妊娠高血压综合征、剖宫产与围产儿死亡关系的前瞻性研究  

Association between pregnancy-induced hypertension, cesarean delivery and perinatal mortality： a prospective study

作　　者：叶荣伟[1] 刘英惠[1] 马蕊[1] 任爱国[1] 刘建蒙[1] 

机构地区：[1]北京大学生育健康研究所,100191

出　　处：《中华流行病学杂志》2009年第9期891-894,共4页Chinese Journal of Epidemiology

摘　　要：目的前瞻性评价妊娠高血压综合征（妊高征）严重程度及发病时间与围产儿死亡危险的关系。方法研究对象为1995--2000年在浙江省嘉兴地区7县（市）孕满28周分娩出生的134858名单胎儿及其母亲。根据是否发生妊高征建立研究队列。资料来源于监测系统的记录。应用logistic回归模型控制混杂因素，估计相对危险度（OR）及95％可信区间（CI）。结果非妊高征组和妊高征组的围产儿死亡率（95％CI）分别为7．6％。（7．1～8．1）和9．2‰（7．7～10．8）；剖宫产率分别为45．7％和55．7％。与非妊高征组相比，妊高征组围产儿死亡的OR值（95％CI）为1．21（1．01～1．46）；轻度、中度和重度妊高征组分别为0．97（0．77～1．22）、1．73（1．26～2．37）和2．01（1．18～3．43）；产时、孕晚期和孕中期发病组分别为0．99（0．77～1．26）、1．39（1．05～1．84）和2．69（1．54～4．69）。调整母亲分娩时年龄、职业、文化程度、产次、产前检查次数、新生儿性别、妊娠期疾病和剖宫产后，妊高征组围产儿死亡的OR值（95％CI）为1．09（0．90～1.31）；轻度、中度和重度妊高征组分别为0．81（0．64～1．02）、1．94（1．41～2．67）和3．32（1．92～5．75）；产时、孕晚期和孕中期发病组分别为0．82（0．63～1．05）、1．51（1．14～2．00）和2．67（1．52～4．70）。结论妊高征病情越重、发病时间越早，围产儿死亡危险越高；剖宫产可降低妊高征患者的围产儿死亡危险。Objective To examine the relationship between pregnancy-induced hypertension （PIH） and risks of perinatal mortality. Methods A population-based, retrospective cohort study was conducted based on 134 858 women registered in a perinatal health care surveillance system and delivered singleton births between 1995 to 2000 in Zhejiang province, China. Multivariate logistic regression models were employed to estimate the relative risk （OR） and 95% CI. Results The perinatal mortality rate （95%CI）was 7.6 per thousand （7.1-8.1） in normotensive women and 9.2 per thousand （7.7-10.8） in PIH women. The cesarean delivery rate was 45.7% in normotensive women and 55.7% in groups with PIH. When compared with the normotensive women, the unadjusted OR （95%CI） for perinatal mortality was 1.21 （1.01-1.46） in groups with PIH; 0.97 （0.77-1.22） in groups with mild PIH, 1.73（1.26-2.37） in groups with moderate PIH, and2.01 （1.18-3.43） in groups with severe PIH; 0.99 （0.77-1.26） in groups with PIH developed before delivery, 1.39（1.05-1.84） in groups with PIH developed in second trimester, and 2.69（1.54-4.69） in groups with PIH developed in third trimester. After controlling for maternal age, occupation, educational attainment, parity, times of prenatal visit, infant＇s sex, pregnancy complications and cesarean delivery, the OR （95% CI） for perinatal mortality was 1.09 （0.90-1.31 ） in women with PIH when compared with the normotensive groups. The adjusted OR for perinatal mortality was 0.81 （0.64-1.02） in groups with mild PIH, 1.94 （1.41-2.67） in groups with moderate PIH, and 3.32 （1.92-5.75） in groups with severe PIH; 0.82 （0.63-1.05） in groups with PIH developed before delivery, 1.51 （1.14-2.00） in groups with PIH in second trimester, and 2.67 （1.52-4.70） in groups with PIH in third trimester. Conclusion Moderate and severe PIH early developed during pregnancy could increase the risk of perinatal mortality, while cesarean delivery could decrease the risks

关 键 词：妊娠高血压综合征 围产儿死亡 前瞻胜研究 

分 类 号：R714.246[医药卫生—妇产科学] R714.7[医药卫生—临床医学]