目的 探讨新生儿低出生体重(LBW)(出生体重＜2500 g)发生率与产前检查质量的关系.方法 采用Kessner's评定方法,对2008年1月至2009年12月在西安交通大学医学院第一附属医院产科产前检查的2964例单胎活产孕妇中,进行《产前检查问卷》调查.剔除缺项≥5项的问卷,共计回收有效问卷2928份,回收率为98.79％.对符合纳入标准的2928例单胎活产儿孕妇的产前检查质量进行评价.按照产前检查质量标准,将其分为充分组(n=1262)、居中组(n=1502)和不足组(n=164).采取回顾性分析方法于产后(2～7)d,依照《孕产妇产前检查手册》或门诊及住院病历记录3组孕妇的一般情况及其产前检查、孕期患病和分娩等情况.采用非条件logistic逐步回归分析法分析与LBW发生的相关危险因素及其与产前检查质量的关系(本研究遵循的程序符合本院人体试验委员会所制定的伦理学标准,得到该委员会批准,征得受试对象知情同意并与之签署临床研究知情同意书).3组孕妇孕前体重指数(BMI)、本次妊娠胎数比较,差异无统计学意义(P＞0.05).结果 LBW儿发生率在充分组、居中组和不足组分别为3.49％(44/1262),5.26％(79/1502)和19.51％ (32/164).产前检查不足组LBW儿发生率最高,与其他两组比较,差异有统计学意义(P＜0.01).LBW儿发生的相关危险因素包括:①孕妇年龄;②婚姻状况;③是否有妊娠合并症;④分娩地点;⑤孕期体重增加;⑥分娩孕周等,与产前检查质量密切相关(r=0.83,0.69,0.85,-0.68,-0.71,-0.74;P＜0.05).LBW儿发生与产次无相关性(r=0.26,P＞0.05).本组LBW儿与正常体重儿(≥2500 g)母亲的产前检查质量、年龄、婚姻状况、产次、是否有妊娠合并症、分娩地点、孕期体重增加、分娩孕周等比较,差异有统计学意义(x2=96.05,58.84,21.41,52.38,38.10,33.44,66.32,258.42;P＜0.05).与正常体重儿比较,LBW儿母亲孕期平均接受产前检查次数较少[(7.6±3.1)次vs.(5.4±2.9)次;t=9.16,P＜0.01];产前检查充分组较居中组LBW儿发生率低(OR=0.51,95％CI:0.35～0.72).调整孕妇年龄、孕期体重增加、妊娠并发症、产前检查医院类别及分娩孕周后,产前检查次数较少,仍是LBW儿发生的危险因素(OR=4.56,95％CI:3.02～6.84).结论 采用Kessner's评定方法评估产前检查质量相对客观准确,产前检查次数较少,是LBW儿发生的独立危险因素.
目的 探討新生兒低齣生體重(LBW)(齣生體重＜2500 g)髮生率與產前檢查質量的關繫.方法 採用Kessner's評定方法,對2008年1月至2009年12月在西安交通大學醫學院第一附屬醫院產科產前檢查的2964例單胎活產孕婦中,進行《產前檢查問捲》調查.剔除缺項≥5項的問捲,共計迴收有效問捲2928份,迴收率為98.79％.對符閤納入標準的2928例單胎活產兒孕婦的產前檢查質量進行評價.按照產前檢查質量標準,將其分為充分組(n=1262)、居中組(n=1502)和不足組(n=164).採取迴顧性分析方法于產後(2～7)d,依照《孕產婦產前檢查手冊》或門診及住院病歷記錄3組孕婦的一般情況及其產前檢查、孕期患病和分娩等情況.採用非條件logistic逐步迴歸分析法分析與LBW髮生的相關危險因素及其與產前檢查質量的關繫(本研究遵循的程序符閤本院人體試驗委員會所製定的倫理學標準,得到該委員會批準,徵得受試對象知情同意併與之籤署臨床研究知情同意書).3組孕婦孕前體重指數(BMI)、本次妊娠胎數比較,差異無統計學意義(P＞0.05).結果 LBW兒髮生率在充分組、居中組和不足組分彆為3.49％(44/1262),5.26％(79/1502)和19.51％ (32/164).產前檢查不足組LBW兒髮生率最高,與其他兩組比較,差異有統計學意義(P＜0.01).LBW兒髮生的相關危險因素包括:①孕婦年齡;②婚姻狀況;③是否有妊娠閤併癥;④分娩地點;⑤孕期體重增加;⑥分娩孕週等,與產前檢查質量密切相關(r=0.83,0.69,0.85,-0.68,-0.71,-0.74;P＜0.05).LBW兒髮生與產次無相關性(r=0.26,P＞0.05).本組LBW兒與正常體重兒(≥2500 g)母親的產前檢查質量、年齡、婚姻狀況、產次、是否有妊娠閤併癥、分娩地點、孕期體重增加、分娩孕週等比較,差異有統計學意義(x2=96.05,58.84,21.41,52.38,38.10,33.44,66.32,258.42;P＜0.05).與正常體重兒比較,LBW兒母親孕期平均接受產前檢查次數較少[(7.6±3.1)次vs.(5.4±2.9)次;t=9.16,P＜0.01];產前檢查充分組較居中組LBW兒髮生率低(OR=0.51,95％CI:0.35～0.72).調整孕婦年齡、孕期體重增加、妊娠併髮癥、產前檢查醫院類彆及分娩孕週後,產前檢查次數較少,仍是LBW兒髮生的危險因素(OR=4.56,95％CI:3.02～6.84).結論 採用Kessner's評定方法評估產前檢查質量相對客觀準確,產前檢查次數較少,是LBW兒髮生的獨立危險因素.
