不同避孕方式对女性再次受孕的影响因素分析

Influencing factors of different contraceptive methods on female fertility

目的:探讨宫内节育器(IUD)与避孕套避孕对育龄妇女再次受孕的影响因素。方法:选择2016年1月至2018年12月连云港地区孕产保健系统中各级医院住院分娩且生育二孩的15031例孕妇为研究对象。采用回顾性队列研究法,按照孕前采取的避孕措施不同,将其分为IUD组(n=7452,孕前采取IUD者)和避孕套组(n=7579,孕前采取避孕套者)。于2019年1月30日至2020年11月30日,对2组受试者完成再生育基线调查、生育二孩后第1次随访及数据资料汇总,观察2组育龄妇女再次受孕的影响因素。本研究经过江苏省连云港市妇幼保健院伦理委员会批准(审查批号:LYG-MEP202101)。结果:①2组孕妇年龄、职业、人体质量指数(BMI)、流产次数等一般临床资料比较,差异均无统计学意义(P>0.05)。②2组不同年龄、流产次数、第1胎分娩方式及避孕时间育龄妇女的再受孕时间比较,差异均有统计学意义(P<0.05)。③2组在停用避孕措施后的6、12、18、24个月内的累计妊娠率比较,差异均无统计学意义(P>0.05)。④对育龄妇女再次受孕影响因素的多因素COX回归分析结果显示,年龄≥35岁(HR=1.063,95%CI:1.027~1.101,P<0.05),体重指数<18.5 kg/m^(2)(HR=0.867,95%CI:0.802~0.938,P<0.001),体重指数≥24.0 kg/m^(2)(HR=1.265,95%CI:1.054~1.519,P<0.05),流产次数为1~2次(HR=1.439,95%CI:1.349~1.534,P<0.001),流产次数为≥3次(HR=1.352,95%CI:1.268~1.441,P<0.001),均是影响育龄妇女再次受孕的独立危险因素。结论:育龄妇女应避免高龄妊娠、合理控制体重和减少人工终止妊娠术次数。正确使用IUD,对于取出IUD后育龄妇女再次受孕无影响。

ObjectiveTo investigate influencing factors of subsequent pregnancy ability of childbearing-aged women after the discontinuation of intrauterine device (IUD).MethodsA retrospective analysis was conducted by extracting 15 031 pregnant women from the Lianyungang Maternal Health Care System who gave birth in hospitals at all levels in Lianyungang area from January 2016 to December 2018. They were divided into IUD group (discontinuation of IUD, n=7 452) and condom group (discontinuation of condom, n=7 579) according to the different discontinuation of contraceptive measures. From January 30, 2019 to November 30, 2020, the baseline survey, first follow-up visit after the birth of second child were completed and subsequent pregnancy ability of childbearing-aged women after the discontinuation of IUD were summarized. This study was approved by the Ethics Committee of Lianyungang Maternal and Child Health Hospital, Jiangsu Province (Approve No. LYG-MEP202101).Results① There were no statistically significant differences between two groups of age, occupation, body mass index (BMI), and number of miscarriages (P>0.05). ② There were statistically significant differences in the subsequent pregnancy time of childbearing women at different ages, abortion frequency, delivery mode of the first child and contraceptive time between the two groups (P<0.05). ③There was no significant difference in the cumulative pregnancy rate in 6, 12, 18 and 24 months after the cessation of contraception between the two groups (P>0.05). ④ The results of COX multivariate regression analysis on the influencing factors of fertility in women of childbearing age showed that age ≥35 years old (HR=1.063, 95%CI: 1.027-1.101, P<0.05), body mass index < 18.5 kg/m^(2) (HR=0.867, 95%CI: 0.802-0.938, P<0.001), body mass index ≥24.0 kg/m^(2)(HR=1.265, 95%CI: 1.054-1.519, P<0.05), the number of abortions was 1-2 (HR=1.439, 95%CI: 1.349-1.534, P<0.001), the number of abortion ≥3 (HR=1.352, 95%CI: 1.268-1.441, P<0.001), were independent risk factors affecting fertility in women of childbearing age.ConclusionsChildbearing-aged women should avoid advanced pregnancy, control their weight reasonably and reduce the number of artificial termination of pregnancy. Proper use of the IUD has no effect on the fertility of women of childbearing age after removal of the IUD.