成都市孕妇贫血状况及其对产后出血影响的纵向研究

A longitudinal study of anemia status and its association with postpartum hemorrhage among pregnant women in Chengdu,China

目的了解成都市孕妇贫血状况及其变化规律,探讨孕妇贫血对产后出血的影响。方法采用纵向研究方法,选取成都市妇幼医疗机构产前门诊548名孕6~12周单胎健康孕妇为研究对象,通过问卷调查收集孕妇基本信息、孕产次及产后出血等资料,采用氰化高铁血红蛋白法测定孕妇各孕期血红蛋白含量,按照WHO孕妇贫血诊断标准（2011）诊断孕妇贫血,分析各孕期孕妇贫血状况及其变化规律,应用混合效应Logistic回归方法分析孕妇贫血对产后出血的影响。结果孕妇总贫血率为31.9%,孕早、中、晚期贫血率分别为5.5%、22.8%和18.2%,孕中、晚期贫血率显著高于孕早期,差异有统计学意义（P〈0.05）。孕早、中、晚期均以轻度贫血为主（分别93.3%、78.4%和70.0%）,无重度贫血。在控制妊娠年龄、分娩方式等混杂因素后,与非贫血孕妇组比较,孕晚期贫血孕妇组产后出血发生风险是非贫血孕妇组的6.47倍（95%CI 1.23~34.23）,孕早、中期贫血对产后出血无显著性影响。结论成都市孕妇孕中晚期贫血问题亟待改善,孕晚期贫血可能是产后出血发生的独立危险因素。

Objective To investigate the anemia status and its changing trend among pregnant women in Chengdu,China,and to explore the association between anemia and postpartum hemorrhage.Methods A total of 548 healthy singleton primiparas were selected and followed up from three hospitals in Chengdu until delivery.Data on maternal demographic characteristics,delivery information were collected with questionnaire,and the hemoglobin（ Hb） concentration was determined using cyanide methemoglobin method in each trimesters.Mixed fitting logistic regression models were performed to test the association between anemia and postpartum hemorrhage.Results The overall prevalenceof anemia was 31.9%.The prevalence of anemia in the 1st,2nd and 3rd trimesters during pregnancy was 5.5%,22.8% and 18.2%, respectively.The prevalence of anemia of pregnant women in the 2nd and 3rd trimesters were significantly higher than 1st trimester（ P 〈 0.05）.Most of them were mild anemia,and pregnant women with severe anemia had not been found.After adjustment confounding factors（ age and type of delivery etc.）,pregnant women with anemia in the 3rd trimester showed a 6.47 times higher risk of postpartum hemorrhage（ 95% CI 1.23-34.23）.Conclusion The anemia status of pregnant women in the 2nd and 3rd trimesters should be paid attention and improvement.Anemia of pregnant women in 3rd trimester is negative associated with postpartum hemorrhage.