平谷区中医孕前体质干预对促进婴儿智能发育的效果评价

发布时间：2018-07-17 22:08

【摘要】：研究背景开展孕前保健工作可以从源头上消除或减少日后不良妊娠结局发生的几率,有效提高妇女及其后代健康水平,降低卫生保健服务的费用。如今我国计划生育基本国策面临重大调整,"全面二孩"政策正式实施,放宽生育限制后我国人口形势也将发生重大变化。新的人口发展形势下,加快完善孕前保健服务,切实保障母婴健康,是符合国情的必然选择。中医优生干预在孕前保健中有其独特的优势,通过中医保健措施来促进育龄妇女及后代健康兼具针对性和安全性,具有重要的现实意义。已有研究显示,基于中医体质学的孕前优生干预不仅能够改善育龄妇女体质,还可以减少孕期并发症及新生儿疾病的发生。目前常规的孕前优生干预措施仍主要以西医为基础,中医孕前优生干预尚未大规模普及,拥有巨大的发展空间。另外,孕前体质干预研究多局限于对育龄妇女体质改善的效果评价,评估对其后代健康影响时也仅限于如身高、体重等体格发育指标,对智能发育的影响评价仍处于空白阶段,因而开展有关孕前体质干预对促进婴儿智能发育的效果评价研究势在必行。研究目的本研究通过比较中医孕前体质干预对象与常规孕前干预对象所生婴儿智能发育水平的差异,为探索中医孕前优生干预对婴儿智能发育的影响提供科学依据及数据支持,可为日后将中医体质学应用于孕前保健领域、推进优生优育工作的顺利开展提供建议。研究方法采用现场试验研究的方法,选择北京市平谷区作为研究现场,按照社会经济发展状况基本可比原则,将平谷区划分为两个区域,随机设置试验区与对照区。采取整群抽样的方法,筛选所有符合干预对象纳入标准的育龄妇女,按照其所在乡镇的分组情况,依次进入试验组和对照组,对试验组妇女实施中医体质干预与常规优生干预相结合的干预措施,对照组妇女实施常规孕前优生干预。(1)对所有干预对象进行追踪随访,待其怀孕并生产后,采用格赛尔婴幼儿智能发育量表对孕前体质干预组与常规优生干预组育龄妇女所生婴儿在满6、9、12月龄时进行智能发育水平测评,比较两组婴儿大运动及语言能区发育商得分差异;(2)采用分层分析法对混杂因素进行调整,进一步比较婴儿大运动及语言能区发育商组间差异。研究结果1.研究对象基本情况干预后一年内,孕前体质干预试验组妇女怀孕率为80.49%,常规优生干预对照组怀孕率为78.65%,经检验两组妇女怀孕率无统计学差异。根据研究对象纳入与排除标准,共纳入131例婴儿及其母亲,其中试验组64例,对照组67例。婴儿母亲年龄、文化程度、职业、家庭人均月收入分布情况在两组间均无显著性差异。婴儿母亲平均年龄为26.09岁,中专以上文化程度居多,占94.66%,工作方面以私营企业与个体经营者居多,合计46.56%,其次是在事业单位与公务员或国企工作者,占35.11%。除婴儿母亲妊娠期被动吸烟率在组间差异有统计学意义外(P=0.03),其它妊娠相关情况包括妊娠期患病、营养不良及分娩方式在两组间均无显著性差异。孕前体质干预试验组和常规优生干预对照组婴儿性别、喂养方式、添加辅食时间及早期教育情况无统计学差异,两组均未见患苯丙酮尿症、高胆红素血症等影响智能发育的新生儿疾病的婴儿。2.婴儿母亲体质干预效果干预前,孕前体质干预试验组和常规优生干预对照组婴儿母亲平和质得分无显著性差异(P=0.78)。3个月干预后,试验组婴儿母亲平和质得分均值由59.23±13.69提升至64.52±16.95,干预前后平和质得分均值差为5.29±14.97,对照组婴儿母亲的平和质得分均值由60.49±13.36变为60.74±12.45,干预前后平和质均值差为0.25±13.29;两组婴儿母亲干预前后平和质得分均值差经检验具有统计学差异(P=0.03),试验组婴儿母亲平和质得分变化高于对照组婴儿母亲平和质得分的变化,中医孕前体质干预对育龄人群偏颇体质的改善效果优于常规优生干预的效果。3.试验组与对照组婴儿体格发育比较采用重复测量方差分析法比较两组婴儿的身长、体重,组内效应的检验结果显示,婴儿身长6、9、12月龄三个测试时点间具有显著性差异(P=0.00),婴儿体重在3个测试时点间同样具有显著性差异(P=0.00),孕前体质干预试验组和常规优生干预对照组婴儿身长、体重均随着时间而增长;组间效应方差分析结果表明,孕前体质干预试验组和常规优生干预对照组妇女生育的婴儿在身长方面无显著性差异(P=0.43),两组婴儿在体重方面同样无显著性差异(P=0.84)。4.试验组与对照组婴儿智能发育比较对试验组和对照组婴儿6、9、12月龄的大运动及语言领域智能发育水平进行重复测量方差分析。组内效应的检验结果显示婴儿大运动及语言能区发展商在6、9、12月龄三个时点间无统计学差异。组间效应方差分析结果显示试验组和对照组妇女生育的婴儿在大运动及语言能区发展商均无显著性差异(P0.05)。鉴于本研究婴儿母亲妊娠期被动吸烟情况在试验组和对照组间并不均衡,可能造成混杂影响,对婴儿母亲妊娠期有无被动吸烟情况进行分层分析,在控制了潜在混杂因素后,孕前体质干预试验组和常规优生干预对照组妇女生育的婴儿大运动及语言能区智能水平均无显著性差异(P0.05)。结论1.体格发育方面,孕前体质干预试验组与常规优生干预对照组婴儿身长、体重均未见显著性差异(P0.05)。2.试验组与对照组婴儿大运动及语言能区发展商均未见显著性差异(P0.05)。控制了妊娠期被动吸烟因素影响后对试验组与对照组婴儿大运动及语言能区发展商进行比较,两组婴儿大运动及语言能区发育水平仍未见显著性差异(P0.05)。3.本研究结果尚不能确定在育龄妇女中实施孕前优生干预对其生育婴儿在身长、体重以及大运动、语言能区发育方面是否存在促进效果,需扩大样本量、延长干预时间展开进一步研究。
[Abstract]:Research background to carry out pre pregnancy health care work can eliminate or reduce the incidence of adverse pregnancy outcomes from the source, improve the health level of women and their offspring and reduce the cost of health care services. Today, the basic national policy of family planning in China is faced with a major adjustment, the "overall two child" policy is formally implemented and after the birth restriction is relaxed, I In the new population development situation, it is an inevitable choice to accelerate the improvement of pre pregnancy health service and ensure the health of mother and child. The intervention of traditional Chinese medicine has its unique advantages in pre pregnancy health care and the health care measures of traditional Chinese medicine to promote the health and safety of women and children of childbearing age. Sex is of great practical significance. Previous studies have shown that pre pregnancy intervention based on physical constitution of traditional Chinese medicine can not only improve the physical fitness of women of childbearing age, but also reduce the complications of pregnancy and the occurrence of neonatal diseases. The current intervention measures for prepregnancy eugenics are still based on Western medicine, and the intervention of prepregnancy eugenics is not large in large scale. In addition, there is a huge space for development. In addition, pre pregnancy physical intervention studies are mostly limited to the evaluation of the effect of physical improvement on women of