我国产后二年内非意愿妊娠发生现状及其影响因素  

Incidence of unintended pregnancy within 2 years after delivery and its influencing factors in China

作　　者：杨彩霞[1] 赵旭红 李玉艳[2] 周燕飞[3] 张林爱[4] 袁冬 夏伟[6] 王建梅[7] 宋建东[8] 吕雯 骆永凤 蒋丽芳 蒋丽[12] 黄小琛[13] 胡晓宇 董晓静[15] 程同银 周远忠 张妍[2] 车焱 Yang Caixia;Zhao Xuhong;Li Yuyan;Zhou Yanfei;Zhang Lin'ai;Yuan Dong;Xia Wei;Wang Jianmei;Song Jiandong;Lyu Wen;Luo Yongfeng;Jiang Lifang;Jiang Li;Huang Xiaochen;Hu Xiaoyu;Dong Xiaojing;Cheng Tongyin;Zhou Yuanzhong;Zhang Yan;Che Yan(Department of Obstetrics,Tianjin Baodi Hospital,Tianjin 301800,China;Shanghai Institute for Biomedical and Pharmaceutical Technologies,National Health Commission Key Laboratory of Reproduction Regulation,School of Public Health,Fudan University,Shanghai 200237,China;Center for Maternal Health Care,Changsha Hosptial for Maternal and Child Health Care,Changsha 410007,China;Department of Family Planning,Women Health Center of Shanxi,Taiyuan 030013,China;Department of Obstetrics and Gynecology,Tianjin Hedong District Obstetrics and Gynecology Hospital,Tianjin 300042,China;Family Planning Research Institute,Tongji Medical College,Huazhong University of Science and Technology,Wuhan 430030,China;Department of Family Planning,The Second Hospital of Tianjin Medical University,Tianjin 300211,China;Department of Obstetrics and Gynecology,Affiliated Hospital of Inner Mongolia Medical University,Hohhot 010059,China;Department of Gynecology,Tongde Hospital of Zhejiang Province,Hangzhou 310012,China;Department of Reproductive Gynecology,Jilin Province Maternal and Child Health Hospital,Changchun 130051,China;Research Center of Social Medicine,Henan Institute of Reproduction Health Science and Technology,Zhengzhou 450002,China;Department of Gynecology,Matemal and Child Health Hospital of Guangxi Zhuang Autonomous Region,Nanning 530003,China;Department of Gynecology,Fujian Maternity and Children Health Hospital,Fuzhou 350001,China;Department of Maternity Care,Shanghai Center for Women and Children′s Health,Shanghai 200062,China;Department of Obstetrics and Gynecology,The Second Affiliated Hospital of Chongqing Medical University,Chongqing 400010,China;Department of Maternal Health Care,Maternal and Child Health Care Hospital of Urumqi,Urumqi 830000,China;Department of Health Toxicology,School of Publ

机构地区：[1]天津市宝坻区人民医院产科,301800 [2]上海市生物医药技术研究院,复旦大学公共卫生学院国家卫生健康委员会计划生育药具重点实验室,200237 [3]长沙市妇幼保健院妇女保健中心,410007 [4]山西省妇幼保健院计划生育科,太原030013 [5]天津市河东区妇产科医院妇产科,300042 [6]华中科技大学同济医学院生殖健康研究所,武汉430030 [7]天津医科大学第二医院计划生育科,300211 [8]内蒙古医科大学附属医院妇产科,呼和浩特010059 [9]浙江省立同德医院妇科,杭州310012 [10]吉林省妇幼保健院生殖妇科,长春130051 [11]河南省生殖健康科学技术研究院社会医学研究中心,郑州450002 [12]广西壮族自治区妇幼保健院妇科,南宁530003 [13]福建省妇幼保健院妇科,福州350001 [14]上海市妇幼保健中心孕产妇保健科,200062 [15]重庆医科大学附属第二医院妇产科,400010 [16]乌鲁木齐市妇幼保健院妇保科,830000 [17]遵义医科大学公共卫生学院卫生毒理学教研室,563006

出　　处：《中华妇产科杂志》2021年第9期616-621,共6页Chinese Journal of Obstetrics and Gynecology

基　　金：上海市计划生育科学研究所科技攀登项目(PD2017-10)。

摘　　要：目的分析我国育龄期妇女产后2年内非意愿妊娠发生现状及其影响因素。方法在我国东、中、西部地区15个省市自治区的60家医院,采用结构式问卷调查2015年7月至2016年6月分娩的产妇,了解其产后2年内非意愿妊娠发生情况,探讨人口学特征、孕产史、母乳喂养、产后避孕启动及避孕方法等因素对产后非意愿妊娠发生风险的影响,采用描述性分析、寿命表法和Cox回归模型等方法进行统计学分析。结果共调查18045例产妇,产后1年和2年累积非意愿妊娠率分别为5.3%(95%CI为4.5%~6.1%)和13.1%(95%CI为11.3%~14.8%)。Cox回归模型分析显示,低龄、少数民族、既往有流产史、阴道分娩、哺乳时间短以及产后避孕启动时间晚者,产后2年内非意愿妊娠的发生风险增加(P均<0.01),未发现产后非意愿妊娠发生风险与地区、分娩机构有关(P均>0.05)。结论我国产后2年内非意愿妊娠发生风险较高。服务机构应促进产妇(尤其是产后非意愿妊娠高风险人群)在产后首次性生活时乃至之前使用高效避孕方法。Objective To investigate the present situation of unintended pregnancy within two years postpartum and its influencing factors in China.Methods Participants who delivered a live birth at 60 hospitals in 15 provinces in the eastern,central and western regions of China during July 2015 to June 2016 were interviewed by using structured questionnaire.Information on occurrence of unintended pregnancy within 2 years after delivery,postpartum contraceptive use,sexual resumption,breastfeeding,and women′s socio-demographic characteristics,and so on,were collected.Life-table analysis,cluster log-rank tests and a 2-level Cox regression model were used for data analysis.Results A total of 18045 postpartum women were investigated.The cumulative 1-and 2-year unintended pregnancy rates after delivery were 5.3%(95%CI:4.5%-6.1%)and 13.1%(95%CI:11.3%-14.8%),respectively.Cox regression model analysis showed that the risk of unintended pregnancy within 2 years postpartum were increased in younger women,ethnic minorities,women with abortion history,and those who had a vaginal delivery with short lactation time and late postpartum contraceptive initiation(all P<0.01).The risk of postpartum unintended pregnancy was not associated with geographic regions and hospitals where women gave a birth(all P>0.05).Conclusions In China,the risk of unintended pregnancy within 2 years after delivery is relatively high.Service institutions and service providers should improve the quality of postpartum family planning services,promote the use of high effect contraceptive methods,and educate women to use a method at the time of their sexual resumption or even before.

关 键 词：产后期 妊娠 意外 妊娠率 危险因素 

分 类 号：R714.1[医药卫生—妇产科学]