中华预防医学杂志    2018年07期 2014-2016年江苏省太仓市孕产妇贫血率及相关因素分析    PDF     文章点击量:181    
中华预防医学杂志2018年07期
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李芳 张诚 陈郁钢 沈菊英 姜珊 李俊 荫士安 杨振宇 赖建强 王杰
LiFang,ZhangCheng,ChenYugang,ShenJuying,JiangShan,LiJun,YinShian,YangZhenyu,LaiJianqiang,WangJie
2014-2016年江苏省太仓市孕产妇贫血率及相关因素分析
Analysis on maternal anemia rate and related factors in Taicang of Jiangsu Province in 2014-2016
中华预防医学杂志, 2018,52(7)
http://dx.doi.org/10.3760/cma.j.issn.0253-9624.2018.07.005

文章历史

投稿日期: 2017-08-15
上一篇:北京市学龄期儿童打鼾现况及与学习成绩的关系研究
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2014-2016年江苏省太仓市孕产妇贫血率及相关因素分析
李芳 张诚 陈郁钢 沈菊英 姜珊 李俊 荫士安 杨振宇 赖建强 王杰     
李芳 215400 江苏省太仓市妇幼保健所妇女保健科
张诚 215400 江苏省太仓市妇幼保健所行政办公室
陈郁钢 215400 江苏省太仓市妇幼保健所检验科
沈菊英 215400 江苏省太仓市妇幼保健所妇女保健科
姜珊 中国疾病预防控制中心营养与健康所
李俊 215400 江苏省太仓市妇幼保健所行政办公室
荫士安 中国疾病预防控制中心营养与健康所
杨振宇 中国疾病预防控制中心营养与健康所
赖建强 中国疾病预防控制中心营养与健康所
王杰 中国疾病预防控制中心营养与健康所
摘要: 目的  了解江苏省太仓市孕产妇贫血率并分析其相关因素。方法  选取2014-2016年在江苏省太仓市25家医疗卫生机构进行孕期保健和分娩的孕产妇,共13 278名,排除建卡时>12孕周者1 179名,孕期无血红蛋白检测记录者144名和孕周记录错误者25名,最终11 930名孕产妇纳入分析。从妇幼保健电子病历系统数据库中获取孕产妇基本信息,以及孕期和产后血红蛋白水平,采用多因素非条件logistic回归模型分析孕产妇贫血的相关因素。结果  11 930名孕产妇建卡时年龄为(27.0±4.5)岁,孕早期BMI的P50P25~P75)为21.4(19.6~23.7)kg/m2。孕期贫血率为37.2%(4 434/11 930),其中孕早期(≤12孕周)、孕中期(13~27孕周)和孕晚期(≥28孕周)贫血率分别为5.5%(276/5 035)、24.4%(1 802/7 377)和47.8%(3 328/6 966),产后42 d贫血率为19.9%(680/3 418)。多因素非条件logistic回归模型分析显示,孕产妇贫血的相关因素包括建卡时年龄<21岁[OR(95%CI):1.28(1.07~1.53)]、孕早期BMI<18.5 kg/m2[OR(95%CI): 1.14(1.00~1.29)]、外地户口[OR(95%CI):1.35(1.20~1.52)]、初中及以下文化水平[OR(95%CI):初中:1.24(1.05~1.47),小学:1.36(1.01~1.82)]、职业为家务或农民[OR(95%CI):家务:1.21(1.06~1.38),农民:1.21(1.03~1.44)];产后42 d贫血的相关因素包括经产妇[OR(95%CI):1.59(1.12~2.27)]、孕早期贫血[OR(95%CI):3.26(1.92~5.55)]、孕早期未服叶酸[OR(95%CI):1.34(1.00~1.80)]和产后出血≥500 ml[OR(95%CI):2.26(1.02~4.97)]。结论  江苏省太仓市孕产妇贫血率处于较低水平,孕期贫血的相关因素包括孕产妇年龄、体质、户籍、职业、文化水平;产后贫血的相关因素包括经产妇、孕早期贫血、孕早期未服叶酸和产后出血。
关键词 :怀孕期间;产后期;贫血;纵向研究
Analysis on maternal anemia rate and related factors in Taicang of Jiangsu Province in 2014-2016
LiFang,ZhangCheng,ChenYugang,ShenJuying,JiangShan,LiJun,YinShian,YangZhenyu,LaiJianqiang,WangJie     
Department of Gynecology, Taicang Maternity and Child Health Care Hospital, Taicang 215400, China
Corresponding author: Wang Jie, Email: wangjie@ninh.chinacdc.cn
