早产危险因素多中心调查分析

Multi-Center Investigation and Analysis of Risk Factors of Premature Birth

摘要: 目的：通过研究得到早产危险因素，为下一步早产防治提供理论依据。方法：前瞻性研究。随机选取2018年1月1日至2018年12月31日四家三甲综合性医院分娩484例活产早产儿的孕母为研究对象，按照1:1配对选取早产儿时间最近的484例活产足月儿孕母为对照组。通过问卷调查采集相关信息。通过X2检验及Fisher确切概率检验得到早产的危险因素，再使用多因素Logistic回归分析得到早产独立危险因素。结果：单因素分析得到早产危险因素为：母亲年龄 > 40岁、既往早产史、胎儿窘迫、生殖系统畸形、怀孕次数 > 3次、分娩次数 > 2次、宫颈机能不全、体力劳动职业、孕期阴道流血、羊水量异常、妊娠期高血压疾病、胎膜早破、多胎、低水平收入、农村家庭、营养状况差(BMI < 18.5)、胎盘早剥、前置胎盘、胎盘植入、顺产、CPSS平均 > 26分，共计21项(P值均 < 0.05)。多因素Logistic回归分析显示，早产独立危险因素依次为：既往早产史、宫颈机能不全、阴道流血、妊娠期高血压疾病、胎膜早破、胎盘早剥、前置胎盘、多胎、羊水量异常、胎儿宫内窘迫、体力劳动职业(OR值分别为14.493、7.378、4.196、12.343、7.731、10.693、12.584、22.468、2.345、5.254、1.905，P值均<0.05)；而中、高收入水平为早产的保护因素(OR值分别为0.116、0.136，P < 0.05)。结论：既往早产史、宫颈机能不全、阴道流血、妊娠期高血压疾病、胎膜早破、胎盘早剥、前置胎盘、多胎、羊水量异常、胎儿宫内窘迫、体力劳动职业为早产危险因素，中、高收入水平为早产的保护因素。

Abstract: Objective: The risk factors of preterm birth are obtained through research, which provides a theoretical basis for the prevention and treatment of preterm birth. Methods: Prospective research. The pregnant mothers who gave birth to 484 live premature infants in four third-grade general hospitals from 1st Jan. 2018 to 31st Dec. 2018 were randomly selected as the research objects. According to 1:1 matching principle, 484 pregnant mothers who gave birth to live full-term infants after the most recent premature infants were selected as the control group. Collect relevant information through questionnaire surveys. The risk factors for preterm birth were obtained by X2 test or Fisher exact test, and then independent risk factors for preterm birth were obtained by multivariate logistic regression analysis. Result: The risk factors through univariate analysis are as following: mother’s age > 40 years old, history of premature birth, fetal distress, reproductive system malformation, gravidity > 3, delivery times > 2, cervical insufficiency, manual workers, vaginal bleeding during pregnancy, polyhydramnios or oligohydramnios, gestational hypertension disease during pregnant, premature rupture of membranes, multiple pregnancy, low income family, rural family, poor nutritional status (BMI < 18.5), placental abrupt, placenta previa, placenta accreta, vaginal delivery, CPSS average value > 26 points, totally 21 risk factors (average P value < 0.05). Multivariate logistic regression analysis showed that the independent risk factors for preterm birth were in following order: previous history of preterm birth, cervical insufficiency, vaginal bleeding during pregnancy, hypertensive disorders during pregnancy, premature rupture of membranes, placental abruption, placenta previa, multiple births, polyhydramnios or oligohydramnios, fetal distress, manual workers (The OR values were 14.493, 7.378, 4.196, 12.343, 7.731, 10.693, 12.584, 22.468, 2.345, 5.254 and 1.905, all P < 0.05). The middle and high levels of income were the protective factors for preterm birth (The OR value 0.116, 0.136, P < 0.05, respectively). Conclusion: Previous history of preterm birth, cervical insufficiency, vaginal bleeding during pregnancy, hypertensive disorders during pregnancy, premature rupture of membranes, placental abruption, placenta previa, multiple births, polyhydramnios or oligohydramnios, fetal distress, manual workers were risk factors for preterm birth. The middle and high levels of income were the protective factors for preterm birth.