목적 탐토신생인저출생체중(LBW)(출생체중＜2500 g)발생솔여산전검사질량적관계.방법 채용Kessner's평정방법,대2008년1월지2009년12월재서안교통대학의학원제일부속의원산과산전검사적2964례단태활산잉부중,진행《산전검사문권》조사.척제결항≥5항적문권,공계회수유효문권2928빈,회수솔위98.79％.대부합납입표준적2928례단태활산인잉부적산전검사질량진행평개.안조산전검사질량표준,장기분위충분조(n=1262)、거중조(n=1502)화불족조(n=164).채취회고성분석방법우산후(2～7)d,의조《잉산부산전검사수책》혹문진급주원병력기록3조잉부적일반정황급기산전검사、잉기환병화분면등정황.채용비조건logistic축보회귀분석법분석여LBW발생적상관위험인소급기여산전검사질량적관계(본연구준순적정서부합본원인체시험위원회소제정적윤리학표준,득도해위원회비준,정득수시대상지정동의병여지첨서림상연구지정동의서).3조잉부잉전체중지수(BMI)、본차임신태수비교,차이무통계학의의(P＞0.05).결과 LBW인발생솔재충분조、거중조화불족조분별위3.49％(44/1262),5.26％(79/1502)화19.51％ (32/164).산전검사불족조LBW인발생솔최고,여기타량조비교,차이유통계학의의(P＜0.01).LBW인발생적상관위험인소포괄:①잉부년령;②혼인상황;③시부유임신합병증;④분면지점;⑤잉기체중증가;⑥분면잉주등,여산전검사질량밀절상관(r=0.83,0.69,0.85,-0.68,-0.71,-0.74;P＜0.05).LBW인발생여산차무상관성(r=0.26,P＞0.05).본조LBW인여정상체중인(≥2500 g)모친적산전검사질량、년령、혼인상황、산차、시부유임신합병증、분면지점、잉기체중증가、분면잉주등비교,차이유통계학의의(x2=96.05,58.84,21.41,52.38,38.10,33.44,66.32,258.42;P＜0.05).여정상체중인비교,LBW인모친잉기평균접수산전검사차수교소[(7.6±3.1)차vs.(5.4±2.9)차;t=9.16,P＜0.01];산전검사충분조교거중조LBW인발생솔저(OR=0.51,95％CI:0.35～0.72).조정잉부년령、잉기체중증가、임신병발증、산전검사의원유별급분면잉주후,산전검사차수교소,잉시LBW인발생적위험인소(OR=4.56,95％CI:3.02～6.84).결론 채용Kessner's평정방법평고산전검사질량상대객관준학,산전검사차수교소,시LBW인발생적독립위험인소.
Objective To explore the relationship between low birth weight (LBW) (birth weight ＜ 2500 g) and the quality of prenatal care,Methods According to Kessne's Adequency of Prenatal Care Index,prenatal care quality of 2964 pregnancy women with single pregnancy who received prenatal examination at First Affiliated Hospital of Medical College,Xi'an Jiaotong University from January 2008 to December 2009 were included into this study.All of them had the survey about Prenatal Examination Questionnaire.A total of 2928 valid questionnaires were collected after excluding questionaires with missing items ≥5.The recovery rate was 98.79％.The qualified 2928 questionnaires were classified three groups according to different prenatal examination quality:Adequate group (n =1262),intermediate group (n=1502) and inadequate group (n=164).General information,prenatal examination,gestational and delivery status within 2-7 d after delivery were analyzed retrospectively.The relationship between LBW related risk factors and prenatal examination were analyzed by non-conditional logistic regression.The study protocol was approved by the Ethical Review Board of Investigation in Human Being of First Affiliated Hospital of Medical College,Xi'an Jiao Tong University.Informed consent was obtained from all participants.Results Incidence rates of LBW was 3.49％ (44/1262) for adequate group,5.26％ (79/1502) for intermediate group,and 19.51％ (32.164) for inadequate group.The inadequate group had the highest incidence rate of LBW infant compared with those in the other two groups (P＜0.01).Close correlation risk factors to LBW infant including:Maternal age,marital status,pregnancy complications,hospital delivery,gestational weight gain,and gestational weeks of delivery (r=0.83,0.69,0.85,-0.68,-0.71,-0.74 ; P＜0.05).The rate of LBW had no correlation with parity (r=0.26,P＞0.05).There had significant differences between LBW infants and normal infants (birth weight ≥2500 g) on mean times of maternal prenatal care quality,maternal age,marital status,parity,pregnancy complications,hospital delivery,gestational weight gain,and pregnancy week delivery (x2 =96.05,58.84,21.41,52.38,38.10,33.44,66.32,258.42,P＜0.05).Compared with normal birth weight infants,the mean times of prenatal care was lower than that in LBW infants [(7.6±3.1) vs.(5.4±2.9); t=9.16,P＜0.01].The prevalence of LBW infant in adequate group was lower than that in intermediate group (OR=0.51,95％CI:0.35 0.72).After adjusting maternal age,marital status,pregnancy complications,gestational weight gain,hospital delivery and gestational age,a significant increased risk of LBW remained for infants of women with inadequate prenatal care (OR=4.56,95％CI:3.02-6.84).Conclusions Kessne's Adequency of Prenatal Care Index was more objective and accurate to evaluate the quality of prenatal care.Inadequately prenatal care was an independent effect on LBW.
