妊娠期高血压疾病与小于胎龄儿的关联研究
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摘要
目的了解河北5县妊娠期高血压疾病(HDCP)和小于胎龄儿(SGA)的发病情况,探讨妊娠期高血压疾病及其严重程度、发病时间和亚型与小于胎龄儿的关系。方法利用2006—2009年中美预防出生缺陷和残疾合作项目在河北5个县开展的"孕期营养项目"的数据。以早产和足月进行分层分析,并将HDCP按照亚型、严重程度和发病时间分组分析。采用χ~2检验进行各组SGA发生率的比较得到相对危险度(RR),采用非条件logistic回归进行多因素分析,得到比值比(OR)和95%置信区间(95%CI)。结果在17 262例孕产妇中,发生HDCP共1 207例,发生率为7.0%;子代发生SGA共1 238例,发生率为7.2%。HDCP组发生SGA的RR值为1.17(0.94,1.45)。以早产和足月分层后,早产孕产妇中HDCP组的发生SGA的RR值为7.94(3.14,20.03),足月孕产妇HDCP组SGA发生率与非HDCP组相比差异无统计学意义。用多因素分析控制孕产妇年龄、BMI、职业、民族、文化程度、孕次、孕检次数、早产、吸烟情况、增补微量营养素分组后,HDCP组、妊娠诱发高血压组、重度HDCP组、早发型HDCP组发生SGA的OR值分别为1.31(1.06,1.63)、1.29(1.03,1.62)、3.63(2.00,6.58)和1.86(1.13,3.07)。结论 HDCP是SGA的危险因素,HDCP的严重程度越大、发病时间越早,越容易娩出SGA,但慢性高血压与SGA发生不相关;HDCP会导致早产儿发生SGA,但不影响足月产儿。应预防HDCP,给予患HDCP的孕产妇合理健康指导,加强围产期监测和干预,减少SGA的发生。
Objective To investigate the incidence of hypertensive disorders complicating pregnancy( HDCP) and small for gestational age babies( SGA) in 5 counties of Hebei province,association of severity,onset time and subtype of HDCP with SGA was also explored. Methods The data was from " Pregnancy Nutrition Project" which was a part of China-US Collaborative Project on Birth Defects and Disabilities Prevention conducted in 2006-2009 in 5 counties of Hebei.Stratified analysis was performed on preterm and term birth and HDCP was grouped according to subtype,severity and time of onset. The Chi-square test was used to compare the incidence of SGA in each group and estimate relative risk( RR).Unconditional logistic regression was used for multivariate analysis to estimate odds ratio( OR) and 95% confidence intervals( 95% CI). Results A total of 1 207 cases with HDCP among 17 262 pregnant women,the incidence was 7. 0%; 1 238 SGA were found among offspring with the incidence was 7. 2%. The RR of SGA in HDCP group was 1. 17( 0. 94,1. 45),the RR of SGA in premature delivery pregnant women was 7. 94( 3. 14,20. 03) stratified by preterm and term birth. There was no significant difference between the incidence of SGA in HDCP group and non-HDCP group. The OR of SGA in the HDCP group,the pregnancy induced hypertension group,the severe HDCP group and the early-onset HDCP group were 1. 31( 1. 06,1. 63),1. 29( 1. 03,1. 62),3. 63( 2. 00,6. 58) and 1. 86( 1. 13,3. 07),respectively,after adjustment by maternal age,BMI,occupation,ethnicity,education,gravidity,pregnancy test times,preterm,smoking status and pill-taking or not. Conclusion HDCP is a risk factor for SGA. More severe and earlier the onset of HDCP would increase the risk of SGA,but chronic hypertension is not associated with SGA; HDCP was related with SGA in preterm birth,but not in term births. Preventing HDCP,providing reasonable health guidance,and strengthening the perinatal monitoring and intervention would be helpful to reduce the occurrence of SGA.
