上海市城区产后妇女意外妊娠及影响因素分析

Study on Unintended Pregnancy and Risk Factors among Postnatal Women in Shanghai

目的:了解上海市城区产后妇女意外妊娠的发生及其影响因素。方法:通过结构式问卷,对1767名产后1-2年妇女的产后意外妊娠情况进行调查。结果:产后第1年和第2年意外妊娠发生密度分别为4.64/100人年和6.57/100人年。产后性生活恢复、避孕开始、母乳喂养和产后闭经的中位时间分别为产后4个月、5个月、6个月和4个月。产后妇女最常用的3种避孕措施为避孕套、安全期和体外排精。产后1年内意外妊娠单因素分析显示:不同年龄组、文化程度、户籍、产后性生活开始早晚、母乳喂养及闭经时间长短间意外妊娠的发生密度差异有统计学意义(P<0.05)。多元Cox逐步回归分析显示,产妇年龄越大、母乳喂养时间越长、性生活开始时间越晚,产后1年内意外妊娠发生的风险越小;而外来人口意外妊娠发生的风险高于户籍人口。结论:产后妇女避孕开始滞后于性生活恢复,大多使用避孕效果相对不太稳定的避孕方法。外来人口、年轻产妇、产后开始性生活较早、母乳喂养时间较短的人群是产后1年内意外妊娠的高危人群。产后应尽早落实可靠的避孕措施及加强避孕套正确使用的宣教。

Objective： To understand and analyze the status and influencing factors about unintended pregnancy after delivery in Shanghai. Methods： A retrospective study under the adoption of anonymous closed questionnaires was conducted among 1 767 postnatal women. Results： The incidence density of unintended pregnancy in the first and second year after delivery was 4.64/100 person year and 6.57/100 person year, respectively.Median time of sexuality resume, contraception initiation, breast feeding and amenorrhea was 4 months, 5 months, 6 months and 4 months, respectively. The top three contraceptive methods for postnatal women were condom, period abstinency and withdraw. Single-factor analysis showed that subjects with different age, education level, household, time of sex resume, time of amenorrhea, time of breastfeeding had different rates of unintended pregnancy in the first year postpartum and the differences between them were all significant （P〈0.05）. Multi-factors Cox stepwise regression showed that elder age of women, longer time of breast feeding, sex resume later were the protect factors for unintended pregnancy in the first year postpartum. And internal migrants had higher risk for unintended pregnancy. Conclusion： Women adopt contraception methods later than sex resuming after delivery, and majority of them use less effective contraceptive methods. Internal migrants and women with lower age, resuming sex earlier and shorter time of breastfeeding were at high risk for unintended pregnancy within 1 year postpartum, especially in 3 months after delivery. Adopting contraceptives earlier after delivery is important for decreasing repeated conception. It is necessary to strengthen the education about right usage of condom among postnatal women.