childbearing age. The assessment of the health effects on their offspring is limited to the physical development indicators such as height and weight, and the evaluation of the influence of intellectual development is still in the empty stage. It is imperative to study the effect evaluation of infant intelligence development. The purpose of this study is to provide scientific basis and data support for exploring the influence of pre pregnancy eugenic intervention on infant intelligence development by comparing the difference of the level of intellectual development of infants born before pregnant and prepregnancy intervention. Medical physique is applied to the field of pre pregnancy health care and advices on the smooth development of eugenic and eugenic work. The method of field experiment is used to select Pinggu District of Beijing as the research site. According to the basic principle of social and economic development, the Pinggu zoning is divided into two regions, and the experimental area and the control area are randomly set up. The method of cluster sampling was adopted to screen all the women of childbearing age who were in accordance with the standard of intervention. According to the group situation in the villages and towns in which they were located, they entered the experimental group and the control group in turn. The intervention measures were carried out to the women in the experimental group, and the control group was treated with the routine prepregnancy intervention. (1) All the subjects were followed up, and after their pregnancy and production, the intelligence development level of the pre pregnancy physical intervention group and the conventional eugenic intervention group was evaluated by the Gesell infant intelligence development scale, and the differences in the scores of the two groups were compared in the two groups. (2) A stratified analysis was used to adjust the confounding factors to further compare the difference between the big sports and the developmental quotient groups in the language energy area. Results 1. in the first year of the study, the pregnancy rate of women in the pre pregnancy physical intervention group was 80.49%, the pregnancy rate in the routine eugenics intervention group was 78.65%, and the pregnancy rate of two groups of women was tested. There was no statistical difference. According to the inclusion and exclusion criteria, 131 infants and their mothers were included, including 64 cases in the experimental group and 67 cases in the control group. There was no significant difference between the infant mother's age, educational level, occupation and family per capita monthly income distribution between the two groups. The average age of the baby mother was 26.09 years, and the secondary school and higher education level was at the higher level. More, accounting for 94.66%, the majority of the work in the private sector and the individual operator, the total number of 46.56%, secondly in the institutions and civil servants or state-owned enterprises workers, 35.11%. except infant mother pregnancy passive smoking rate between groups is statistically significant (P=0.03), other pregnancy related pregnancy related conditions include pregnancy disease, malnutrition and childbirth There was no significant difference between the two groups. There was no statistical difference between the pre pregnancy physical intervention test group and the routine eugenics intervention control group, the feeding mode, the supplementary feeding time and the early education situation, and the two groups did not have the infant.2. infant's constitution of infantile diseases such as hyperbilirubinuria and hyperbilirubinemia. Before intervention, there was no significant difference (P=0.78) between pre pregnancy physical intervention test group and routine eugenic intervention control group (P=0.78) for.3 months, the average score of level and quality of infant mother