Abstract:Objective  To investigate anemia rate and to analyze related factors in maternal women in Taicang of Jiangsu province.Methods  There were 13 278 pregnant women who had prenatal care and gave birth in 25 hospitals during 2014-2016 in Taicang of Jiangsu Province. We excluded 1 179 women who registered after 12 weeks of gestation, 144 women who did not test hemoglobin during gestation, and 25 women whose gestational weeks were incorrect. Finally, data from 11 930 pregnant women were analyzed. From the electronical medical record system of maternal and child health care, we obtained basic information of these pregnant women, their hemoglobin levels and related data during gestation and postpartum. Anemia rate was descripted, and factors associated with anemia were identified using multiple unconditional logistic regression.Results  Age of the 11 930 pregnant women was (27.0±4.5) years old, and the P50 (P25-P75) of BMI at the first trimester was 21.4 (19.6-23.7) kg/m2. The anemia rate during gestation was 37.2% (4 434/11 930). The anemia rate was 5.5% (276/5 035), 24.4% (1 802/7 377), and 47.8% (3 328/6 966) at the first, second and third trimesters, respectively. Anemia rate at 42 days postpartum was 19.9% (680/3 418). Multiple unconditional logistic regression indicated that anemia during gestation was related with maternal age <21 years old at prenatal registration (OR (95%CI): 1.28 (1.07-1.53)), body mass index(BMI) <18.5 kg/m2 at the first trimester (OR (95%CI): 1.14 (1.00-1.29)), non-local residence (OR (95%CI): 1.35 (1.20-1.52)), education of middle school and lower (OR (95%CI): middle school: 1.24 (1.05-1.47), primary school: 1.36 (1.01-1.82)), occupation of housewife or farmer (OR (95%CI): housewife: 1.21 (1.06-1.38), farmer: 1.21 (1.03-1.44)). Anemia at 42 days postpartum was associated with multipara (OR(95%CI): 1.59 (1.12-2.27)), anemia at the first trimester (OR(95%CI): 3.26 (1.92-5.55)), no folic acid supplementation at the first trimester (OR(95%CI): 1.34 (1.00-1.80)), and hemorrhage≥500 ml during 24 h postpartum (OR(95%CI): 2.26 (1.02-4.97)).Conclusion  Anemia rate was low for maternal women in Taicang of Jiangsu Province. The factors associated with gestational anemia included pregnant women's age, BMI, local or non-local residence, occupation, and education. The factors associated with postpartum anemia included multipara, anemia at the first trimester, no folic acid supplementation at the first trimester, and hemorrhage 24 h postpartum.
Key words :Peripartum period;Postpartum period;Anemia;Longitudinal studies
全文