Objective To investigate the incidence of hypertensive disorders complicating pregnancy( HDCP) and small for gestational age babies( SGA) in 5 counties of Hebei province,association of severity,onset time and subtype of HDCP with SGA was also explored. Methods The data was from " Pregnancy Nutrition Project" which was a part of China-US Collaborative Project on Birth Defects and Disabilities Prevention conducted in 2006-2009 in 5 counties of Hebei.Stratified analysis was performed on preterm and term birth and HDCP was grouped according to subtype,severity and time of onset. The Chi-square test was used to compare the incidence of SGA in each group and estimate relative risk( RR).Unconditional logistic regression was used for multivariate analysis to estimate odds ratio( OR) and 95% confidence intervals( 95% CI). Results A total of 1 207 cases with HDCP among 17 262 pregnant women,the incidence was 7. 0%; 1 238 SGA were found among offspring with the incidence was 7. 2%. The RR of SGA in HDCP group was 1. 17( 0. 94,1. 45),the RR of SGA in premature delivery pregnant women was 7. 94( 3. 14,20. 03) stratified by preterm and term birth. There was no significant difference between the incidence of SGA in HDCP group and non-HDCP group. The OR of SGA in the HDCP group,the pregnancy induced hypertension group,the severe HDCP group and the early-onset HDCP group were 1. 31( 1. 06,1. 63),1. 29( 1. 03,1. 62),3. 63( 2. 00,6. 58) and 1. 86( 1. 13,3. 07),respectively,after adjustment by maternal age,BMI,occupation,ethnicity,education,gravidity,pregnancy test times,preterm,smoking status and pill-taking or not. Conclusion HDCP is a risk factor for SGA. More severe and earlier the onset of HDCP would increase the risk of SGA,but chronic hypertension is not associated with SGA; HDCP was related with SGA in preterm birth,but not in term births. Preventing HDCP,providing reasonable health guidance,and strengthening the perinatal monitoring and intervention would be helpful to reduce the occurrence of SGA.
引文
1王庆红,杨于嘉,魏克伦,等.我国小于胎龄儿现状分析.中国实用儿科杂志,2009,24:177-180.
2祝捷,马军,徐萍,等.小于胎龄儿健康状况及其影响因素的流行病学调查.中国儿童保健杂志,2012:228-230.
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4叶荣伟,李宏田,马蕊,等.妊娠高血压综合征与早产、低出生体重关系队列研究.中华预防医学杂志,2010,44:70-74.
5 Chen XK,Wen SW,Smith G,et al.Pregnancy-induced hypertension is associated with lower infant mortality in preterm singletons.BJOG,2006,113:544-551.
6张振,任爱国,叶荣伟,等.妊娠高血压综合征与小于胎龄儿的相关性研究.中华流行病学杂志,2008,29:313-316.
7 Heard AR,Dekker GA,Chan A,et al.Hypertension during pregnancy in south australia,part 1:pregnancy outcomes.Aust NZ J Obstet Gyn,2004,44:404-409.
8 Xiong X,Demianczuk NN,Buekens P,et al.Association of preeclampsia with high birth weight for gestational age.Am J Obstet Gynecol,2000,183:148-155.
9 Chandiramani M,Joash K,Shennan AH.Options and decision-making:hypertensive disorders of pregnancy.Future Cardiol,2010,6:535-546.
10朱丽,张蓉,张淑莲,等.中国不同胎龄新生儿出生体重曲线研制.中华儿科杂志,2015,53:97-103.
11 Liu JM,Mei Z,Ye R,et al.Micronutrient supplementation and pregnancy outcomes:double-blind randomized controlled trial in China.JAMA Inter Med,2013,173:276-282.
12谢幸,苟文丽.妇产科学,第8版.人民卫生出版社,2013.
13 Katz PJ,Lee AC,Kozuki N,et al.Mortality risk in preterm and small-for-gestational-age infants in low-income and middle-income countries:a pooled country analysis.Lancet,2013,382:417-425.
14 Saenger P,Czernichow P,Hughes I,et al.Small for gestational age:short stature and beyond.Endocrine Rev,2007,28:219.
15李盛强,周守方,袁贵龙.小于胎龄儿的高危因素Logistic回归分析.中国妇幼保健,2012:3126-3128.
