妊娠高血压综合征对新生儿出生体重的影响及其与其他因素的交互作用研究

摘要

Objective To research the influence of pregnancy-induced hypertension (PIH) on neonatal birth weight and its interaction with other factors.Methods A retrospective cohort study was conducted in this study.14 townships were randomly selected by cluster random sampling method from 37 townships in Liuyang city,Hunan province.All pregnant women from these 14 townships with pregnancy care manual and delivery record,during April 1st,2008 to March 31st,2011 were selected as subjects of this study.Blood pressure during pregnancy and neonatal birth weight were recorded.Multinomial logistic regression model was used to adjust the confounding factors.Addictive effects model was used for interaction analysis.Results Data from 6 102 subjects were collected,including 418 (6.9％) pregnant women with PIH,166 (2.7％) infants with low birth weight and 333(5.5％)with fetal macrosomia.Results from the Multinomial logistic regression analysis showed significant association between neonatal birth weight and PIH,premature birth,BMI ＜ 18.5before pregnancy,and weight gain ≥ 16 kg during pregnancy.Data from the Interaction analysis showed that there was strong positive interactions between PIH and premature birth to low birth weight infants (RERI=35.08,API=0.435,S=1.7),and between PIH and BMI＜18.5 before pregnancy to low birth weight infants.However,no significant interaction was found between PIH and weight gain.Conclusion Factors as PIH,premature birth,BMI before pregnancy and weight gain showed impact on low birth weight or fetal macrosomia.PIH also showed significant interaction on neonatal birth weight with premature birth as well as BMI before pregnancy,respectively.%目的 研究妊娠高血压综合征(妊高症)对低体重儿与巨大儿的影响及其与其他因素的交互作用.方法 应用回顾性队列研究方法,从湖南省浏阳市37个乡镇中随机抽取14个乡镇,收集2008年4月1日至2011年3月31日所有孕产妇孕期保健手册和分娩病历记录.内容包括基本信息、孕期血压和新生儿出生体重.多因素分析采用多项logistic回归分析.交互作用分析选择相加模型.结果 共获得有效数据6 102份.其中妊高症418例,发生率为6.9％;低体重儿166例(2.7％),巨大儿333例(5.5％).多因素研究显示妊高症、早产、孕前BMI＜ 18.5 kg/m2、孕期增重≥16 kg与新生儿体重的关联具有统计学意义.交互作用研究显示妊高症与早产对低体重儿存在较为明显的正交互作用[超额相对危险度(RERI) =35.08,交互作用归因比(API) =0.435,交互作用指数(S)=1.7],妊高症与孕前消瘦(孕前BMI＜ 18.5 kg/m2)对低体重儿存在正交互作用(RERI=1.426,API=0.291,S=1.575),妊高症与孕期体重增加对胎儿出生体重无明显的交互作用.结论 低体重儿和巨大儿的发生与妊高症、早产、孕前BMI、孕期体重的变化有关;且妊高症与早产及孕前BMI对新生儿体重的影响还存在明显的交互作用.