孕产妇贫血影响母婴健康和妊娠结局,是世界范围内重要的公共卫生问题之一[1,2]。孕期贫血增加早产、宫内发育迟缓、低出生体重和剖宫产风险[3,4,5,6],延长分娩住院时间[7],影响新生儿铁储备、婴儿体格发育、贫血及儿童智力发育[8,9,10,11]。近年研究显示,孕期贫血增加抑郁和心血管疾病的发病风险[12,13]。可见,预防和控制孕产妇贫血是孕产妇保健的重要内容。中国2014年发布了《妊娠期铁缺乏和缺铁性贫血诊治指南》[14],但仍有1/3以上的孕产妇受到贫血困扰[15,16,17,18]。饮食习惯、经济条件、营养状况等使贫血存在地区和个体差异[19,20],了解孕期和哺乳期贫血发生规律,有利于贫血的早期发现和预防治疗,降低贫血对母婴的健康损害。本研究利用电子病例系统,了解江苏省太仓市孕产妇贫血率及相关因素,为孕产妇贫血的干预提供科学依据。

资料与方法  

1.资料:  从江苏省太仓市妇幼保健电子病历系统数据库中获取2014-2016年在江苏省太仓市医疗卫生机构进行孕期保健和分娩的孕产妇基本信息,孕期和产后血红蛋白水平及相关信息,包括建卡年龄、基本情况、孕周、产次、孕早期BMI、孕早期叶酸服用情况、孕期和产后42 d血红蛋白水平、分娩方式和产后出血情况等。排除建卡>12孕周者1 179名,孕期无血红蛋白检测记录者144名和孕周记录错误者25名,最终11 930名孕产妇资料纳入本研究。本项目通过了中国疾病预防控制中心营养与食品安全所(现已更名为中国疾病预防控制中心营养与健康所)伦理委员会审批(批号:2013-001)。

2.孕期、体质分类标准和贫血诊断标准:  ≤12孕周为孕早期,13~27孕周为孕中期,≥28孕周为孕晚期。BMI值<18.5 kg/m2为低体重,18.5~23.9 kg/m2为正常体重,24.0~27.9 kg/m2为超重,≥28.0 kg/m2为肥胖。孕期任一次检查中血红蛋白水平<110 g/L为孕期贫血,其中100~109 g/L为轻度贫血,70~99 g/L为中度贫血,<70 g/L为重度贫血[21,22,23];产后42 d血红蛋白水平<120 g/L为产后贫血,其中110~119 g/L为轻度贫血,80~109 g/L为中度贫血,<80 g/L为重度贫血[2]

3.质量控制:  各医疗卫生机构使用同一电子病例系统,遵守孕期产检和产后保健规范,每个月由太仓市妇幼保健所对当地所有医疗卫生机构的妇幼保健医生进行统一培训。血红蛋白检测以定值质控品做质控,血红蛋白检测结果具有良好的溯源性。

4.统计学分析:  采用SAS 9.4进行数据整理和统计学分析。年龄和血红蛋白水平为正态分布,以±s表示;孕早期BMI和建卡孕周不符合正态分布,以P50(P25~P75)表示。采用线性回归对血红蛋白随孕周的变化进行趋势检验。采用χ2检验进行贫血率的单因素分析,将单因素分析中有统计学意义的因素纳入多因素非条件logistic回归模型,分析贫血的相关因素。以P<0.05为有统计学意义。

结果  

1.基本特征:  11 930名孕产妇建卡时年龄为(27.0±4.5)岁,孕早期BMI的P50P25~P75)为21.4(19.6~23.7)kg/m2,建卡时孕周为9.0(7.0~11.0)周。农村孕产妇占71.2%(8 500名),孕早期服用叶酸6 003名(50.3%),剖宫产4 633名(38.8%)。

2.孕期血红蛋白水平和贫血率:  30孕周前,孕产妇血红蛋白水平随孕周增加呈下降趋势(t=-75.54, P<0.001),30孕周后血红蛋白水平又逐渐升高(t=21.61, P<0.001)(图1)。孕期贫血率为37.2%(4 434/11 930),其中以轻度贫血为主,占69.8%(3 096/4 434),中度贫血占29.9%(1 326/4 434),重度贫血仅占0.3%(12/4 434)。孕早期、中期和晚期贫血患病率分别为5.5%(276/5 035)、24.4%(1 802/7 377)和47.8%(3 328/6 966),不同孕周的贫血患病率详见图2

