不同生育政策时期产妇特征及妊娠结局相关指标变化情况分析

摘要

Objective To assess the potential impact of recent family planning policy adjustments on maternal characteristics and birth outcomes in China.Methods Pregnant women who delivered in six hospitals in Hubei and Gansu provinces in 2013-2016 were surveyed.The hospitals included one tertiary and two secondary hospitals in each province.Information on major maternal characteristics and birth outcomes were extracted from hospital delivery registration form.Three phases were categorized based on the implement of family planning policy:One-Child Policy period refers to January,2013 to September,2014;Selective Two-Child Policy period refers to October,2014 to July,2016 and Universal Two-Child Policy period refers to August,2016 to December,2016,and the secular trends in the major maternal characteristics and birth outcomes were described accordingly.Results In total,29 895 women (30 532 neonates) were included in the analysis.The overall percentage of women with advanced age (aged ≥35 years) was 9.6％,and 39.0％ were multiparous.The overall prevalence rate of preterm delivery and low birth weight was 9.0％ and 7.7％,respectively.Over the three phases,the percentage of women with advanced age increased significantly from 8.6％ to 9.6％ and it's 12.3％ in the Universal Two-Child Policy period,and the percentage of multiparous women was 34.9％,39.7％ and 46.9％ respectively.Over the study period,there were no significant increase in the prevalence of preterm delivery (9.5％,8.4％ and 9.7％),low birth weight (7.5％,7.9％ and 7.6％),and the mean 1-minter Apgar scores [(8.7 ± 0.9),(8.8 ± 1.0),(8.9 ± 1.5)].Further stratified by the institutions,compared with One-Child Policy period,there was a 24.3％ ～97.4％ and 28.1％ ～75.2％ increase in the percentage of women with advanced maternal age at the last period in 2 tertiary and 2 secondary hospitals respectively.While the remaining two midwifery institutions (one of them has the annual delivery of around 100 cases,the other was close to tertiary midwifery institutions) has no corresponding upward trend.In all the 6 hospitals,there were no increases in the rate of preterm delivery and low birth weight,and no decreases in the mean 1-minter Apgar scores over the study period.Conclusion Maternal characteristics have changed substantially after relaxation of the One-Child policy,especially after implementation of the universal Two-Child Policy,typically characterized by a substantial increase in the percentage of women with advanced age and that of multiparous women.However,no evidence showed the increase in the prevalence of preterm delivery and low birth weight,and decreases in the mean 1-minter Apgar scores.The safety of mothers and neonates has been effectively guaranteed in the early stage of family planning policy adjustments,although the number of high risk pregnancies increases after adjustment of family planning policy.However,follow up study was still necessary for continued monitoring the potential impacts of the Universal Two-Child Policy,in order to optimize allocation of health resources and guarantee the safety of mothers and neonates.%目的 了解不同生育政策时期产妇特征及妊娠结局相关指标变化情况,评价两次生育政策调整效应. 方法 调查现场为湖北和甘肃两省6所助产机构(三级医院各1所,二级医院各2所),调查对象为2013-2016年在这6所助产机构分娩的部分产妇及新生儿.调查内容为产妇特征及妊娠结局相关指标,所有资料均来源于医疗记录,即通过查阅产科分娩登记簿收集相关资料.综合考虑两次生育政策调整时间及妊娠周期等因素,研究将整个时段划分为独生子女政策期(2013年1月至2014年9月)、单独二孩政策期(2014年10月至2016年7月)、全面两孩政策期(2016年8月至2016年12月),描述在这三个阶段中产妇特征及妊娠结局相关指标的变化情况. 结果 纳入分析的产妇共计29 895名(分娩活产新生儿30 532名),其中高龄产妇占比为9.6％,经产妇占比39.0％,早产发生率9.0％,低出生体重发生率7.7％.三个阶段(独生子女政策期,单独二孩政策期,全面两孩政策期)高龄产妇占比从8.6％升至9.6％再升至12.3％(x2趋势=-6.5,P＜0.000 1)、经产妇占比从34.9％升至39.7％再升至46.9％(x2趋势=-13.5,P ＜0.000 1);三个阶段早产发生率(依次为9.5％,8.4％和9.7％)、低出生体重发生率(依次为7.5％,7.9％和7.6％)未见上升趋势,1分钟Apgar评分[依次为(8.7±0.9)分,(8.8±1.0)分,(8.9±1.5)分]未见下降趋势.按助产机构分层分析发现,2所三级和2所二级助产机构高龄产妇及经产妇占比在三个政策阶段呈上升趋势(全面两孩政策期较独生子女政策期升幅范围分别是24.3％ ～ 97.4％和28.1％ ～75.2％);其余2所二级助产机构(1所年均分娩量100余例,另1所紧邻三级助产机构)未见相应升势;全部6所助产机构早产及低出生体重发生率均未见上升趋势,新生儿1分钟Apgar评分均未见下降趋势. 结论 生育政策调整后,尤其是全面两孩政策实施之初,经产妇、高龄产妇占比明显上升;早产及低出生体重发生率未见上升、Apgar评分未见下降,提示生育意愿集中释放初期,母婴安全得到保障;仍需继续监测生育政策调整的后续效应,以优化资源配置、持续保障母婴安全与健康.