孕期体力活动、久坐行为与胎膜早破发生风险的相关性及剂量反应关系

Association and dose-response relationship of physical activity and sedentary behavior with risk of premature rupture of membranes

目的探究孕期妇女体力活动(physical activity, PA)、久坐行为与胎膜早破(premature rupture of membranes, PROM)发生风险的相关性及剂量反应关系。方法采用国际体力活动短问卷收集中国孕产妇队列研究·协和项目中孕妇的体力活动状况和静坐时间(sedentary time, ST),并随访收集研究对象PROM的诊断情况,采用Logistic回归分析模型和限制性立方样条模型进行数据分析,计算OR及95%CI值。结果共纳入研究对象6 848例。孕妇PROM的发生率为13.79%。在中/低强度PA方面,与低频组相比,高频组PROM的发生风险更高(中强度OR=1.50, 95%CI:1.01~2.23;低强度OR=1.19, 95%CI:1.04~1.73);高强度PA频次每增加1 d/week,PROM发生风险增加13%(OR=1.13, 95%CI:1.03~1.24);ST每增加1 h/d,PROM发生风险增加2%(OR=1.02, 95%CI:1.01~1.04)。剂量反应关系显示,高强度PA超过2 d/周,中强度超过5 d/周或低强度超过5 d/周均可增加PROM的发生风险(OR及95%CI均>1)。结论孕期高频体力活动和久坐行为是胎膜早破发生的危险因素,应鼓励孕妇进行适宜和中低强度体力活动的同时,减少静坐时间,以降低胎膜早破的发生风险。

Objective To investigate the association and dose-response relationship of physical activity(PA) and sedentary behavior with premature rupture of membranes(PROM). Methods Data were collected from the Chinese Pregnant Women Cohort Study. The International Physical Activity Questionnaire-Short Form was used to assess the frequency of PA and sedentary time(ST), and diagnosis of PROM was collected in the follow-up period. Logistic regression analysis model and restricted cubic spline(RCS) model were used for data analyses. The odds ratio(OR) with its 95% confidence interval(CI) was calculated. Results A total of 6 848 participants were included in this study. The incidence of PROM was 13.79% among pregnant women. Compared with low frequency group, women with high frequencies of moderate-intensity PA(OR=1.50, 95% CI: 1.01-2.23) and light-intensity PA(OR=1.19, 95% CI: 1.04-1.37) had higher risks of PROM respectively. The risk of PROM increased 13%(OR=1.13, 95% CI: 1.03-1.24) per 1 d/week increase of vigorous-intensity PA, while the risk increased 2%(OR=1.02, 95% CI: 1.01-1.04) per 1 h/d increase of ST. The RCS model showed that the risk for PROM was significant with frequencies of over 2 d/week of vigorous-intensity PA, over 5 d/week of moderate-intensity PA or over 5 d/week of light-intensity PA(all ORs with corresponding 95% CIs>1). Conclusions High frequency of physical activity and sedentary behavior are risk factors for PROM. Pregnant women are supposed to conduct physical activity with proper frequency and moderate intensity as well as decreasing sedentary time, so as to prevent the risk of PROM during pregnancy.