人工流产史与死胎死产的关系:云南17万妇女的前瞻性队列研究  

Association of induced abortion history with subsequent stillbirth:a prospective population-based cohort study including 170 thousand women in Yunnan Province,China

作　　者：姜楠[1] 赵子高 车焱 王涛 张妍 李玉艳 叶汉风 Jiang Nan;Zhao Zigao;Che Yan;Wang Tao;Zhang Yan;Li Yuyan;Ye Hanfeng(School of Public Health,Fudan University,Shanghai 200032,China;NHC Key Laboratory of Periconception Health Birth in Western China(Yunnan Population and Family Planning Research Institute),Kunming 650021,China;Key Lab.of National Health Commission for Family Planning and Contraceptives,Shanghai Institute of Planned Parenthood Research,Institute for Reproduction and Development of Fudan University,Shanghai 200032,China)

机构地区：[1]复旦大学公共卫生学院,上海200032 [2]云南省人口和计划生育科学技术研究所国家卫生健康委西部孕前优生重点实验室,昆明650021 [3]复旦大学生殖与发育研究院上海市计划生育科学研究所,国家卫生健康委员会计划生育药具重点实验室,200032

出　　处：《中华生殖与避孕杂志》2021年第5期440-447,共8页Chinese Journal of Reproduction and Contraception

摘　　要：目的:研究人工流产对再次妊娠发生死胎死产的影响。方法:基于2010至2017年云南省“国家免费孕前优生检查”项目登记计划妊娠妇女的基本信息、病史、体格检查及其他检查结果,追踪随访妊娠结局。运用SPSS20.0和SAS9.4描述研究对象的基本特征、死胎死产发生率,并进行分层分析和多因素logistic回归分析。结果:最终纳入研究174782例,死胎死产发生率为0.64%(1119/174782);人工流产组(暴露组)的死胎死产发生率为0.83%(333/40216),显著高于无人工流产组(非暴露组)发生率为0.58%(786/134566)。非条件多因素logistic回归结果显示,与非暴露组相比,暴露组人工流产1次和≥2次者死胎死产发生率高20%~40%(OR=1.22,95%CI=1.05~1.41;OR=1.33,95%CI=1.08~1.64)。2011至2016年死胎死产率低于2010年(OR=0.66,95%CI=0.51~0.85)。此外,多因素分析结果显示,死胎死产发生率与民族、年龄、学历、产次、孕前体质量指数(body mass index,BMI)有关,与母亲职业、自然流产史、早产史、死胎死产史无统计学关联。结论:既往人工流产将增加其后妊娠死胎死产的风险,民族、年龄、文化程度、产次、孕前BMI与死胎死产发生的风险有关,孕前超重和肥胖是发生死胎死产的危险因素。Objective To explore the association of induced abortion with subsequent stillbirth.Methods The data collected from the National Free Pre-Pregnancy Health Examination Project in Yunnan Province between 2010 and 2017 were used in this analysis.Information on women's background characteristics,pregnant history,disease history,physical examination,etc.were recorded.After their pre-pregnancy health examination,women were routinely followed up and any pregnancies and pregnancy outcomes were recorded.By using SPSS20.0 and SAS9.4 software,we employed description analysis,Chi-square tests,stratified analysis and multivariate logistic regression for data analysis.Results A total of 174782 pregnancies were included in this analysis,and the total incidence rate of stillbirths was 0.64%(1119/174782).The incidence rate of stillbirths in the group of women who had a previous history of induced abortion(exposed group)was 0.83%(333/40216),which was significantly higher than 0.58%(786/134566)in the non-induced abortion group(unexposed group).Results of unconditional multivariate logistic regression analysis demonstrated that,compared with unexposed group,the risk of stillbirth in exposed group was higher in those with 1 and 2 or more induced abortions(OR=1.22,95%CI=1.05-1.41;OR=1.33,95%CI=1.08-1.64).The risk of stillbirth was significant lower in women who conceived in 2011-2016 than in 2010(OR=0.66,95%CI=0.51-0.85).Mother's ethnicity,age,education level,parity and body mass index(BMI)before pregnancy were significantly associated with the risk of stillbirth.Women's occupation,previous histories of premature birth,stillbirth and natural abortion were not associated with subsequent stillbirth.Conclusion Induced abortion is associated with an increase of the risk of subsequent stillbirth.Mother's ethnicity,age,education level,parity and BMI are significantly associated with the risk of stillbirth.Overweight and obesity before pregnancy increase the risk of stillbirth.

关 键 词：人工流产 妊娠结局 死胎死产 前瞻性研究 影响因素 

分 类 号：R169.42[医药卫生—公共卫生与预防医学] R714.2