山西省农村地区高出生体重危险因素研究
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摘要
目的探索孕期环境因素和行为因素暴露与农村高出生体重(high birth weight,HBW)发生风险之间的关联。方法从2007-2012年期间山西省平定县出生人口及不良出生结局监测系统随访到204例对照、125例≥4 200 g HBW病例和171例4 000～4 200 g HBW病例。采用病例对照研究探索HBW风险因素。结果 2007-2012年期间,总出生数为18 749人,高出生体重1 177例,发生率为6. 28%。HBW <4 200 g组病例对照研究结果显示,调整了父母亲生育年龄、产次后,分娩孕周≥42孕周生育HBW的风险是<42孕周的3. 10倍(95%CI:1. 67～5. 76),生育男孩发生HBW风险是生育女孩的2. 30倍(95%CI:1. 46～3. 63),孕前BMI与HBW发生风险无统计学关联; HBW≥4 200 g组病例对照研究结果显示,调整了母亲生育年龄、产次后,分娩孕周≥42孕周生育HBW的风险是<42孕周的3. 01倍(95%CI:1. 49～6. 08),母亲孕前BMI≥24生育HBW的风险是BMI <24者的1. 91倍(95%CI:1. 15～3. 16),母亲孕期每周食用豆制品次数为4～7次,生育HBW的风险是每周食用豆制品次数≤1次者的2. 59倍(95%CI:1. 06～6. 32)。结论降低高出生体重的发生风险可从育龄人群的孕前体重、孕期饮食和分娩孕周管理入手。
Objective To estimate the association between the risk of high birth weight( HBW)and maternal environmental and behavioral factors exposure during pregnancy in rural areas. Methods Data were collected from the surveillance system of birth population and adverse pregnancy outcome in Pingding County,Shanxi Province during 2007 and 2012,where we followed up 204 controls with normal birth weight,125 cases with HBW≥4 200 g and 171 cases with HBW 4 000-4 200 g. Case control study was performed to explore the potential risk factors of HBW. Results The total number of births was 18 749,including 1 177 cases of high birth weight,with an incidence rate of 6. 28% between 2007 and 2012. Concerning the case control study on HBW < 4 200 g,after adjusting parental reproductive age and parity,the risk of HBW was 3. 10( 95% CI: 1. 67-5. 76) times higher among women with gestational weeks ≥42 than that of women with gestational weeks < 42. The risk of HBW in boys was 2. 30( 95% CI: 1. 46-3. 63) times higher than that in girls. No significant association was observed between maternal BMI before pregnancy and the risk of HBW; Regarding the case control study on HBW≥4200 g,after adjusting maternal reproductive age and parity,the risk of HBW was 3. 01( 95% CI: 1. 49-6. 08)times higher among women with gestational weeks≥42 than that of those with gestational weeks < 42.The risk of HBW was 1. 91( 95% CI: 1. 15-3. 16) times higher among women with pre-pregnancy BMI≥24 than that of those with pre-pregnancy BMI < 24. The risk of HBW was 2. 59( 95% CI: 1. 06-6. 32) times higher in women who ate soybean products ≥4 times a week than that of those who ate soybean products less than once a week. Conclusion It would be of public health significance to reduce the risk of high birth weight,which can be reduced by managing pre-pregnancy BMI,diet during pregnancy and controlling gestational week.
Objective To estimate the association between the risk of high birth weight( HBW)and maternal environmental and behavioral factors exposure during pregnancy in rural areas. Methods Data were collected from the surveillance system of birth population and adverse pregnancy outcome in Pingding County,Shanxi Province during 2007 and 2012,where we followed up 204 controls with normal birth weight,125 cases with HBW≥4 200 g and 171 cases with HBW 4 000-4 200 g. Case control study was performed to explore the potential risk factors of HBW. Results The total number of births was 18 749,including 1 177 cases of high birth weight,with an incidence rate of 6. 28% between 2007 and 2012. Concerning the case control study on HBW < 4 200 g,after adjusting parental reproductive age and parity,the risk of HBW was 3. 10( 95% CI: 1. 67-5. 76) times higher among women with gestational weeks ≥42 than that of women with gestational weeks < 42. The risk of HBW in boys was 2. 30( 95% CI: 1. 46-3. 63) times higher than that in girls. No significant association was observed between maternal BMI before pregnancy and the risk of HBW; Regarding the case control study on HBW≥4200 g,after adjusting maternal reproductive age and parity,the risk of HBW was 3. 01( 95% CI: 1. 49-6. 08)times higher among women with gestational weeks≥42 than that of those with gestational weeks < 42.The risk of HBW was 1. 91( 95% CI: 1. 15-3. 16) times higher among women with pre-pregnancy BMI≥24 than that of those with pre-pregnancy BMI < 24. The risk of HBW was 2. 59( 95% CI: 1. 06-6. 32) times higher in women who ate soybean products ≥4 times a week than that of those who ate soybean products less than once a week. Conclusion It would be of public health significance to reduce the risk of high birth weight,which can be reduced by managing pre-pregnancy BMI,diet during pregnancy and controlling gestational week.
