超高海拔地区足月新生儿出生体质量及影响因素

Birth weight and influencing factors of full-term newborns in ulta-high altitude area

目的:了解平均海拔3 700 m地区的藏族足月新生儿的平均出生体质量及其与平原地区同胎龄新生儿的差别,以及发生低出生体质量儿(LBWI)的危险因素。方法:回顾性收集2018年9月1日至2019年9月1日在西藏山南市妇幼保健院产科出生的足月新生儿的出生体质量、母亲基本信息及孕期合并症等资料,按照胎龄和性别分组,与平原地区相应数据比较,并分析其中发生LBWI的危险因素。结果:共纳入716例藏族足月新生儿,各胎龄平均体质量均低于全国相应胎龄的平均体质量,差异具有统计学意义(P<0.05)。LBWI共94例(占13.13%),卡方检验示出生季节、产妇年龄、产妇贫血、妊娠高血压综合征(妊高征)、肝功能受损、妊娠期糖尿病、羊水过少、初中以下文化水平、居住地海拔更高(≥4 000 m)及出生窒息等10个因素与LBWI有关(P<0.05),多因素Logistic回归分析示冬春季出生、产妇年龄≥35岁、产妇贫血、妊高征、羊水过少以及出生窒息是LBWI的危险因素,初中及以上文化水平、居住地海拔<4 000 m是LBWI的保护因素。结论:高海拔地区足月新生儿的平均出生体质量低于平原地区同胎龄新生儿。根据该地区发生LBWI的主要危险因素,建议可通过加强高海拔地区孕产妇孕期营养指导和宣教,规律产检管理以及配合政府由高海拔向低海拔地区移民等方式,降低LBWI发生率,提高该地区人口出生质量。

Objective: To survey the average birth weight of full-term newborns of Tibetan nationality in the area with an average altitude of 3 700 meters, and to analyze its difference from that in the same gestational age of infants in the plain area, as well as the risk factors of developing low birth weight infants(LBWI).Methods: Data such as birth weight, maternal basic information and complications of fullterm newborns born in the Obstetrics Department of Shannan Maternal and Child Health Hospital from September 1, 2018, to September 1, 2019 were collected retrospectively. The data were grouped by different gestational age and gender, and compared with those in the plain area, and then the risk factors of developing LBWI were analyzed.Results: A total of 716 Tibetan full-term newborns were enrolled. The average birth weight of each gestational age groups was lower than that respectively of the national average weight of the same gestational age groups, with statistically significant differences(P<0. 05). There were 94 cases of LBWI(13. 13%). The chi-square test showed that 10 factors including the season of birth, maternal age, maternal anemia, pregnancy induced hypertension syndrome,liver function impairment, gestational diabetes mellitus, oligohydramnios, education level below junior middle school, higher altitude of residence(≥4 000 meters) and neonatal asphyxia were related to LBWI(P<0. 05). The multivariate Logistic regression analysis showed that winter and spring birth,maternal age ≥35 years old, maternal anemia, pregnancy-induced hypertension syndrome, oligohydramnios and birth asphyxia were risk factors for LBWI. The protection factors of LBWI were the education level of junior high school and above, and the living altitude <4 000 meters.Conclusion: The mean birth weight of full-term newborns in high altitude areas was lower than that in plain areas. According to the main risk factors of LBWI in the region, it is suggested that the incidence of LBWI can be reduced and the birth quality of the population in high-altitude areas can be improved through strengthening nutrition guidance and education for pregnant women in high-altitude areas, regular management of antenatal examination, and emigrating from high-altitude to low-altitude areas.