孕妇收缩压变化轨迹与新生儿胎龄体重的关联性研究  

Association between SBP Trajectory Pattern of Pregnant Women and Neonatal Weight by Gestational Age

作　　者：胡浩 冯佩 喻茜 朱蔚 郭倩岚 李红美[1] Hu Hao;Feng Pei;Yu Qian(Department of Epidemiology and Biostatistics,School of Public Health Medical College of Soochow University(215123),Suzhou)

机构地区：[1]苏州大学医学部公共卫生学院流行病与卫生统计学教研室,215123 [2]昆山市妇幼保健院

出　　处：《中国卫生统计》2021年第1期28-32,38,共6页Chinese Journal of Health Statistics

基　　金：江苏省自然科学基金面上项目(BK20181438)。

摘　　要：目的探讨妊娠期女性收缩压轨迹的变化模式与新生儿胎龄体重的关系。方法采用回顾性队列研究,收集江苏省昆山地区2013-2017年进行产检建卡(孕8~14周)并单胎分娩的63724名孕妇及其新生儿的资料,主要包括孕妇一般人口学特征、疾病史、妊娠期血压监测记录、分娩信息,新生儿出生性别、体重等。通过SAS软件Proc Traj程序将孕妇妊娠期收缩压变化轨迹模式分为四类,即低-稳定轨迹型、正常-稳定轨迹型、高-正常轨迹型、正常-高轨迹型,并根据分娩周数、性别及出生体重将新生儿出生体重分为小于胎龄儿(smaller for gestional age, SGA)、适于胎龄儿(appropriate for gestional age, AGA)及大于胎龄儿(larger for gestional age, LGA)。采用无序多分类logistic回归模型分析孕妇不同的血压轨迹变化模式与SGA及LGA的关联性。结果低-稳定型、正常-稳定型、高-正常型、正常-高型中SGA发生率分别为8.39%、8.37%、11.79%、16.12%,四组间的差异具有统计学意义;而四种不同血压轨迹组LGA发生率分别为10.09%、11.63%、13.10%、11.81%,四组间差异亦有统计学意义。调整混杂因素后,在多因素logistic回归分析中,与低—稳定型相比,正常-稳定型,高-正常型,正常-高型发生SGA的风险增加,其OR值(95%CI)分别为1.19(1.13~1.25)、1.52(1.02~2.32)、2.21(1.80~2.51),而不同的血压轨迹模式与LGA的关联性未发现有统计学意义。结论无论是妊娠早期高SBP还是妊娠期SBP过度升高均增加SGA发生的风险。Objective To evaluate the associations between the pattern of systolic blood pressure(SBP)trajectory of pregnant women and the birthweight by gestational age.Methods 63724 pregnant women with single pregnancy and their newborns registered between January 2013 and December 2017 in Kunshan,were investigated by a retrospective cohort study.Demographic characteristics at≤14 weeks of gestation,history of diseases,blood pressure monitoring records and delivery information for pregnant women,and neonatal sex,weigh were collected.The trajectory patterns of SBP were divided into four groups:low-stable group,normal-stable group,high-normal group and normal-high group.According to gestational weeks,sex and birth weights,neonates were divided into smaller for gestational age(SGA),appropriate for gestational age(AGA)and larger for gestational age(LGA).The multivariate logistic regression model was used to analyze the association between blood pressure trajectories and birth weight in neonates.Results The incidence of SGA in low-stable,normal-stable,high-normal and normal-high SBP groups was 8.39%,8.37%,11.79%and 16.12%,respectively,and there were significant differences among the four groups.The incidence of LGA in four different blood pressure trajectory groups was 10.09%,11.63%,13.10%and 11.81%.After adjusting for confounding factors,the logistic regression analysis showed that compared with the low stable group,the normal-stable group,the high-normal group and the normal-high group of SBP had higher risks of SGA,with OR values(95%CI)of 1.19(1.13~1.25)、1.52(1.02~2.32)、2.21(1.80~2.51).However,the incidence of LGA was not associated with the trajectory patterns of SBP.Conclusion Both high SBP in early pregnancy and excessive SBP increase during pregnancy are risk patterns for SGA.

关 键 词：收缩压轨迹 小于胎龄儿 大于胎龄儿 队列研究 

分 类 号：R714[医药卫生—妇产科学]