CAJ | 학술논문

目的：研究产前保健利用指标（初次产检孕周、产前检查次数）与产妇文化程度对低出生体重（LBW）风险的交互作用。方法利用昆山市2001-2009年“围产保健监测系统”的数据，将孕妇按文化程度分层（初中及以下、高中和大专及以上），对产前保健利用指标按正常体重儿组四分位法进行重新赋值，拟合logistic回归模型，以最低四分位作为参照，估计其他3个水平LBW的OR值及95%CI，通过引入乘积项，评估产前保健利用指标和产妇文化程度对LBW发生风险。结果孕妇文化程度不论分层前还是分层后，随着产前检查次数增多，新生儿LBW的风险先降后升，呈“U”形曲线趋势。与参比组相比，其中产前检查次数第三分位对LBW发生的OR值及95%CI分别为不分层组：0.48（0.35～0.64）、初中及以下组：0.55（0.32～0.95）、高中组：0.50（0.32～0.80）、大专及以上组：0.36（0.20～0.66），随着文化程度的提高OR值明显降低，产前检查次数和产妇文化程度对LBW风险有明显的交互作用（χ2＝4.6502，P＝0.0311）。未发现初次产检孕周与文化程度对LBW发生风险有交互作用（χ2＝0.9297，P＝0.3349）。结论产前检查次数与产妇文化程度对LBW发生具有协同保护作用。需要加强低文化群体的产前保健。
목적：연구산전보건이용지표（초차산검잉주、산전검사차수）여산부문화정도대저출생체중（LBW）풍험적교호작용。방법이용곤산시2001-2009년“위산보건감측계통”적수거，장잉부안문화정도분층（초중급이하、고중화대전급이상），대산전보건이용지표안정상체중인조사분위법진행중신부치，의합logistic회귀모형，이최저사분위작위삼조，고계기타3개수평LBW적OR치급95%CI，통과인입승적항，평고산전보건이용지표화산부문화정도대LBW발생풍험。결과잉부문화정도불론분층전환시분층후，수착산전검사차수증다，신생인LBW적풍험선강후승，정“U”형곡선추세。여삼비조상비，기중산전검사차수제삼분위대LBW발생적OR치급95%CI분별위불분층조：0.48（0.35～0.64）、초중급이하조：0.55（0.32～0.95）、고중조：0.50（0.32～0.80）、대전급이상조：0.36（0.20～0.66），수착문화정도적제고OR치명현강저，산전검사차수화산부문화정도대LBW풍험유명현적교호작용（χ2＝4.6502，P＝0.0311）。미발현초차산검잉주여문화정도대LBW발생풍험유교호작용（χ2＝0.9297，P＝0.3349）。결론산전검사차수여산부문화정도대LBW발생구유협동보호작용。수요가강저문화군체적산전보건。
Objective To investigate the interaction of prenatal care indexes including weeks of initiation of prenatal care,number of prenatal care visits and maternal educational level on the risk of neonatal low birth weight (LBW). Methods Logistic Regression Model was performed to estimate the association including the interaction with OR and 95%CI between prenatal care indexes and LBW risk in all the subjects. Three educational levels(junior high,senior high,junior college)of mothers were also assessed. New variables of the prenatal care indexes were transformed using the quartiles,according to the distribution of the original variables on pregnant women with newborns of normal birth weight. Results Whether the pregnant women were stratified by educational level,with the increasing number of prenatal care visits,LBW risk was shown a U-type tendency in different strata of educational levels,when comparing with the reference group,respectively. Compared to the baseline group,the OR and 95%CI of the third quartile on number of prenatal care visits were 0.48 (0.35-0.64),0.55(0.32-0.95),0.50(0.32-0.80),0.36(0.20-0.66)in all subjects who had received educational levels as junior middle school,senior middle school or junior college degree ect., respectively. A significant interaction was shown between the number of prenatal care visits and maternal educational level on the neonatal LBW risk(χ2=4.650 2,P=0.031 1). However,no interaction was found between the week of initiation of prenatal care and maternal educational level on the neonatal LBW risk(χ2=0.929 7,P=0.334 9). Conclusion Data from our study indicated that there was a protective interaction on reducing the neonatal LBW risk between maternal educational level and the number of prenatal care visits,but not the weeks on the initiation of prenatal care. More prenatal care programs should be implemented among the pregnant women with lower educational level.