新生儿早产、低出生体重及小于胎龄的危险因素

Risk factors for preterm birth,low birth weight and small for gestational age:a prospective cohort study

目的研究早孕期相关暴露因素与新生儿早产、低体重及小于胎龄的关系。方法选取"中国孕产妇队列研究·协和"项目于2017年7月25日至2018年7月24日入组并于2018年12月31日前分娩且符合纳入标准的3 172例孕妇为研究对象,使用二分类logistic回归分析对早孕期相关暴露因素与新生儿不良分娩结局的关系进行统计分析。结果新生儿早产、低体重及小于胎龄的发生率分别为4.76%、3.53%、5.74%。在早产方面,北方孕妇和孕期增重是早产的保护因素,而胎膜早破、妊娠期高血压、1~3年内有口腔检查或治疗、家庭人口为3~4人是早产的危险因素。在低出生体重方面,孕期增重和食用奶及奶制品是低出生体重儿的保护因素,而胎膜早破、妊娠期高血压、工作久坐时间>6 h、1~3年内有口腔检查或治疗、被动吸烟等是低出生体重儿的危险因素。在小于胎龄方面,女婴、被动吸烟、食用花生油及口味偏淡是小于胎龄儿的危险因素,而补充叶酸是小于胎龄儿的保护因素。结论新生儿早产、低体重及小于胎龄的影响因素是多因素的,应针对相关危险因素采取有针对的预防和干预措施以降低新生儿不良出生结局的发生风险。

Objective To study the relationship between exposure factors in early pregnancy and preterm birth(PB),low birth weight(LBW)and small for gestational age(SGA)of neonates.Methods A total of 3 172 pregnant women who were enrolled in the project of Chinese Pregnant Women Cohort Study-Peking Union Medical College(CPWCS-PUMC)from July 25,2017 to July 24,2018 and delivered before December 31,2018 were selected as subjects in this study.The relationship between exposure factors in early pregnancy and adverse outcomes of neonatal delivery was analyzed by using binary logistic regression analysis.Results The incidence rates of PB,LBW and SGA were 4.76%,3.53%and 5.74%,respectively.In terms of PB,the analysis results showed that the gestational weight gain(GWG)and living in northern China were protective factors,while premature rupture of membranes,gestational hypertension,dental examination or treatment within 1-3 years and family with 3-4 members were risk factors.In the respect of LBW,GWG and daily consumption of milk and dairy products were the protective factors,while premature rupture of membranes,gestational hypertension,sedentary working time more than 6 hours,dental examination or treatment within 1-3 years and passive smoking were risk factors.For SGA,baby girl,passive smoking,peanut oil consumption and unsalted taste were risk factors,while folic acid supplementation was protective factor.Conclusion The risk factors for PB,LBW and SGA were multifactorial,and relevant specific measures should be taken to reduce the occurrence of adverse neonatal outcomes.