“二孩政策”后四川省经产妇人口学特点和高龄产妇妊娠与分娩期疾病分布

The demographic characteristics in multiparas and the distribution of pregnancy and parturition diseases distribution in advanced maternal age after the “two-child policy” in Sichuan province

目的探讨“二孩政策”后四川省经产妇的人口学特点,分析高龄产妇妊娠与分娩期疾病的分布变化。方法在四川省全民健康信息平台中提取2015年至2017年3月住院分娩的二孩产妇资料。2015全年为单独二孩阶段,设为A阶段;2016年1月至2016年9月为过渡阶段,设为B阶段;2016年10至2017年3月为全面二孩阶段,设为C阶段。分析人口学特点及妊娠与分娩期疾病分布。结果共获得305 717例二孩产妇资料, B阶段经产妇较A阶段月增加比例为69.01%,C阶段经产妇较A阶段月增加比例为161.20%。A B C 3个阶段,非高龄组构成比为83.64%~86.88%,均高于高龄组(P<0.05)。高龄组与非高龄组经产妇妊娠与分娩期疾病前3名排序相同但比例不同,依次为:贫血(34.04%vs 24.15%)、脐带绕颈或扭转(23.91%vs 24.22%)、胎膜早破(17.72%vs 10.92%)。分娩方式比较,高龄组与非高龄组均以经阴道助产率高,为59.75%vs 60.62%,剖宫产率为40.25%与39.38%,但两组比较差异无统计学意义(P>0.05)。高龄组经产妇瘢痕子宫(71.38%)和流产>2次比例(51.33%)均远高于非高龄组(14.10%、31.26%)(P<0.05)。高龄组经产妇发生胎盘粘连(8.18%)、贫血(34.04%)、妊娠期糖尿病(17.00%),妊娠期高血压疾病(10.56%)的比例均高于非高龄组(0.86%、24.15%、7.57%、1.82%)(P<0.05)。结论“二孩政策”后经产妇人数迅猛增加,以非高龄组比例增高明显;高龄组经产妇发生胎盘粘连、糖尿病、高血压和贫血的风险增加。

Objective To study the demographic characteristics in multiparas and analyze the distributional changes of pregnancy and parturition diseases after the "two-child policy" in Sichuan province. Methods The date on pregnancy women with 2 nd parturition from 2015 to March 2017 was extracted from the Sichuan National Health Information Platform. The whole year of 2015 was designed as phase A;January 2016 to September 2016 was the transition phase, designed as phase B;from October 2016 to March 2017 was a universal two-child stage, established as phase C. Results There were totally 305,717 cases retrieved out. The average monthly number of pregnant women in phase B increased by 69.01% compared with that in phase A, and the average monthly number of pregnant women in phase C increased by 161.2% compared with those in phase A.In the three phases of ABC, the composition ratio of non-senior group was 83.64 %~86.88 %, higher than that of senior group, which was statistically significant( P<0.05). The order of the top 3 diseases during pregnancy and delivery was the same but the proportion was different between the senior group and the non-senior group: anemia(34.04 % vs 24.15 %), umbilical cord around neck or twist( 23.91 % vs 24.22 %), premature rupture of membranes( 17.72 % vs 10.92 %). Compared with delivery modes, the vaginal augmentation rate was 59.75 % and 60.62 % in the senior group and non-senior group, and the rate of caesarean section delivery was 40.25 % and 39.38 %, but there was no significant difference between the two groups(P>0.05). The maternal scar uterus(71.38 %) and abortion>2 times(51.33 %) were significantly higher in the senior group than in the non-senior group(14.10 %, 31.26 %)(P<0.05). The proportion of placental adhesions(8.18 %), anemia(34.04 %), gestational diabetes(17.00 %), and hypertensive disorder complicating pregnancy(10.56 %) were higher in the senior group than in the non-senior group(0.86 %, 24.15 %, 7.57 %, 1.82 %)(all P<0.05).Conclusion After the " two-child policy", the number of multiparas increased rapidly, and the proportion of non-senior group still increased obviously. Old age increases the risk of placental adhesion, diabetes, hypertension and anemia.