藏族农村育龄妇女自然流产的流行病学特征及其影响因素分析

Epidemiological features and risk factors of spontaneous abortion among rural Tibetan women at childbearing age

目的 了解藏族农村育龄妇女自然流产状况及其相关影响因素.方法 对2006-2012年藏族农村孕妇采取入户访问获得其生育史,并进行随访直至获得本次妊娠结局.采用广义Poisson回归模型探索影响自然流产的因素,估计各研究因素的OR值及其95％CI.结果 共随访1 557名孕妇,总妊娠2 687次,总产次2 382次,发生自然流产171人204次;人工流产93人101次.自然流产妊娠比为7.6％,自然流产率为7.9％,发生自然流产的育龄妇女比例为11.0％.孕次是发生自然流产的重要原因,随着孕次增加,育龄妇女发生自然流产的风险增加,孕次超过3次时其风险最大,Poisson回归分析OR=3.921 （95％ CI：2.553 ～ 6.021）,aOR=4.722（95％CI：2.834～7.866）;随着产次的增加,育龄妇女发生自然流产的风险减少.自然流产的发生风险与怀孕年份有关,2009年后妇女发生自然流产的风险较低,OR=0.419（95％CI：0.285～ 0.616）,aOR=0.580（95％CI：0.380 ～ 0.885）.并未发现社会人口学特征与其自然流产的发生有显著关联.结论 藏族育龄妇女自然流产率并不高于陕西等平原地区,加强孕产期保健、延长生育间隔和减少育龄妇女的妊娠次数有助于降低西藏地区育龄妇女发生自然流产的风险.

Objective To study the current status and risk factors of spontaneous abortion of women with Tibetan ethnicity at reproductive age in rural areas.Methods Pregnant women who lived in fibet were interviewed on their former reproductive history and being followed on the outcomes of pregnant from 2006 to 2012.Generalized Poisson regression model was used to explore the influencing factors of spontaneous abortion.OR value of the research factors was estimated and its 95% confidence interval counted.Results There were 1 557 pregnant women under this study,with a total number of 2 687 pregnancies and 2 382 productions.171 women underwent spontaneous abortion,with a total number of 204 times,93 women had histories of abortion,with a total number of 101 times.Among all the Tibetan pregnant women,the ratio between spontaneous abortion and pregnant women was 7.6% while the rate of spontaneous abortion was 7.9%.Ratio between the number of women who had experienced spontaneous abortion and the total number of women under survey was 11.0%.Pregnancy appeared the important reason on spontaneous abortion.The risk of having spontaneous abortion would increase among women who had more than 3 pregnancies.Results from Poisson regression analysis revealed that the odds ratio （OR） value before the adjustment was 3.921 （95%CI：2.553-6.021） but after the adjustment,it increased to 4.722 （95%CI：2.834-7.866）.The increase of production time could reduce the risk of spontaneous abortion in women of childbearing age.Risks related to spontaneous abortion were associated with the number of pregnancies.Women seemed to have lower risk for spontaneous abortion after 2009,with OR value as 0.419（95%CI：0.285-0.616） before,compared to aOR value as 0.580 （95%CI：0.380-0.885） after the adjustment Social-demographic characteristics was not found to be particularly associated with the occurrence of spontaneous abortion.Conclusion Rate of spontaneous abortion among Tibetan women at childbearing age was not particularly high when comparing to those women living in the plain area such as Shaanxi.However,in order to further reduce the incidence of spontaneous abortion among Tibetan women,approaches should include the following items：strengthening maternal health care,extending the spacing of pregnancy and reducing the frequency of pregnancy.