity before pregnancy, more than 18kg in pregnancy, 20 pregnancy. Zhou Houcai conducted the first prenatal examination. The number of birth defects was a risk factor for macrosomia. The odds ratios were 1.81,1.33,1.91,1.98,3.20,1.80,3.60,1.85.
[Conclusion]
The quality of the births in the rural areas of the 1. provinces and the six counties was not good, only according to the two objective indicators of pregnancy and birth weight, and the quality of the poor birth population accounted for more than 15% of the total birth population.
2. less developed, the incidence of macrosomia in poor rural areas is high, 10% of newborns are macrosomia, and mildly large children and young children. Nearly 20% of the macrosomia weigh more than 4400 grams.
3. the rate of macrosomia in boys was significantly higher than that in girls, especially in Mengcheng County of Anhui province and Biyang County of Henan province. The rate of macrosomia was close to 20%.
4. the childbearing age is more than 35 years old. There are gestational diseases, premature rupture of membranes, and fewer birth examinations. Boys are a risk factor for preterm delivery. Weight gain during pregnancy is a protective factor for premature delivery.
5. male baby, the maternal age is 25 years old and above, the expired birth, overweight and obesity before pregnancy, the weight gain over 18kg during pregnancy, the first antenatal examination after 20 weeks of pregnancy, and the risk factor of the unknown number of labor.
[policy recommendations]
1. encourage women to give birth at the best childbearing age, and reduce the proportion of young women (20 years old) and elderly parturients (35 years old).
2. monitoring of pre pregnancy health: monitoring pre pregnancy health of women through public health monitoring and related research mechanisms. Combining pre pregnancy health services with existing local public health and related fields, there are both general population intervention strategies and high-risk group intervention strategies, such as planned pregnant husband. Both sides should have a physical examination; control the women's BMI index to keep it in the ideal area and plan for pregnancy; pregnancy control blood sugar; disease screening to reduce the incidence of pregnancy disease.
3. health care between the two pregnancies: special intervention measures for women with adverse pregnancy outcomes (abortion, stillbirths, premature birth, low birth weight infants, etc.).
4. to carry out in-depth research, to scientifically formulate the appropriate weight gain standards during pregnancy, to improve the level of health care in pregnancy, to emphasize the operability of the diet scientifically and rationally, and to provide the guidance of individualized eugenics and nurture.
5. advocate natural childbirth and reduce the cesarean section rate of macrosomia, especially for children with mild macrosomia.
【学位授予单位】：北京协和医学院
【学位级别】：硕士
【学位授予年份】：2011
【分类号】：C924.25

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