引文
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[15]Li Z,Zhang L,Ye R,et al.Indoor air pollution from coal combustion and the risk of neural tube defects in a rural population in Shanxi province,China[J].Am J Epidemiol,2011,174(4):451-458.DOI:10.1093/aje/kwr108.
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[17]于冬梅,翟凤英,赵丽云,等.中国2006年巨大儿发生率及其影响因素[J].中国儿童保健杂志,2008,16(1):11-13.Yu DM,Zhai FY,Zhao LY,et al.Incidence of fetal macrosomia and influencing factors in China in 2006[J].CJC HC,2008,16(1):11-13.
[18]张雨寒,何电,侯丽艳,等.2008年三省六县农村地区巨大儿流行状况研究[J].中国儿童保健杂志,2011,19(2):117-120.Zhang YH,He D,Hou LY,et al.Incidence of fetal macrosomia in rural China,2008[J].CJC HC,2011,19(2):117-120.
[19]丁海燕,夏木斯叶·木依都力,李敏超,等.舟山市2002-2015年出生体重变化与不良出生结局及影响因素分析[J].中华疾病控制杂志,2018,22(4):380-385.DOI:10.16462/j.cnki.zhjbkz.2018.04.014.Ding HY,Xiamusiye MYDL,Li MC.Analysis of trends of birth weight,and incidence of adverse birth outcomes and relevant factors from 2002 to 2015[J].Chin J Dis Control Prev,2018,22(4):380-385.DOI:10.16462/j.cnki.zhjbkz.2018.04.014.
[20]Simic M,Wikstr9m AK,Stephansson O.Accelerated fetal growth in early pregnancy and risk of severe large-for-gestational-age and macrosomic infant:a cohort study in a low-risk population[J].Acta Obstet Gynecol Scand,2017,96(10):1261-1268.DOI:10.1111/aogs.13189.
[21]闫小红,方红霞,张小丽,等.巨大儿发生率及其相关因素分析[J].中华全科医学,2012,10(11):1731-1732.DOI:10.16766/j.cnki.issn.1674-4152.2012.11.070.Yan XH,Fang HX,Zhang XL,et al.Incidence rate of macrosomia and its correlated factors[J].Chinese Journal of General Practice.2012,10(11):1731-1732.DOI:10.16766/j.cnki.issn.1674-4152.2012.11.070.
[22]Bhutta ZA,Das JK,Rizvi A,et al.Evidence-based interventions for improvement of maternal and child nutrition:what can be done and at what cost[J].Lancet,2013,382(9890):452-477.DOI:10.1016/S0140-6736(13)60996-4.
[2]Steer PJ,Modi N.Elective caesarean sections--risks to the infant[J].Lancet,2009,374(9691):675-676.DOI:10.1016/S0140-6736(09)61544-0.
[3]Hyde MJ,Mostyn A,Modi N,et al.The health implications of birth by caesarean section[J].Biol Rev Camb Philos Soc,2012,87(1):229-243.DOI:10.1111/j.1469-185X.2011.00195.x.
[4]Manco M,Putignani L,Bottazzo GF.Gut microbiota,lipopolysaccharides,and innate immunity in the pathogenesis of obesity and cardiovascular risk[J].Endocr Rev,2010,31(6):817-844.DOI:10.1210/er.2009-0030.
[5]Kc K,Shakya S,Zhang H.Gestational diabetes mellitus and macrosomia:a literature review[J].Ann Nutr Metab,2015,66:14-20.DOI:10.1159/000371628.
[6]Monasta L,Batty GD,Cattaneo A,et al.Early-life determinants of overweight and obesity:a review of systematic reviews[J].Obes Rev,2010,11(10):695-708.DOI:10.1111/j.1467-789X.2010.00735.x.
[7]Wei JN,Li HY,Sung FC,et al.Birth weight correlates differently with cardiovascular risk factors in youth[J].Obesity(Silver Spring),2007,15(6):1609-1616.DOI:10.1038/oby.2007.190.
[8]Huang RC,Mori TA,Beilin LJ.Early life programming of cardiometabolic disease in the Western Australian pregnancy cohort(Raine)study[J].Clin Exp Pharmacol Physiol,2012,39(11):973-978.DOI:10.1111/j.1440-1681.2012.05746.x.
