妊娠间隔对经产妇妊娠结局的影响多中心回顾性研究  

Effects of interpregnancy interval on pregnancy outcomes of subsequent pregnancy:a multicenter retrospective study

作　　者：隽娟 杨慧霞[1] 魏玉梅[1] 宋耕[1] 苏日娜[1] 陈叙[2] 杨秋红[3] 顔建英 肖梅[5] 李颖[6] 崔世红[7] 胡娅莉[8] 赵先兰[9] 樊尚荣[10] 冯玲 张眉花[12] 马玉燕[13] 尤子善 孟海霞[15] 刘海蔚[16] 朱莹 吴春凤[18] 蔡雁[19] 胡可佳 丁虹娟[21] Juan Juan;Yang Huixia;Wei Yumei;Song Geng;Su Rina;Chen Xu;Yang Qiuhong;Yan Jianying;Xiao Mei;Li Ying;Cui Shihong;Hu Yali;Zhao Xianlan;Fan Shangrong;Feng Ling;Zhang Meihua;Ma Yuyan;You Zishan;Meng Haixia;Liu Haiwei;Zhu Ying;Wu Chunfeng;Cai Yan;Hu Kejia;Ding Hongjuan(Department of Obstetrics and Gynecology,Peking University First Hospital,Beijing 100034,China;Department of Obstetrics,Tianjin Central Obstetrics and Gynecology Hospital,Tianjin 300052,China;Department of Obstetrics,Jinan Maternal and Child Health Hospital,Jinan 250000,China;Department of Obstetrics,Fujian Maternal and Child Health Hospital,Fuzhou 350001,China;Department of Obstetrics,Maternal and Child Hospital of Hubei Province,Wuhan 430070,China;Department of Obstetrics,Dalian Maternity Hospital,Dalian 116033,China;Department of Obstetrics and Gynecology,the Third Affiliated Hospital of Zhengzhou University,Zhengzhou 450052,China;Department of Obstetrics and Gynecology,Nanjing Drum Tower Hospital,the Affiliated Hospital of Nanjing University Medical School,Nanjing 210008,China;Department of Obstetrics and Gynecology,the First Affiliated Hospital of Zhengzhou University,Zhengzhou 450052,China;Department of Obstetrics,Peking University Shenzhen Hospital,Shenzhen 518036,China;Department of Obstetrics and Gynecology,Tongji Hospital,Tongji Medical College,Huazhong University of Science and Technology,Wuhan 430030,China;Department of Obstetrics,Taiyuan Maternal and Child Health Hospital,Taiyuan 030012,China;Department of Obstetrics and Gynecology,Qilu Hospital of Shandong University,Jinan 250012,China;Department of Obstetrics and Gynecology,Suzhou Jiulong Hospital Affiliated to Shanghai Jiaotong University,Suzhou 320571,China;Department of Obstetrics,Affiliated Hospital of Inner Mongolia Medical University,Huhhot 010050,China;Department of Endocrinology,Hainan General Hospital,Haikou 570311,China;Department of Obstetrics and Gynecology,Harbin Red Cross Central Hospital,Harbin 150070,China;Department of Obstetrics,the First Affiliated Hospital of Harbin Me

机构地区：[1]北京大学第一医院妇产科,100034 [2]天津市中心妇产科医院产科,300052 [3]济南市妇幼保健院产科,250000 [4]福建省妇幼保健院产科,福州350001 [5]湖北省妇幼保健院产科,武汉430070 [6]大连市妇产医院产科,116033 [7]郑州大学第三附属医院妇产科,450052 [8]南京大学医学院附属鼓楼医院妇产科,210008 [9]郑州大学第一附属医院妇产科,450052 [10]北京大学深圳医院产科,518036 [11]华中科技大学同济医学院附属同济医院妇产科,武汉430030 [12]太原市妇幼保健院产科,030012 [13]山东大学齐鲁医院妇产科,济南250012 [14]上海交通大学附属苏州九龙医院妇产科,320571 [15]内蒙古医科大学附属医院产科,呼和浩特010050 [16]海南省人民医院内分泌科,海口570311 [17]哈尔滨红十字中心医院妇产科,150070 [18]哈尔滨医科大学第一附属医院产科,150001 [19]哈尔滨医科大学第四附属医院妇产科,150001 [20]北京市顺义区医院产科,101300 [21]南京市妇幼保健院产科,210000

