妊娠间隔与经产妇妊娠并发症的相关性  

Association between interpregnancy interval and pregnancy complications in multiparas

作　　者：李阳 向雨欣 陈佳林 马艳 雷东 侯柯如 张玲萍 雷小平 Li Yang;Xiang Yuxin;Chen Jialin;Ma Yan;Lei Dong;Hou Keru;Zhang Lingping;Lei Xiaoping(Department of Neonatology,Affiliated Hospital of Southwest Medical University,Luzhou 646000,China;School of Pediatrics,Southwest Medical University,Luzhou 646000,China;Department of Perinatology,Affiliated Hospital of Southwest Medical University,Luzhou 646000,China;Sichuan Clinical Research Center for Birth Defects,Luzhou 646000,China)

机构地区：[1]西南医科大学附属医院新生儿科,泸州646000 [2]西南医科大学儿科学系,泸州646000 [3]西南医科大学附属医院围产医学中心,泸州646000 [4]四川省出生缺陷临床医学研究中心,泸州646000

出　　处：《中华围产医学杂志》2023年第5期416-422,共7页Chinese Journal of Perinatal Medicine

基　　金：国家大学生创新创业训练计划项目(202010632026);四川省科技厅项目(2019YJ0696)。

摘　　要：目的探讨妊娠间隔对经产妇妊娠并发症的影响。方法本研究为回顾性队列研究,研究对象为2015年12月至2020年12月在西南医科大学附属医院产科分娩、既往有28周及以上新生儿分娩史、此次分娩孕周≥28周的7669例单胎妊娠孕妇。收集产妇的人口学特征、妊娠并发症,以及新生儿胎龄、出生体重等资料。根据妊娠间隔分为以下5组:<12个月组(n=350)、≥12~<24个月组(n=945)、≥24~<60个月组(n=2544)、≥60~<120个月组(n=2478)及≥120个月组(n=1352)。参考世界卫生组织推荐的标准,以妊娠间隔≥24~<60个月孕妇作为对照组,采用logistic回归调整相关混杂因素,计算各组产妇妊娠期糖尿病(gestational diabetes mellitus,GDM)和妊娠期高血压疾病(hypertensive disorders of pregnancy,HDP)等妊娠并发症的发生风险。进一步根据年龄及前次分娩方式分析两者对妊娠间隔与妊娠并发症相关性的影响。采用方差分析、χ^(2)检验或Cochran-Mantel-Haenszelχ^(2)检验对数据进行统计学分析。结果与对照组相比,≥60~<120个月组GDM和HDP的发生风险升高[OR值(95%CI)分别为1.23(1.01~1.48)和1.47(1.13~1.92)],≥120个月组GDM和HDP的发生风险亦升高[OR值(95%CI)分别为1.37(1.07~1.78)和1.92(1.39~2.64)];<12个月组子宫破裂或产后出血及≥12~<24个月组胎盘早剥发生风险均升高[OR值(95%CI)分别为1.54(1.01~2.34)和2.38(1.13~5.02)]。≥60~<120个月组GDM(校正后OR=1.71,95%CI:1.36~2.14)及≥120个月组GDM和HDP发生风险升高仅存在于非高龄产妇中[校正后OR值(95%CI)分别为3.11(2.10~4.62)和1.81(1.12~2.91)]。在前次剖宫产经产妇中,≥120个月组GDM发生风险升高(校正后OR=1.35,95%CI:1.00~1.81)。而≥60~<120个月组(校正后OR=1.79,95%CI:1.08~2.95)和≥120个月组(校正后OR=3.32,95%CI:1.91~5.77)的阴道分娩史经产妇HDP发生风险升高。结论长妊娠间隔(≥60个月)是经产妇GDM和HDP发生的独立危险因素,其相关性受年龄的影响Objective To explore the influence of interpregnancy interval(IPI)on pregnancy complications in multiparas.Methods This was a retrospective cohort study involving 7669 singleton parturients who delivered at≥28 gestational weeks in the Affiliated Hospital of Southwest Medical University between December 2015 and December 2020 and had given birth in the third trimester before.Clinical data were collected,including the baseline characteristics,pregnancy complications,gestational weeks at delivery,and neonatal birth weight.According to the IPI,these women were divided into five groups:<12 months(n=350),12-<24 months(n=945),24-<60 months(n=2544),60-<120 months(n=2478),and≥120 months(n=1352).Based on the recommendation of the World Health Organization,pregnant women with an IPI of 24-<60 months were the control group.A multivariate logistic model was used to adjust for confounders and calculate the risks of pregnancy complications,including gestational diabetes mellitus(GDM)and hypertensive disorders of pregnancy(HDP).The influences of maternal age and previous delivery mode on the associations between IPI and maternal complications were analyzed.Analysis of variance(ANOVA),Chi-square test,and Cochran-Mantel-Haenszel Chi-square test were used for statistical analysis.Results Compared with the control group,the incidence of GDM and HDP increased in the 60-<120 months group(OR=1.23,95%CI:1.01-1.48 and OR=1.47,95%CI:1.13-1.92)and≥120 months group(OR=1.37,95%CI:1.07-1.78 and OR=1.92,95%CI:1.39-2.64);the risks of uterine rupture/postpartum hemorrhage and placental abruption increased in the<12 months group(OR=1.54,95%CI:1.01-2.34)and 12-<24 months group(OR=2.3895%CI:1.13-5.02),respectively.In the 60-<120 months group,the risk of GDM increased only in non-elderly women(adjusted OR=1.71,95%CI:1.36-2.14),so did the risks of GDM and HDP in the≥120 months group(adjusted OR=3.11,95%CI:2.10-4.62 and adjusted OR=1.81,95%CI:1.12-2.91).Among women who had undergone a previous cesarean section,the risk of GDM increased in the�

关 键 词：生育间隔 妊娠并发症 危险因素 孕妇 年龄因素 母亲年龄 

分 类 号：R714.25[医药卫生—妇产科学]