2017–2022年单中心产妇妊娠特征和新生儿不良出生结局分析^*

Analysis of Maternal Pregnancy Characteristics and Adverse Neonatal Birth Outcomes at a Single Center From 2017 to 2022

摘要

目的 分析2017–2022年某三级甲等医院产妇的妊娠特征和新生儿不良出生结局的变化趋势和关联，为有针对性预防新生儿不良出生结局提供依据。方法 回顾性收集2017年1月1日–2022年12月31日期间产科分娩医疗记录数据。采用描述性分析方法对产妇妊娠特征和新生儿不良出生结局进行分析，并通过单因素和多因素分析，探讨此时期二者的关系。结果 最终分析共纳入93 547例新生儿数据和对应88 857例产妇数据。2017–2022年本院产妇和新生儿数量总体呈增加趋势。本地区女性的主要生育年龄集中于30～34岁，高龄产妇（≥35岁）占比整体呈下降趋势，差异有统计学意义（χ²_趋势= 13.261，P<0.001）。除了剖宫产，本地区的早产、低出生体重（low birth weight, LBW）、巨大儿、小于胎龄儿（small for gestational age infant, SGA）和大于胎龄儿（large for gestational age infant, LGA）的发生风险整体呈下降趋势，差异有统计学意义（P<0.05）。多变量逻辑回归分析结果显示，与<30岁产妇组相比，30～34岁和≥35岁产妇年龄组的新生儿剖宫产发生风险升高，分别为1.339倍〔调整比值比（aOR）=1.339，95%置信区间（CI）：1.297～1.382〕和2.646倍（aOR=2.646，95%CI：2.532～2.765），在LGA发生风险方面，仅≥35岁产妇年龄组的新生儿发生风险增高（aOR=1.111，95%CI：1.049～1.178，P<0.001）；经产组剖宫产、早产和巨大儿的发生风险分别是初产组的1.151倍（aOR=1.151，95%CI： 1.114～1.189）、1.558倍（aOR=1.558，95%CI：1.486～1.633）和1.595倍（aOR=1.595，95%CI：1.527～1.688），而经产组SGA发生风险低于初产组（aOR=0.684，95%CI：0.655～0.715）；体外受精（in vitro fertilization, IVF)组新生儿的剖宫产、巨大儿和LGA的发生风险分别是自然受孕组的2.295倍（aOR=2.295，95%CI：2.170～2.427）、1.274倍（aOR=1.274，95%CI：1.122～1.447）和1.300倍（aOR=1.300，95%CI：1.216～1.391），但SGA的发生风险反而低于非IVF组（aOR=0.774，95%CI：0.729～0.821）。结论 2017–2022年本院产妇妊娠特征发生改变，且此期间的部分新生儿不良出生结局发生风险呈现降低趋势。此外，不同高危人群（年龄≥35岁产妇、经产妇和辅助技术助孕产妇）的新生儿出生结局呈现差异化特征。

Abstract

Objective To analyze changes and correlations in the pregnancy characteristics of parturients and adverse birth outcomes of newborns in a tertiary grade A hospital from 2017 to 2022, and provide a basis for targeted prevention of adverse birth outcomes in newborns. Methods Medical records of obstetric deliveries from January 1, 2017, to December 31, 2022, were retrospectively collected. Descriptive analysis was used to examine the pregnancy characteristics of parturients and adverse birth outcomes of newborns. Univariate and multivariate analyses were conducted to explore the relationship between these factors during this period. Results The final analysis included data from 93 547 newborns and 88 857 corresponding mothers. From 2017 to 2022, the number of mothers and newborns at our hospital showed an overall increasing trend. The main reproductive age for women in this region was concentrated between 30 and 34 years. The proportion of older mothers (≥ 35 years) showed a general downward trend, and this difference was statistically significant (χ²_trend = 13.261, P < 0.001). Except for cesarean section, the risks of preterm birth, low birth weight (LBW), macrosomia, small for gestational age infant (SGA), and large for gestational age infant (LGA) in this region showed an overall downward trend, with statistically significant differences ( P < 0.05). Multivariate logistic regression analysis showed that, compared with mothers under 30 years, the risk of cesarean section for newborns was 1.339 times higher in the 30-34 age group (adjusted odds ratio [aOR] = 1.339, 95% CI: 1.297-1.382) and 2.646 times higher in the ≥ 35 age group (aOR = 2.646, 95% CI: 2.532-2.765). For LGA risk, only mothers aged ≥ 35 years showed an increased risk for newborns (aOR = 1.111, 95% CI: 1.049-1.178, P < 0.001). The risks of cesarean section, preterm birth, and macrosomia in the multiparous group were 1.151 times (aOR = 1.151, 95% CI: 1.114-1.189), 1.558 times (aOR = 1.558, 95% CI: 1.486-1.633), and 1.595 times (aOR = 1.595, 95% CI: 1.527-1.688) those in the primiparous group, respectively, while the risk of SGA in the multiparous group was lower than in the primiparous group (aOR = 0.684, 95% CI: 0.655-0.715). The risks of cesarean section, macrosomia, and LGA in the in vitro fertilization (IVF) group were 2.295 times (aOR = 2.295, 95% CI: 2.170-2.427), 1.274 times (aOR = 1.274, 95% CI: 1.122-1.447), and 1.300 times (aOR = 1.300, 95% CI: 1.216-1.391) those in the natural conception group, respectively, but the risk of SGA was lower than in the non-IVF group (aOR = 0.774, 95% CI: 0.729-0.821). Conclusion From 2017 to 2022, the characteristics of pregnant women in our hospital changed, and the risk of some adverse neonatal outcomes showed a decreasing trend during this period. Additionally, neonatal birth outcomes among different high-risk groups (women aged 35 or older, multiparous women, and women who conceived with assisted reproductive technology) exhibited distinct characteristics.

关键词

高龄 / 经产妇 / 体外受精 / 不良新生儿结局

Key words

Advanced maternal age / Multiparous women / In vitro fertilization (IVF) / Adverse neonatal outcomes

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基金资助

*四川大学横向课题(21H0395)