出　　处：《中华妇产科杂志》2021年第3期161-170,共10页Chinese Journal of Obstetrics and Gynecology

基　　金：国家自然科学基金(82003528)。

摘　　要：目的探讨不同妊娠间隔(IPI)对经产妇妊娠结局的影响。方法基于全国14个省区市共21家医院开展多中心回顾性研究,通过查阅病历收集2011—2018年间两次妊娠均在同一家医院分娩的经产妇的年龄、身高、孕前体重、IPI、既往史、妊娠合并症和并发症、分娩孕周、分娩方式、妊娠结局等资料。根据不同IPI分为4组:<18个月组、18~23个月组、24~59个月组和≥60个月组,分析其临床特征和妊娠结局。根据WHO的推荐,以24~59个月组作为参照,比较各组经产妇的妊娠结局。进一步根据年龄、妊娠期糖尿病(GDM)史、巨大儿分娩史和早产史进行分层分析,探讨不同特征经产妇中IPI对其妊娠结局的影响。结果本研究共纳入经产妇8026例,其中<18个月组、18~23个月组、24~59个月组和≥60个月组分别为423、623、5512和1468例。(1)<18个月组、18~23个月组、24~59个月组和≥60个月组的妊娠年龄、本次妊娠前体质指数(BMI)、剖宫产史比例、GDM发生率、妊娠期高血压发生率以及剖宫产术分娩比例均逐渐增加,分别比较,差异均有统计学意义(P均<0.05)。(2)校正混杂因素后,与24~59个月组经产妇相比,≥60个月组经产妇的早产、胎膜早破和羊水过少的发生风险分别增加42%(OR=1.42,95%CI为1.07~1.88,P=0.015)、46%(OR=1.46,95%CI为1.13~1.88,P=0.004)和64%(OR=1.64,95%CI为1.13~2.38,P=0.009),其他组均未见不良妊娠结局的发生风险增加(P均>0.05)。(3)根据妊娠年龄分层,校正混杂因素后,与24~59个月组比较,高龄经产妇≥60个月组羊水过少的发生风险明显增加(OR=2.87,95%CI为1.41~5.83,P=0.004);非高龄经产妇<18个月组胎膜早破的发生风险明显增加(OR=1.59,95%CI为1.04~2.43,P=0.032),≥60个月组胎膜早破(OR=1.58,95%CI为1.18~2.13,P=0.002)和早产(OR=1.52,95%CI为1.07~2.17,P=0.020)的发生风险均显著增加。根据有无GDM史分层,校正混杂因素后,与24~59个月组比较,≥60个月组有GDM史经�Objective To explore the effects of interpregnancy interval(IPI)on pregnancy outcomes of subsequent pregnancy.Methods A multicenter retrospective study was conducted in 21 hospitals in China.Information of age,height,pre-pregnancy weight,IPI,history of diseases,complications of pregnancy,gestational age of delivery,delivery mode,and pregnancy outcomes of the participants were collected by consulting medical records of pregnant women who had two consecutive deliveries in the same hospital during 2011 to 2018.The participants were divided into 4 groups according to IPI:<18 months,18-23 months,24-59 months and≥60 months.According to the WHO′s recommendation,with the IPI of 24-59 months group as a reference,to the effects of IPI on pregnancy outcomes of subsequent pregnancy were analyzed.Stratified analysis was further carried out based on age,history of gestational diabetes mellitus(GDM),macrosomia,and premature delivery,to explore the differences in the effects of IPI on pregnancy outcomes among women with different characteristics.Results A total of 8026 women were included in this study.There were 423,623,5512 and 1468 participants in<18 months group,18-23 months group,24-59 months group and≥60 months group,respectively.(1)The age,pre-pregnancy body mass index(BMI),history of cesarean section,GDM,gestational hypertension and cesarean section delivery rate of<18 months group,18-23 months group,24-59 months group and≥60 months group were gradually increased,and the differences were statistically significant(P<0.05).(2)After adjusting for potential confounding factors,compared with women in the IPI of 24-59 months group,the risk of premature delivery,premature rupture of membranes,and oligohydramnios were increased by 42%(OR=1.42,95%CI:1.07-1.88,P=0.015),46%(OR=1.46,95%CI:1.13-1.88,P=0.004),and 64%(OR=1.64,95%CI:1.13-2.38,P=0.009)respectively for women in the IPI≥60 months group.No effects of IPI on other pregnancy outcomes were found in this study(P>0.05).(3)After stratified by age and adjusted for confou

关 键 词：生育间隔 妊娠 妊娠结局 回顾性研究 

分 类 号：R714[医药卫生—妇产科学]