in test group increased from 59.23 + 13.69 to 64.52 + 16.95, and the average difference of level and quality score before and after intervention was 5.29 + 14.97, and the control group of infant mother The average average score of the level and quality of the parents changed from 60.49 + 13.36 to 60.74 + 12.45, and the average difference between the level and quality of the parents before and after intervention was 0.25 + 13.29. The average difference between the average level and quality score of the two groups of infants before and after intervention was statistically different (P=0.03). The changes in the level of level and quality of the mothers of the infants in the experimental group were higher than that in the control group. The effect of pre pregnancy physical intervention on the physique of children of childbearing age was better than that of conventional eugenics..3. test group and control group compared with the control group, the body length, weight, and Intraday Effect of the two groups of infants were compared with the control group. The results showed that the three time points of the baby's length of age were obvious between the three test points. In P=0.00, the baby body weight was also significantly different between the 3 test time points (P=0.00). The pre pregnancy physical intervention test group and the routine eugenics control group had long body weight, and the body weight increased with the time. The results of the inter group effect variance analysis showed that the pre pregnancy physical intervention test group and the routine eugenics intervention control group were pregnant women. There was no significant difference in the length of body length (P=0.43), and there was no significant difference in weight between the two groups of infants (P=0.84) the.4. test group and the control group were compared with the control group for the repeated measurement of variance analysis of the large exercise and the intelligence development level in the language field of the experimental and control groups at the age of 6,9,12. The test of intra group effect The results showed that there was no statistical difference between the big sports and the language energy area developers at the three time points of 6,9,12 months. The results of the inter group effect variance analysis showed that there was no significant difference between the test group and the control group in the big sports and the language area developers (P0.05). The disequilibrium between the experimental group and the control group may result in a mixed effect. There is a stratified analysis on whether the baby's mother has no passive smoking during pregnancy. After controlling the potential confounding factors, there is no significant difference between the pre pregnancy physical intervention test group and the routine eugenics control group. Difference (P0.05). Conclusion 1. body development, pre pregnancy physical intervention test group and routine eugenics control group have no significant difference (P0.05) there is no significant difference (P0.05) between the.2. test group and the control group, there is no significant difference between the big sports and the language energy area developers (P0.05). After the control of the influence of pregnancy passive smoking factors on the experimental group Compared with the control group, there was no significant difference between the two groups of big sports and language energy area developers (P0.05).3.. The results of this study were not determined to determine whether the prenatal eugenics were implemented in women of childbearing age for their fertility, body weight and large exercise, and the development of language energy areas. To promote the effect, we need to expand the sample size and extend the intervention time to further study.
【学位授予单位】：北京中医药大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R211

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