孕期血清铁蛋白动态变化及其与分娩结局的相关性

Correlation between dynamic changes of serum ferritin during pregnancy and its delivery outcomes

目的分析孕期血清铁蛋白(SF)水平的动态变化,探讨不同孕周SF水平与分娩结局的相关关系。方法选取2021年1月至2023年8月期间,在安徽医科大学第一附属医院东城院区规律产检且连续3次SF检测的孕妇665名作为研究对象。分析孕期SF的动态变化,用线性回归模型和限制性立方样条分析不同孕周SF与分娩结局间的相关性,并构建SF动态变化与分娩结局的群组轨迹模型。结果随着孕周增加,SF水平下降,铁缺乏率增加。线性相关性分析显示孕8~16周、孕16~24周SF与分娩结局相关性无统计学意义(P>0.05);孕24-32周SF水平与新生儿身长(β:−0.009,95%CI:−0.015~−0.003)、新生儿体质量(β:−3.331,95%CI:−5.201~−1.461)及分娩孕周(β:−0.013,95%CI:−0.019~−0.008)呈负相关。限制性立方样条曲线拟合显示,孕8~16周SF、孕16~24周SF与分娩结局相关性无统计学意义(P整体>0.05),孕24~32周SF与分娩孕周和新生儿身长呈线性剂量-反应关系(P整体<0.05,P非线性>0.05),与新生儿体质量呈非线性相关关系(P整体<0.05,P非线性<0.05)。群组轨迹模型显示,SF浓度下降较快组早产率高于SF浓度下降中等组和较慢组(P<0.01),SF不同变化轨迹类型与新生儿体重相关性无统计学意义。结论孕24~32周SF水平升高与分娩孕周、新生儿身长和体质量相关,孕期SF持续下降与早产发生风险增加有关。

Objective To analyze the dynamic changes of serum ferritin(SF)levels during pregnancy and explore the relationship be⁃tween SF levels at different gestational weeks and delivery outcomes.Methods A total of 665 pregnant women who had regular prenatal checks and consecutive SF tests three times in the Eastern District of the First Affiliated Hospital of Anhui Medical University from January 2021 to August 2023,and delivered at the same hospital,were selected as the research subjects.The dynamic changes of SF levels during preg⁃nancy were analyzed.Linear regression model and restricted cubic spline analysis were used to analyze the correlation between SF levels at dif⁃ferent gestational weeks and delivery outcomes.A group-based trajectory model was constructed to describe the relationship between the dy⁃namic changes of SF levels and delivery outcomes.Results With the increase of gestational week,the SF levels showed a decreasing trend,and the rate of iron deficiency increased.Linear correlation analysis showed that there was no statistically significant association between SF levels at 8~16 weeks and 16~24 weeks of pregnancy and delivery outcomes(P>0.05);however,SF levels at 24~32 weeks of pregnancy were negatively correlated with newborn length(β=-0.009,95%CI:-0.015~0.003),newborn birth weight(β=−3.331,95%CI:−5.201~−1.461),and gestational week at delivery(β=−0.013,95%CI:−0.019~−0.008).Restricted cubic spline curve fitting showed that there was no statisti⁃cally significant correlation between SF levels at 8~16 weeks and 16~24 weeks of pregnancy and delivery outcomes(Poverall>0.05),while SF lev⁃els at 24~32 weeks of pregnancy were linearly and positively correlated with gestational week at delivery and newborn length(Poverall<0.05,Pnon-linear>0.05),and non-linearly correlated with newborn birth weight(Poverall<0.05,Pnon-linear<0.05).The SF group-based trajectory model showed that the preterm birth rate in the group with rapid decrease in SF concentration was higher than that in the group with moderate de⁃crease and slow decrease in SF concentration(P<0.01),and there was no statistically significant correlation between the different SF change tra⁃jectories and newborn birth weight.Conclusion Increased SF levels at 24~32 weeks of pregnancy are associated with gestational week at de⁃livery,newborn length,and birth weight.Continuous decrease of SF levels during pregnancy is related to the increased risk of preterm birth.