【作者】 尹可云；

【导师】 胡传来； 李迎春；

【作者基本信息】 安徽医科大学 ， 儿少卫生与妇幼保健学， 2008， 硕士

【摘要】 目的描述孕期贫血的患病率及其分布特征,探讨孕期贫血及其他危险因素如孕期合并症、并发症、孕晚期心理因素等对新生儿出生体重的影响,为进一步进行孕期贫血、低出生体重儿的预防干预研究,更好地开展孕期保健服务提供基础依据。方法研究对象来自2006年9月至2007年5月间到安徽省蚌埠市蚌埠医学院附属医院产科门诊进行产前检查的孕妇。按观察队列的纳入与排除标准,收集到完整资料的研究对象共计461例。进入队列时,收集孕妇及其丈夫社会人口学基本资料以及孕早期健康体检资料。定期随访并收集孕妇孕20周以后直至分娩的体重、感染性疾病、孕期合并症和并发症,以及孕晚期的血液学常规检查和血生化检查指标,并于孕晚期采用焦虑自评量表(SAS)、抑郁自评量表(SDS)和生活事件量表(LES)对孕妇的心理因素进行评定。运用SPSS 11.0软件包进行资料的统计分析。结果孕期贫血总患病率为49.7%。孕晚期血红蛋白水平较孕早期下降,贫血患病率孕早期为25.8%,孕晚期为43.8%。贫血患病率随着孕妇或其丈夫文化程度的增高而降低,初中以下、高中、大专以上文化程度者贫血患病率逐渐降低;孕妇或其丈夫职业为农民者贫血患病率最高,职业为文教卫生和公务员者最低。孕晚期血红蛋白和孕晚期血浆白蛋白均与出生体重呈显著正相关。孕期感染性疾病组、其他合并症组低出生体重检出率分别高于无孕期感染性疾病组和无其他合并症组。产科并发症组低出生体重检出率高于无产科并发症组。但贫血组新生儿出生体重和非贫血组之间差异无显著性。单因素Logistic回归分析结果显示孕晚期血红蛋白、孕晚期白蛋白、孕期感染性疾病、孕期其他合并症、胎儿宫内窘迫、胎膜早破、孕期体重增重7个变量有统计学意义。多因素Logistic回归分析显示,孕晚期白蛋白、孕期体重增重与低出生体重呈负相关,RR分别为0.871和0.835,95%CI分别为0.783-0.970和0.766-0.911;孕期感染性疾病、孕期其他合并症、胎儿宫内窘迫、胎膜早破使低出生体重风险增高,RR分别为3.061、7.219、5.080和4.873,95%CI分别为1.062-8.821、2.874-18.137、1.862-13.863和2.087-11.382。结论孕妇孕期贫血患病率达49.7%,贫血随孕周增加而加重。孕期贫血与孕妇及其家庭社会经济等因素有关。孕晚期血红蛋白、血浆白蛋白水平和新生儿出生体重呈正相关。孕期感染性疾病以及孕期其他合并症、胎膜早破和胎儿宫内窘迫是低出生体重的危险因素。没有发现孕妇孕晚期焦虑、抑郁症状与新生儿出生体重之间有统计学关联。更多还原

【Abstract】 Objective This study was performed to reveal the prevalence and characteristics of anemia in pregnancy, explore the influences of pregnancy anemia and other risk factors on newborns’birth weight, such as complications during pregnancy and psychological factors during terminal pregnancy, and to suggest ways to make the further prevention programs on anemia during pregnancy and low birth weight and develop better health care for pregnant women.Methods All subjects were recruited from pregnant women who accepted health care in the obstetrical clinic of Attached Hospital of Bengbu Medical College in Bengbu City, North of Anhui Province, during the period from Sep. 2006 to May. 2007. Completed data of 461 subjects were collected according to the inclusion and exclusion criteria for the cohort of subjects. Health examination records of the subjects during early pregnancy were collected in the beginning they entered the cohort, as well as basic information as social economic characteristics of the pregnant women and their husbands. Weight, infection disease, accompany disease and obstetric complication of the pregnant women were gathered in the following period, and hematology and biochemical index were detected during terminal pregnancy, together with psychological factors determined by LES, SAS, and SDS. Statistical analyses were performed using SPSS 11.0.Results The total prevalence of anemia during pregnancy was 49.7%. Hemoglobin decreased in terminal pregnancy compared to early pregnancy, and led to an increase of anemia prevalence from 25.8% to 43.8%.The prevalence of anemia during pregnancy negatively related to education level of pregnant women and that of their husbands, e.g. from groups of less than junior middle school, senior middle school, to higher than junior college it gradually decreased. Also, the prevalence of anemia during pregnancy was higher in farmers than in those who were civil servants or worked in culture, education and public health enterprises.Hemoglobin and serum albumin during terminal pregnancy were positively related to newborn’s birth weight. The prevalence of low birth weight was significantly lower in newborns of those women who with infection disease or other accompany disease or obstetric complications during pregnancy than those without these diseases. However, no significant difference was found between newborns of anemia and non-anemia groups. Uni-variable logistic regression analyses of risk factors for low birth weight indicated that hemoglobin during terminal pregnancy, infection disease and other accompany diseases during pregnancy, fetal asphyxia, premature rupture of membranes, and weight gain during pregnancy were significantly associated with low birth weight. Multivariate Logistic regression analysis showed that serum albumin during terminal pregnancy and weight gain during pregnancy were negatively related to low birth weight, with RR equal to 0.871 and 0.835, with 95%C.I between 0.783-0.970 and 0.766-0.911; While infectious disease and other accompany diseases during pregnancy, fetal asphyxia, and premature rupture of membranes increased risk of low birth weight, with RR equal to 3.061, 5.080, 7.219, 4.873, respectively, and with 95%C.I in 1.062-8.821, 2.874-18.137, 1.862-13.863, and 2.087-11.382, respectively.Conclusion The total prevalence of anemia during pregnancy is 49.7%. Anemia during pregnancy aggravates with pregnancy progress, and there exist significant associations between anemia in pregnancy and social economic status of pregnancy women and their families. Women with anemia during pregnancy incline to develop infection disease and other pregnancy accompany diseases and obstetric complications.Hemoglobin and serum albumin during terminal pregnancy positively relate to the newborns’birth weight. Infectious diseases and other accompany diseases during pregnancy, premature rupture of membranes, and fetal distress are risk factors for low birth weight. No significant association is found between anxiety, depression of women during terminal pregnancy and newborns’birth weight.更多还原