低出生体重与产前检查质量的回顾性分析

Retrospective Analysis Between Low Birth Weight and Quality of Prenat al Care

目的探讨新生儿低出生体重(LBW)(出生体重<2500g)发生率与产前检查质量的关系。方法采用Kessner′s评定方法,对2008年1月至2009年12月在西安交通大学医学院第一附属医院产科产前检查的2964例单胎活产孕妇中,进行《产前检查问卷》调查。剔除缺项≥5项的问卷,共计回收有效问卷2928份,回收率为98.79%。对符合纳入标准的2928例单胎活产儿孕妇的产前检查质量进行评价。按照产前检查质量标准,将其分为充分组(n=1262)、居中组(n=1502)和不足组(n=164)。采取回顾性分析方法于产后(2～7)d,依照《孕产妇产前检查手册》或门诊及住院病历记录3组孕妇的一般情况及其产前检查、孕期患病和分娩等情况。采用非条件logistic逐步回归分析法分析与LBW发生的相关危险因素及其与产前检查质量的关系(本研究遵循的程序符合本院人体试验委员会所制定的伦理学标准,得到该委员会批准,征得受试对象知情同意并与之签署临床研究知情同意书)。3组孕妇孕前体重指数(BMI)、本次妊娠胎数比较,差异无统计学意义(P>0.05)。结果 LBW儿发生率在充分组、居中组和不足组分别为3.49%(44/1262),5.26%(79/1502)和19.51%(32/164)。产前检查不足组LBW儿发生率最高,与其他两组比较,差异有统计学意义(P<0.01)。LBW儿发生的相关危险因素包括:①孕妇年龄;②婚姻状况;③是否有妊娠合并症;④分娩地点;⑤孕期体重增加;⑥分娩孕周等,与产前检查质量密切相关(r=0.83,0.69,0.85,-0.68,-0.71,-0.74;P<0.05)。LBW儿发生与产次无相关性(r=0.26,P>0.05)。本组LBW儿与正常体重儿(≥2500g)母亲的产前检查质量、年龄、婚姻状况、产次、是否有妊娠合并症、分娩地点、孕期体重增加、分娩孕周等比较,差异有统计学意义(χ2=96.05,58.84,21.41,52.38,38.10,33.44,66.32,258.42;P<0.05)。与正常体重儿比较,LBW儿母亲孕期平均接受产前检查次数较少[(7.6±3.1)次vs.(5.4±2.9)次;t=9.16,P<0.01];产前检查充分组较居中组LBW儿发生率低(OR=0.51,95%CI:0.35～0.72)。调整孕妇年龄、孕期体重增加、妊娠并发症、产前检查医院类别及分娩孕周后,产前检查次数较少,仍是LBW儿发生的危险因素(OR=4.56,95%CI:3.02～6.84)。结论采用Kessner′s评定方法评估产前检查质量相对客观准确,产前检查次数较少,是LBW儿发生的独立危险因素。

Objective To explore the relationship between low birth weight（LBW）（birth weight 2500 g） and the quality of prenatal care.Methods According to Kessner＇s Adequency of Prenatal Care Inde x,prenatal care quality of 2964 pregnancy women with single pregnancy who re ceiv ed prenatal examination at First Affiliated Hospital of Medical College,Xi＇an Jiaotong University from January 2008 to December 2009 were included into this s tudy.All of them had the survey about Prenatal Examination Questionnaire.A total of 2928 valid questionnaires were collected after excluding questionaires with missing items ≥5.The recovery rate was 98.79%.The qualified 2928 questio nnaires were classified three groups according to different prenatal examination quality：Adequate group（n=1262）,intermediate group（n=1502） and inade quate group（n=164）.General information,prenatal examination,gestational and de livery status within 2-7 d after delivery were analyzed retros pectively.The relationship between LBW related risk factors and prenatal examination were anal yzed by non-conditional logistic regression.The study protocol was approved by the Ethical Review Board of Investigation in Human Being of First Affiliated Ho spital of Medical College,Xi＇an Jiao Tong University.Informed consent was obta ined from all participants.Results Incidence rates of LBW was 3.49%（44/1262） for adequate group,5.26%（79/1502） for intermediate group,and 1 9.51%（32.164） for inadequate group.The inadequate group had the highest inciden ce rate of LBW infant compared with those in the other two groups（P 0.01）.Close correlation risk factors to LBW infant including：Maternal age,mar ital status,pregnancy complications,hospital delivery,gestational weight g ain,and gestational weeks of delivery（r=0.83,0.69,0.85,-0.68,-0.71,-0.74;P0.05）.The rate of LBW had no correlation with parity（r=0.26,P0.05）.There had significant differences between LBW infants and normal in fants（birth weight ≥2500 g） on mean times of maternal prenatal care quality,m aternal age,marital status,parity,pregnancy complications,hospital delivery,gest ati onal weight gain,and pregnancy week delivery（χ2=96.05,58.84,21.41,52.38,38.10,33.44,66.32,258.42,P0.05）.Compared with normal birth weight infants,the mean times of prenatal care was lower than that in LBW infants [（7.6±3.1） vs.（5.4±2.9）;t=9.16,P0.01].The prevalence of LBW infant in adequate group was lower than that in intermediate group（OR=0.51,95% CI：0.35-0.72）.After adjusting maternal age,marital status,pregnancy com plications,gestational weight gain,hospital delivery and gestational age,a significant increased risk of LBW remained for infants of women with inadequate prenatal care（OR=4.56,95%CI：3.02-6.84）.Conclusions Kessner＇s Adequency of Prenatal Care Index was more objective and accur ate to evaluate the quality of prenatal care.Inadequately prenatal care was an independent effect on LBW.