图12014-2016年江苏省太仓市孕产妇不同孕周的血红蛋白水平
图22014-2016年江苏省太仓市孕产妇不同孕周的贫血患病率

3.孕期贫血的相关因素分析:  孕期贫血的相关因素包括建卡时年龄、文化水平、职业、孕早期BMI、户口、居住地、孕早期是否服用叶酸、胎次及胎儿数(表1)。多因素非条件logistic模型分析结果提示,年龄<21岁、孕早期BMI<18.5 kg/m2、外地户口、初中或小学及以下文化水平、职业为家务或农民是孕期贫血的相关因素(表2)。

表12014-2016年江苏省太仓市孕产妇孕期贫血的单因素分析
表22014-2016年江苏省太仓市孕产妇孕期贫血的多因素非条件logistic回归分析

4.产后贫血率及相关因素分析:  产后42 d血红蛋白水平为(125.8±9.1)g/L,贫血率为19.9%(680/3 418),其中轻度贫血554例(81.5%),中度贫血125例(18.4%),重度贫血仅1例。多因素非条件logistic回归模型分析结果显示,产后贫血的相关因素包括经产妇、孕早期贫血、产后出血和孕早期未服用叶酸(表3)。

表32014-2016年江苏省太仓市产妇产后42 d贫血的多因素非条件logistic回归分析

讨论  2014-2016年江苏省太仓市孕产妇孕早期贫血率低于我国2010-2012年全国横断面调查中的孕早期贫血率(9.9%)[24],低于土耳其孕早期贫血率20.0%[25],也低于2016年陕西省宝鸡市孕早期贫血率(17.2%)[26];本研究中孕期中度和重度贫血率(11.2%)低于成都(2006-2007年:35.0%)[16]报道结果。可见本研究中孕产妇贫血率处于较低水平,可能与该地区经济水平较高,基本医疗服务和孕产妇保健服务较好有关。
        本研究中,参加产后42 d贫血检测的女性仅占28.7%。新西兰的一项研究中,该比例为22.8%[27]。本研究中产后42 d贫血率为19.9%,接近发达国家水平[1],低于印度、越南、尼日利亚的相关报道[28]。母亲贫血增加婴儿贫血的风险[29],为了母子的健康,哺乳期女性应该预防和及时纠正贫血。
        本研究结果显示,孕产妇年龄<21岁、孕早期BMI<18.5 kg/m2、外地户口、初中及以下文化水平、职业为家务或农民与孕期贫血有关,与以往研究结果一致[30,31,32]。孕期贫血和产后出血是影响产后贫血的重要因素[33,34],经产妇发生产后贫血的风险也较高[34,35]。经产妇更易发生产后贫血的原因可能与瘢痕子宫手术失血较多及产妇年龄增高后宫缩乏力等有关[36],经产妇贫血风险也受上一次怀孕的铁损耗及两次怀孕间隔时间影响[37]
        孕期哺乳期贫血以缺铁性贫血为主,通过经常摄入富含铁和多种维生素的食物和补充剂可以有效改善机体铁储备[2]。针对孕产妇开展贫血预防与治疗知识教育,使孕产妇深刻了解贫血对母子健康的危害,指导孕产妇的膳食搭配和补充剂选择技能,改善孕产妇对贫血临床治疗的依从性是决定贫血预防和疗效的关键[38,39]。计划再次怀孕的女性更应该在孕前、孕期和产后监测贫血状况,注重贫血预防和治疗,保障母子健康。
        本研究涵盖了在规定时间内参加孕产妇保健的所有女性,不存在人群选择偏移。但由于电子病例中未记录贫血孕产妇的治疗情况,无法获得治疗依从性及其对贫血治愈率的影响;本研究也未分析经济收入、膳食和疾病对贫血风险的影响。

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