首次和再次分娩孕产妇的人口社会学特征及妊娠合并症分布比较:基于一项全国16省24家医院的横断面研究  

Distribution of demographic sociological characteristics and co-morbidities among primiparous and multiparous pregnant females: a national cross-sectional study of 24 hospitals in 16 provinces

作　　者：齐亚娜 谭婧[1] 孙鑫[1] 何国琳[2] 杨红梅[2] 刘兴会[2] 高岩[3] 刘秀丽[4] 周玮[5] 贺晶[6] 陈璐[6] 张雪芹 张红萍 汪云 徐秀芬 邹丽[10] 肖梅[11] 彭敏[11] 赵先兰[12] 周艳[12] 唐卉[13] 曹引丽 袁宁霞[15] 李红梅[16] 丁桂凤 彭艳 刘彩霞[18] 乔宠[18] 战芳 阴春霞[20] 蔡雁[21] 范玲[22] 李介岩[22] 陈叙[23] 张国华[24] 张洁文[25] QI Yana;TAN Jing;SUN Xin;HE Guolin;YANG Hongmei;LIU Xinghui;GAO Yan;LIU Xiuli;ZHOU Wei;HE Jing;CHEN Lu;ZHANG Xueqin;ZHANG Hongping;WANG Yun;XU Xiufen;ZOU Li;XIAO Mei;PENG Min;ZHAO Xianlan;ZHOU Yan;TANG Hui;CAO Yinli;YUAN Ningxia;LI Hongmei;DING Guifeng;PENG Yan;LIU Caixia;QIAO Chong;ZHAN Fang;YIN Chunxia;CAI Yan;FAN Ling;LI Jieyan;CHEN Xu;ZHANG Guohua;ZHANG Jiewen(Chinese Evidence-based Medicine Center,West China Hospital,Sichuan University,Chengdu,610041,P.R.China;West China Second University Hospital,Sichuan University/West China Women's and Children's Hospital,Chengdu,610041,P.R.China;Sichuan Provincial Hospital for Women and Children,Chengdu,610045,P.R.China;Panzhihua Central Hospital,Panzhihua,617000,P.R.China;Chongqing Health Center for Women and Children,Chongqing,400010,P.R.China;Women's Hospital School of Medicine,Zhejiang University,Hangzhou,310006,P.R.China;Xiamen Medical Center for Women and Children,Xiamen,361003,P.R.China;Wenzhou People's Hospital,Wenzhou,325000,P.R.China;Suzhou Second People's Hospital/Suzhou Municipal Hospital,Suzhou,215002,P.R.China;Union Hospital,Tongji Medical College,Huazhong University of Science and Technology,Wuhan,430022,P.R.China;Maternal and Child Health Hospital of Hubei Province,Wuhan,430070,P.R.China;The First Affiliated Hospital of Zhengzhou University,Zhengzhou,450000,P.R.China;The First Affiliated Hospital ofGuangxi Medical University,Nanning,530021,P.R.China;Shanxi Provincial Hospital for Women and Children/Northwest Women's and Children's Hospital,Xi'an,710000,P.R.China;The Second Affiliated Hospital of Shanxi University of Traditional Chinese Medicine,Xianyang,712000,P.R.China;Yan'an University Affiliated Hospital,Yanan,716000,P.R.China;Maternal and Child Health Hospital of Urumchi,Xinjiang,Urumchi,830000,P.R.China;Shengjing Hospital of China Medical University,Shenyang,110004,P.R.China;Maternal and Child Health Hospital of Dalian,Dalian,116000,P.R.China;Changchun Obstetrics-Gynecology Hospital,Changchun,130042,P.R.China;The Fourth Affiliated Hospital of Harbin

机构地区：[1]四川大学华西医院中国循证医学中心,成都610041 [2]四川大学华西第二医院,成都610041 [3]四川省妇幼保健院,成都610045 [4]攀枝花市中心医院,四川攀枝花617000 [5]重庆市妇幼保健院,重庆400010 [6]浙江大学医学院附属妇产科医院,杭州310006 [7]厦门市妇幼保健院,福建厦门361003 [8]温州市人民医院,浙江温州325000 [9]苏州市第二人民医院,(苏州市立本部医院),江苏苏州215002 [10]华中科技大学同济医学院附属协和医院,武汉430022 [11]湖北省妇幼保健院,武汉430070 [12]郑州大学附属第一医院,郑州450000 [13]广西医科大学附属第一医院,南宁530021 [14]陕西省妇幼保健院,(西北妇女儿童医院),西安710000 [15]陕西中医药大学第二附属医院,陕西咸阳712000 [16]延安大学附属医院,陕西延安716000 [17]乌鲁木齐妇幼保健院/新疆妇幼保健院,乌鲁木齐830000 [18]中国医科大学附属盛京医院,沈阳110004 [19]大连市妇幼保健院,辽宁大连116000 [20]长春市妇产医院,长春130042 [21]哈尔滨医科大学附属第四医院,哈尔滨150001 [22]首都医科大学附属北京市妇产医院,北京100006 [23]天津市中心妇产科医院,天津300100 [24]石家庄第四医院,石家庄050011 [25]首都医科大学附属北京友谊医院,北京100050

