系统整群抽样调查分析北京地区15家医院经产妇的临床特征

Analysis on clinical characteristics of multipara in 15 hospitals in Beijing area： a systematic cluster sampling survey

目的探讨北京地区经产妇的社会背景、妊娠合并症、并发症及妊娠结局特点。方法通过系统整群抽样调查的方法，选取北京地区15家医院2013年1月至6月分娩的15194例产妇为研究人群，调查并比较初产妇与经产妇的生育年龄、分娩孕周、受教育程度、户籍、社会保险拥有情况、分娩方式、妊娠合并症、妊娠并发症、妊娠结局等相关临床资料。统计学方法采用成组t检验和矿检验。结果产妇人均生育数为1．23（18745／15194），经产妇构成比为21．12％（3209／15194）。经产妇接受高等教育、人均月家庭收入〉3000元、城镇户籍、拥有社会保险的比例低于初产妇（P值均〈0．05）；经产妇生育年龄为（30．02±4.88）岁，孕前体重指数为22．24±3．48，均高于初产妇[分别为（27．82±4．03）岁和21．54±3．29]（t值分别为23．440和11．115，P值均〈0．01）。经产妇分娩孕周和孕期增重低于初产妇[（39．19±1．67）与（39．49±1．67）周，t=-14．044，P=0．000；（14．66±6．24）与（15．81±5．86）b，t=-9．448，P=0．000]；妊娠期总胆固醇、甘油三酯、低密度脂蛋白胆固醇水平均明显高于初产妇[分别为（5．59±1．14）与（5．24±1．15）mmol／L、（2．31±1．38）与（1．96±1．34）mmol／L、（3．03±0．91）与（2．82±0．87）mmol／L，t值分别为12．867、15．718和10．275，P值均〈0．01]；巨大儿发生率高于初产妇[9．29％（298／3209）与7．24％（868／11985），x^2=14．926，P=0．0001。经产妇羊水量异常、胎膜早破、胎儿窘迫、产程异常的发生率低于初产妇（P值均〈0．01）；经产妇新生儿出生体重高于初产妇[（3374．38±504．57）与（3328．39±488．70）g，t=-4．839，P=0．000]；经产妇剖宫产率高于初产妇[45．96％（1475／3209）与42．49％（5092／11985）]，阴道助产分娩率低于初产妇[0．90％（29／3209）与2．54％（305／11985）]（x^2值分别为12．477和28．201，P值均〈0．01）。校正年龄、孕周、孕期增重及孕前体重指数后，经产妇妊娠期糖尿病、糖尿病合并妊娠、妊娠合并心血管疾病、妊娠期高血压疾病的发生风险高于初产妇[aOR值（95％CI）分别为1．265（1．135～1．411）、1．799（1．215-2．663）、1．567（1．221-2．347）、1．647（1．300～2．086），P值均〈0．011。结论北京地区仍以初产妇为主要生育人群，但经产妇具有更多的妊娠高危风险，且妊娠合并症发生率较高，需要严密的孕期保健。

Objective To investigate the clinical characteristics （social background, comorbidity,complications and outcomes of pregnancy） of multipara in Beijing area. Methods A systematic cluster sampling survey was conducted on 15 194 pregnant women who gave birth at 15 hospitals in Beijing from January to June in 2013. The age, gestational weeks at delivery, education background, geographical distribution, health insurance coverage, mode of delivery, comorbidity and complications of pregnancy, pregnant outcomes and other relevant clinical data were collected and analyzed with two-sample t test or Chi-square test. Results The proportion of multipara in Beijing area was 21.12% （3 209/15 194）, the per capita number of delivery was 1.23 （18 745/15 194）. The ratio of women with higher education background, average monthly household income over 3 000 yuan, urban residence and social insurance in multipara were much lower than those in primipara （all P〈0.05）. The mean maternal age of multipara was （30.02±4.88） years, pre-pregnancy body mass index was 22.24±3.48, which were all higher than those of primipara [（27.82±4.03） years and 21.54±3.29, respectively, t=23.440 and 11.115, all P〈0.01 ]. And the gestational weeks at delivery and mean weight gain during pregnancy of multipara was less than that of primipara [（39.15± 1.67） vs （39.49±1.67） weeks, t= - 14.044, P=0.000; （14.66±6.24） vs （15.81 ± 5.86） kg, t=- - 9.448, P=0.000], while the levels of total cholesterol, triglyceride and low density lipoprotein-cholesterol and the incidence of macrosomia were significantly higher [（5.59±1.14） vs （5.24± 1.15） mmol/L, （2.31± 1.38） vs （1.96± 1.34） mmol/L, （3.03±0.91） vs （2.82±0.87） mmol/L, t=12.867,15.718 and 10.275, all P〈0.01; 9.29% （298/3 209） vs 7.24% （868/11 985）, x^2=14.926, P=0.000]. Significantly lower incidences of abnormal amniotic fluid volume, premature rupture of membranes, fetal distress, abnormal labor and vaginal delivery （all P 〈 0.01）, but higher neonatal birth weight [（3 374.38 ± 504.57） vs （3 328.39±488.70） g, t=4.839, P=0.000] and cesarean section rate [45.96% （1 475/3 209） vs 42.49%（5 092/ 11 985）, x^2=12.477, P〈0.01] were found in multipara than in primipara. Compared with primipara, multipara had higher incidence of gestational diabetes mellitus, diabetes during pregnancy, pregnancy complicated with cardiovascular problems, hypertensive disorder complicating pregnancy [adjusted 0R（95%C1）： 1.265 （1.135- 1.411）, 1.799 （1.215-2.663）, 1.567 （1.221-2.347）, 1.647 （1.300-2.086）, all P〈0.01]. Conclusions The primipara is the major reproductive population in Beijing area. However, the multipara requires close antenatal care because of their susceptibility to pregnant complications.