妇幼保健系统建卡孕妇流产状况及其与空气质量的关系

Abortion of pregnant women registered in Tianjin maternal and child health care system and the roles of air quality index

【目的】探讨某基层妇幼保健系统建卡孕妇流产状况及其与空气质量的关系。【方法】利用天津市妇幼保健信息系统收集2009年1月1日至2017年12月31日登记的孕妇资料,追踪建卡孕妇妊娠结局,进行建卡孕妇流产状况分析;收集2013年12月以来的天津每月空气质量数据,利用生态学研究思路探索空气质量与胚胎发育不良的关系研究。年龄和妊娠终止时间根据资料分布状况采用(x±s)或M(P25~P75)表示;率的可信区间采取直接概率计算法。数据对比两组资料根据资料分布类型采取t或t’或Mann-Whitney法非参数检验;率的一致趋势分析采用Pearson相关分析完成;空气质量指数与胚胎发育不良流产的关系采用时间序列的交叉相关分析。【结果】2009年1月1日至2017年12月31日,某社区医院建卡孕妇6 491例,其中因各种原因导致孕妇终止妊娠208例(妊娠终止率为3.20%)(95%CI 2.78%~3.66%)。妊娠终止状况在研究期间内分两个阶段:2009年至2013年时间段内建卡孕妇终止妊娠发生率维持在3.6%左右的水平,而在2014年至2017年时间段(除外2016年)维持在3.0%以下水平。胚胎发育不良的流产率呈现与总妊娠流产率一致的趋势(线性相关趋势R^2=0.80,P<0.01),但其水平更低。建卡孕妇流产主要为胚胎发育不良(75.5%,157/208)和其他原因(24.5%,51/208)所致。流产孕妇平均年龄为(34±4)岁;胚胎发育不良流产孕妇和非胚胎发育不良流产孕妇年龄无差别[(34±4)岁vs(34±3)岁,t=0.16,P=0.87]。流产孕妇终止妊娠时间平均时间为104 d(Q=87~153);胚胎发育不良流产孕妇(M=95,Q=66~127)终止妊娠时间早于非胚胎发育不良流产孕妇(M=157,Q=111~182)(非参数检验,Z=5.71,P<0.001)。空气质量与胚胎发育不良流产有相关性(相关系数为0.301±0.167),空气质量指数达到高峰后,都会伴随相应的胚胎发育不良流产率的升高,空气质量指数高峰要早于胚胎发育不良流产高峰3个月左右。【结论】天津市孕产妇流产率较低并呈现下降趋势;空气质量差可能是造成胚胎发育不良流产的原因之一。

【Objective】To explore the abortion status of pregnant women registered in maternal and child health care system(MCHCS)and its relationship with air quality.【Methods】Basic information from Tianjin MCHCS for registered pregnant women from 1 January2009 to 31 December 2017 and the outcomes of pregnancy were collected. The abortion status of registered pregnant women was analyzed. Monthly air quality data in Tianjin were collected since December 2013. Ecological study methods were used to explore the relation between air quality index(AQI) and dysembryoplasia. Mean ± SD or M(Q=P25-P75) was used to present age or abort time and direct probability calculation method was used to get confidence interval. Student t or t’or Mann-Whitney methods was used to compare average levels of measurable data. Pearson correlation method was used for trend analysis of rates. Also, cross-correlations of time series data were used for exploring the relation of AQI and dysembryoplasia.【Results】Among 6491 registered pregnant women from Tianjin MCHCS in some community hospital from 1 January2009 to 31 December 2017, 208 cases aborted with crude rate of3.20 %(95% CI 2.78%-3.66%). Abortion epidemic curves in two stages(3.6% in 2009-2013 and less than 3.0% in 2014-2017 except2016) were observed. Dysembryoplasia-caused abortion, accounting for 75.5%(157/208), was closely companied with the crude rates(linear trend R^2=0.80, P<0.01) but with lower level. Abortion caused by other reasons accounted for 24.5%(51/208). Mean age of pregnant women with abortion were 34±4 years and no difference was observed between dysembryoplasia-caused abortion and nondysembryoplasia abortion(34±4 years vs 34±3 years,t=0.16,P=0.87). Average miscarriage period was 104(Q=87-153) days and a shorter period was manifested in the dysembryoplasia-caused abortion(M=95 days,Q=66-127 days) than the non-dysembryoplasia abortion(M=157 days,Q=111-182 days)(Z=5.71,P<0.001). A 3-month period of AQI related with dysembryoplasia-caused abortion(cross-correlation coefficient 0.301±0.167) was observed. When the AQI reached the peak, it was accompanied by the increase of the corresponding abortion rate of dysembryoplasia.【Conclusion】The abortion rate in Tianjin pregnant women was low and shows a decreasing trend. Poor air quality may be one reason for dysembryoplasia-caused abortion.