出　　处：《中国循证医学杂志》2020年第2期134-143,共10页Chinese Journal of Evidence-based Medicine

基　　金：国家自然科学基金项目(编号:71704122);国家重点研发计划项目(编号:2016YFC1000406)

摘　　要：目的基于我国全面实施"二孩"政策背景,了解首次和再次分娩孕产妇的人口社会学特征与妊娠合并症分布差异,为临床风险管理与医疗资源合理配置提供基线数据。方法 2016年9月19日~11月20日,以全国16个省(直辖市、自治区)24家医院作为调查点,问卷收集医院产科门诊就诊孕产妇的人口社会学、产科等方面信息,统计描述首次与再次分娩孕产妇的人口社会学特征与妊娠合并症分布情况,采用t检验和χ~2检验进行统计分析。结果共调查了12 403例孕产妇,其中首次和再次分娩孕产妇分别为8 268例(66.7%)和4 135例(33.3%)。华东地区再次分娩人群占比最高(931/2 008,46.4%),东北最低(385/2 179,17.7%)。再次分娩孕产妇相对首次分娩者,35岁及以上人群占比较高(30.6%vs. 6.5%);高中/中专及以下文化程度(29.7%vs. 16.9%)、职业以体力劳动为主或未工作(49.2%vs. 42.5%)、非当地居民(12.7%vs. 10.5%)、家庭年收入12万及以上(41.3%vs.33.3%)人群占比较高;孕前体重指数≥24 kg/m^2(13.6%vs. 9.9%)、人工流产(44.9%vs. 24.0%)和孕次≥4次(23.8%vs.3.1%)的占比较高;采用辅助生殖技术怀孕的占比较低(2.3%vs. 4.7%)。所有孕产妇前五位的妊娠合并症依次是妇科疾病(5.5%)、甲状腺疾病(5.4%)、血液系统疾病(5.0%)、消化系统疾病(4.2%)和乙肝(2.5%)。再次分娩孕产妇的血液系统疾病、乙肝、慢性高血压的构成比分别是5.7%、3.1%、0.6%,相对首次分娩孕产妇(4.7%、2.2%、0.2%)较高,而甲状腺疾病、多囊卵巢综合征、免疫系统疾病的构成比相对较低。妊娠合并症在再次分娩孕产妇中的构成比存在地区差异。以上差异均有统计学意义(P<0.05)。结论首次与再次分娩孕产妇的人口社会学特征与多种妊娠合并症构成比存在差异。应根据孕产妇基线与产科特征进行临床风险管理,针对不同地区重点疾病进行资源配置。Objectives To understand the distribution of demographic sociological characteristics and comorbidities among primiparous and multiparous pregnant females under China’s universal two-child policy,so as to provide baseline data for clinical high-risk management and medical resources allocation.Methods We included pregnant females from 24 hospitals in 16 provinces(municipality,autonomous region)of China and collected their demographic sociological characteristics and obstetrics information by questionnaires from September 19thto November 20th,2016.We then used descriptive analysis to present the distribution of demographic sociological characteristics and pregnancy co-morbidities among primiparous and multiparous females and compared differences between groups by t test or Chi-square test.Results Among 12403 investigated pregnant females,8268(66.7%)were primiparous and 4135(33.3%)were multiparous,with highest proportion in East(931/2008,46.4%)and lowest in Northeast(385/2179,17.7%).Multiparous females compared to primiparous females,were more likely to be elderly than 35 years(accounting for 30.6%vs.6.5%),lower educated with high school or below(29.7%vs.16.9%),occupied in physical labor or unemployed(49.2%vs.42.5%),non-local residents(12.7%vs.10.5%),family annual income higher than 120 thousand yuan(41.3%vs.33.3%),pre-pregnancy body mass index≥24 kg/m2(13.6%vs.9.9%),history of artificial abortions(44.9%vs.24.0%),or pregnancies≥4 times(23.8%vs.3.1%)and were less likely to receive assisted reproductive technology(2.3%vs.4.7%).The most common co-morbidities were gynecology disease(5.5%),thyroid disease(5.4%in all females),blood system disease(5.0%),digestive system disease(4.2%)and hepatitis B infection(2.5%).Multiparous females compared to primiparous females,had higher proportions of blood system disease(5.7%vs.4.7%),hepatitis B infection(3.1%vs.2.2%)and chronic hypertension(0.6%vs.0.2%),however,lower proportions with thyroid diseases,polycystic ovary syndrome,and immune system diseases,whose distribution also

关 键 词：首次分娩 再次分娩 产次 妊娠合并症 多中心调查 横断面研究 

分 类 号：R714.2[医药卫生—妇产科学] C92-05[医药卫生—临床医学]