中国妇女产后2年内避孕措施使用及意外妊娠率影响因素分析

Analysis of contraceptive use and the influencing factors of accidental pregnancy rate in Chinese women within 2 years after delivery

目的分析中国妇女产后2年内避孕措施及意外妊娠风险影响因素。方法在我国东、中、西部地区15个省区市60家医院,通过电话各随机调查2015年7月至2016年6月期间300名分娩产妇,内容包括产后母乳喂养、月经和性生活恢复、避孕措施以及是否意外妊娠等情况。分析其产后2年内避孕措施及意外妊娠风险因素。结果共调查18045名产妇,其中有15328名(84.9%)产妇产后2年内使用了避孕措施。使用避孕措施的产妇2年内意外妊娠率为7.16%,71.88%发生于产后7~18个月,产后不同时间段发生意外妊娠率差异具有统计学意义(P<0.001)。除体外排精/安全期避孕措施外,避孕套、长效避孕方法、短效口服避孕药和其他(紧急避孕/杀精剂)4种避孕措施在不同地区的构成比差异均有统计学意义(P<0.001,P<0.001,P=0.01,P<0.001)。单因素分析显示,产妇年龄、民族、教育程度、地域、分娩方式、产次、孕次、产后避孕方式、产后避孕启动时间、产后性生活恢复时间、产后月经恢复时间、母乳喂养时间与产后2年内意外妊娠率有关(P均<0.001)。多元logistic回归分析显示,地域(P<0.001)、产妇年龄(P<0.001)、教育程度(P<0.001)、民族(P=0.01)、孕次(P=0.04)、产次(P=0.02)、母乳喂养时间(P<0.001)、分娩方式(P=0.01)、产后避孕方法(P<0.001)、产后月经恢复时间(P=0.01)和产后避孕启动时间(P=0.02)是产后2年内意外妊娠的独立风险因素。结论我国妇女产后2年内意外妊娠较高,存在显著的地理差异,易受产妇个人特征的影响。我国应进一步完善产后避孕宣教和服务制度,推广以服务对象为中心的避孕咨询方法和个体化避孕方案,切实降低意外妊娠对母婴健康的伤害。

Objective To analyze the contraceptive measures and the risk factors of accidental pregnancy in Chinese women within 2 years after delivery.Methods In 60 hospitals in 15 provinces in eastern,central and western China,300 pregnant women were randomly surveyed in each hospital by telephone from July 2015 to June 2016,including postpartum breast-feeding,menstrual and sexual recovery,contraceptive measures,and accidental pregnancy.The contraceptive measures and risk factors of accidental pregnancy in 2 years after delivery were analyzed.Results Of the 18045 women surveyed,15328 women(84.9%)had used contraception within 2 years after delivery.The rate of 2-year accidental pregnancy was 7.16%and 71.88%occurred between 7 and 18 months postpartum.The rate of accidental pregnancy at different postpartum periods was statistically significant(P<0.001).There were statistically significant differences in the composition ratio of condoms,long-acting contraceptive methods,combination oral contraceptives and other(emergency contraception/spermicide)contraceptive methods in eastern,central and western regions(P<0.001,P<0.001,P=0.01,P<0.001).Single factor analysis showed that maternal age,nationality,education level,region,delivery way,delivery times,No.of pregnancies,postpartum contraceptive method,postpartum contraceptive start time,postpartum sexual recovery time,postpartum menstrual recovery time,and breastfeeding time were related to the rate of 2-year accidental pregnancy(all P<0.001).Multivariate logistic regression analysis showed that the region(P<0.001),maternal age(P<0.001),education level(P<0.001),nationality(P=0.01),No.of pregnancies(P=0.04),delivery times(P=0.02),breastfeeding time(P<0.001),delivery way(P=0.01),postpartum contraceptive methods(P<0.001),postpartum menstruation recovery time(P=0.01)and postpartum contraception startup time(P=0.02)were the risk factor of 2-year accidental pregnancy.Conclusion Accidental pregnancy rate in 2 years after delivery is higher in Chinese women.In order to reduce the harm of accidental pregnancy to maternal and child health,China should further improve the postpartum contraception education and service system,promote the service object-centered contraceptive counseling method and individual contraception plan.