中国农村地区死胎相关危险因素研究

发布时间：2018-07-10 03:51

  本文选题：死胎 + 危险因素　； 参考：《北京协和医学院》2017年硕士论文

【摘要】：研究目的:通过对“免费孕前优生健康检查”项目收集的数据进行整理分析,探讨我国农村地区死胎的相关危险因素。研究设计:数据来源为“国家免费孕前优生健康检查”项目自2010年1月至2012年12月收集的数据。该项目在全国31个省、市、自治区,220个区县进行多阶段分层抽样。来自全国的248501对计划在半年内怀孕的夫妻被纳入研究。通过问卷调查收集了夫妻怀孕前的社会人口学特征、孕产史、行为习惯、危险因素接触情况等暴露信息以及妻子怀孕后的相关暴露信息。妊娠结局通过医生填写记录。采用巢式病例对照研究,通过倾向值评分匹配的方法对于病例和对照进行1:8配对,校正混杂因素在病例组与对照组间的分布情况。主要采用t检验、卡方检验、多水平logistic回归分析对数据进行比较分析。结果:母亲年龄、教育程度、父亲职业、地域因素在病例组与对照组分布不均衡,且在各其他危险因素的暴露组与对照组间分布也有显著性差异,分析结果显示可能是暴露与结局间的潜在混杂因素,应在为病例匹配对照时予以校正。经过倾向值评分匹配后,病例组与对照组在匹配的因素上分布均衡。单因素分析结果显示,孕前母亲厌食蔬菜(OR=2.25,95%CI(1.16～4.39)),被动吸烟(OR=1.56,95%CI(1.01～2.41)),接触农药(OR=2.24,95%CI(1.26～3.97)),母亲感觉有生活/工作压力(OR= 1.37,95%CI(1.06～1.78))、与亲友同事关系紧张(OR=1.58,95%CI(0.99～2.53))、高血压(OR=1.73,95%CI(1.17～2.56));父亲吸烟(OR=1.28,95%CI(1.09～1.5)),饮酒(OR=1.22,95%CI(1.03～1.43)),接触有机溶剂(OR=1.71,95%CI(1.05～2.77)),父亲有生活/工作压力较大(OR=2.41,95%CI(1.37～4.23))均为死胎发生的危险因素。母亲补充叶酸为死胎的保护因素,与不补充叶酸相比,停经前至少3个月便开始补充叶酸OR=0.70(95%CI:0.58～0.85),停经前1-2月开始补充叶酸OR=0.71(95%CI:0.56～0.9),停经后补充叶酸的OR=0.78(95%CI:0.63～0.96),差异均有统计学意义。多水平logistic回归结果与单因素分析结果基本一致,在控制了水平二,省份的影响之后,个体水平的暴露因素中,母亲农药接触(OR=1.9,95%CI(1.06～3.39)),高血压(OR=1.58,95%CI(1.07～2.34)),厌食蔬菜(OR=1.99,95%CI(1.00～3.93)),服用叶酸及开始时间(与不服用叶酸相比,停经前至少3个月便开始补充叶酸OR=0.72(95%CI:(0.59～0.89),停经前 1-2月开始补充叶酸OR=0.71(95%CI(0.55～0.92),停经后补充叶酸OR=0.81,95%CI:(0.65～1.02)),压力(与无压力相比,感觉有一点压力组OR=1.34,95%CI(1.02～1.76)),均有统计学意义;父亲吸烟(OR=1.22,95%CI(1.02～1.46))、接触有机溶剂(OR=1.64,95%CI(1.01～2.69))有统计学意义。结论:母亲农药接触、厌食蔬菜、高血压、父亲吸烟、接触有机溶剂均为死胎的危险因素,母亲服用叶酸是死胎的保护因素。
[Abstract]:Objective: to study the risk factors of stillbirth in rural areas of China by analyzing the data collected from the item entitled "Free Pre-pregnancy Health examination". Research Design: data from the National Free Pre-Maternal Health screening Program from January 2010 to December 2012. The project carried out multi-stage stratified sampling in 31 provinces, municipalities, autonomous regions and 220 districts and counties. 248501 couples from across the country who plan to become pregnant within six months were included in the study. The social demographic characteristics, pregnancy history, behavior habits, risk factor exposure and other exposure information were collected by questionnaire. Pregnancy outcomes are recorded by a doctor. A nested case-control study was used to match the distribution of confounding factors between the case group and the control group at 1:8 by means of the tendency score matching method to correct the distribution of the confounding factors between the case group and the control group. T test, chi-square test and multi-level logistic regression analysis were used to compare and analyze the data. Results: the age of mother, education level, father's occupation, geographical factors were not evenly distributed between the case group and the control group, and there were significant differences between the exposure group and the control group of other risk factors. The results suggested that it might be a potential confounding factor between exposure and outcome and should be corrected for case matching. After the tendency score was matched, the distribution of matching factors between the case group and the control group was balanced. The results of single factor analysis show that 瀛曞墠姣嶄翰鍘岄�熻敩鑿�(OR=2.25,95%CI(1.16锝，

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