16张振,任爱国,叶荣伟,等.妊娠高血压综合征与小于胎龄儿的相关性研究.中华流行病学杂志,2008,29:313-316.
17 Xiong X,Demianczuk NN,Saunders LD,et al.Impact of preeclampsia and gestational hypertension on birth weight by gestational age.Am JEpidemiol,2002,155:203-209.
18 Heard AR,Dekker GA,Chan A,et al.Hypertension during pregnancy in South Australia,Part 1:Pregnancy outcomes.Aust Nz J Obstet Gyn,2004,44:404-409.
19 Rasmussen S,Irgens LM.Fetal growth and body proportion in preeclampsia.Obstet Gynecol,2003,101:575-583.
20 Timmermans S,Jaddoe VWV,Hofman A,et al.Periconception folic acid supplementation,fetal growth and the risks of low birth weight and preterm birth:the Generation R Study.Brit J Nutr,2009,102:777.
2祝捷,马军,徐萍,等.小于胎龄儿健康状况及其影响因素的流行病学调查.中国儿童保健杂志,2012:228-230.
3 Dore GJ,Kaldor JM,Mccaughan GW.Systematic review of role of polymerase chain reaction in defining infectiousness among people infected with hepatitis c virus.BMJ,1997,315:333.
4叶荣伟,李宏田,马蕊,等.妊娠高血压综合征与早产、低出生体重关系队列研究.中华预防医学杂志,2010,44:70-74.
5 Chen XK,Wen SW,Smith G,et al.Pregnancy-induced hypertension is associated with lower infant mortality in preterm singletons.BJOG,2006,113:544-551.
6张振,任爱国,叶荣伟,等.妊娠高血压综合征与小于胎龄儿的相关性研究.中华流行病学杂志,2008,29:313-316.
7 Heard AR,Dekker GA,Chan A,et al.Hypertension during pregnancy in south australia,part 1:pregnancy outcomes.Aust NZ J Obstet Gyn,2004,44:404-409.
8 Xiong X,Demianczuk NN,Buekens P,et al.Association of preeclampsia with high birth weight for gestational age.Am J Obstet Gynecol,2000,183:148-155.
9 Chandiramani M,Joash K,Shennan AH.Options and decision-making:hypertensive disorders of pregnancy.Future Cardiol,2010,6:535-546.
10朱丽,张蓉,张淑莲,等.中国不同胎龄新生儿出生体重曲线研制.中华儿科杂志,2015,53:97-103.
11 Liu JM,Mei Z,Ye R,et al.Micronutrient supplementation and pregnancy outcomes:double-blind randomized controlled trial in China.JAMA Inter Med,2013,173:276-282.
12谢幸,苟文丽.妇产科学,第8版.人民卫生出版社,2013.
13 Katz PJ,Lee AC,Kozuki N,et al.Mortality risk in preterm and small-for-gestational-age infants in low-income and middle-income countries:a pooled country analysis.Lancet,2013,382:417-425.
14 Saenger P,Czernichow P,Hughes I,et al.Small for gestational age:short stature and beyond.Endocrine Rev,2007,28:219.
15李盛强,周守方,袁贵龙.小于胎龄儿的高危因素Logistic回归分析.中国妇幼保健,2012:3126-3128.
16张振,任爱国,叶荣伟,等.妊娠高血压综合征与小于胎龄儿的相关性研究.中华流行病学杂志,2008,29:313-316.
17 Xiong X,Demianczuk NN,Saunders LD,et al.Impact of preeclampsia and gestational hypertension on birth weight by gestational age.Am JEpidemiol,2002,155:203-209.
18 Heard AR,Dekker GA,Chan A,et al.Hypertension during pregnancy in South Australia,Part 1:Pregnancy outcomes.Aust Nz J Obstet Gyn,2004,44:404-409.
19 Rasmussen S,Irgens LM.Fetal growth and body proportion in preeclampsia.Obstet Gynecol,2003,101:575-583.
20 Timmermans S,Jaddoe VWV,Hofman A,et al.Periconception folic acid supplementation,fetal growth and the risks of low birth weight and preterm birth:the Generation R Study.Brit J Nutr,2009,102:777.