[9]Yu ZB,Han SP,Zhu GZ,et al.Birth weight and subsequent risk of obesity:a systematic review and meta-analysis[J].Obes Rev,2011,12(7):525-542.DOI:10.1111/j.1467-789X.2011.00867.x.
[10]Spellacy WN,Miller S,Winegar A,et al.Macrosomia-maternal characteristics and infant complications[J].Obstet Gynecol,1985,66(2):158-161.
[11]Cleary-Goldman J,Malone FD,Vidaver J,et al.Impact of maternal age on obstetric outcome[J].Obstet Gynecol,2005,105(5Pt 1):983-990.DOI:10.1097/01.AOG.0000158118.75532.51.
[12]梁丽红,彭来勤,曾云英,等.巨大儿发生的相关因素及分娩方式研究[J].中国性科学,2014(6):82-84.DOI:10.3969/j.issn.1672-1993.2014.06.031.Liang LH,Peng LQ,Zeng YY,et al.Related factors and delivery mode of macrosomia[J].The Chinese Journal of Human Sexuality,2014(6):82-84.DOI:10.3969/j.issn.1672-1993.2014.06.031.
[13]詹兵煌,尹丽群,叶玉娥,等.巨大儿产生相关危险因素分析及合理选择分娩方式[J].中国医药科学,2017,7(6):80-82,157.Zhan BH,Yin LQ,Ye YE,et al.Analysis of risk factors and reasonable choice of delivery mode in macrosomia.[J]China Med Pharm,2017,7(6):80-82,157.
[14]江华,王秋伟,荀鹏程,等.巨大儿发生的影响因素的研究[J].现代预防医学,2010,37(6):1012-1016.Jiang H,Wang QW,Xun PC,et al.Investigation on the influencing factors in the development of macrosomia[J].Modern Prevent Med,2010,37(6):1012-1016.
[15]Li Z,Zhang L,Ye R,et al.Indoor air pollution from coal combustion and the risk of neural tube defects in a rural population in Shanxi province,China[J].Am J Epidemiol,2011,174(4):451-458.DOI:10.1093/aje/kwr108.
[16]Jolly MC,Sebire NJ,Harris JP,et al.Risk factors for macrosomia and its clinical consequences:a study of 350,311 pregnancies[J].Eur J Obstet Gynecol Reprod Biol,2003,111(1):9-14.DOI:10.1016/S0301-2115(03)00154-4.
[17]于冬梅,翟凤英,赵丽云,等.中国2006年巨大儿发生率及其影响因素[J].中国儿童保健杂志,2008,16(1):11-13.Yu DM,Zhai FY,Zhao LY,et al.Incidence of fetal macrosomia and influencing factors in China in 2006[J].CJC HC,2008,16(1):11-13.
[18]张雨寒,何电,侯丽艳,等.2008年三省六县农村地区巨大儿流行状况研究[J].中国儿童保健杂志,2011,19(2):117-120.Zhang YH,He D,Hou LY,et al.Incidence of fetal macrosomia in rural China,2008[J].CJC HC,2011,19(2):117-120.
[19]丁海燕,夏木斯叶·木依都力,李敏超,等.舟山市2002-2015年出生体重变化与不良出生结局及影响因素分析[J].中华疾病控制杂志,2018,22(4):380-385.DOI:10.16462/j.cnki.zhjbkz.2018.04.014.Ding HY,Xiamusiye MYDL,Li MC.Analysis of trends of birth weight,and incidence of adverse birth outcomes and relevant factors from 2002 to 2015[J].Chin J Dis Control Prev,2018,22(4):380-385.DOI:10.16462/j.cnki.zhjbkz.2018.04.014.
[20]Simic M,Wikstr9m AK,Stephansson O.Accelerated fetal growth in early pregnancy and risk of severe large-for-gestational-age and macrosomic infant:a cohort study in a low-risk population[J].Acta Obstet Gynecol Scand,2017,96(10):1261-1268.DOI:10.1111/aogs.13189.
[21]闫小红,方红霞,张小丽,等.巨大儿发生率及其相关因素分析[J].中华全科医学,2012,10(11):1731-1732.DOI:10.16766/j.cnki.issn.1674-4152.2012.11.070.Yan XH,Fang HX,Zhang XL,et al.Incidence rate of macrosomia and its correlated factors[J].Chinese Journal of General Practice.2012,10(11):1731-1732.DOI:10.16766/j.cnki.issn.1674-4152.2012.11.070.
[22]Bhutta ZA,Das JK,Rizvi A,et al.Evidence-based interventions for improvement of maternal and child nutrition:what can be done and at what cost[J].Lancet,2013,382(9890):452-477.DOI:10.1016/S0140-6736(13)60996-4.