程诗洋, 张佳琪, 陈莉, 肖春. 全面二孩政策实施前后上海市某区围产儿死因及相关因素分析[J]. 上海预防医学, 2022, 34(3): 231-234. DOI: 10.19428/j.cnki.sjpm.2022.21117
引用本文: 程诗洋, 张佳琪, 陈莉, 肖春. 全面二孩政策实施前后上海市某区围产儿死因及相关因素分析[J]. 上海预防医学, 2022, 34(3): 231-234. DOI: 10.19428/j.cnki.sjpm.2022.21117
CHENG Shiyang, ZHANG Jiaqi, CHEN Li, XIAO Chun. Causes of perinatal mortality and risk factors in a district of Shanghai after the implementation of universal two-child policy[J]. Shanghai Journal of Preventive Medicine, 2022, 34(3): 231-234. DOI: 10.19428/j.cnki.sjpm.2022.21117
Citation: CHENG Shiyang, ZHANG Jiaqi, CHEN Li, XIAO Chun. Causes of perinatal mortality and risk factors in a district of Shanghai after the implementation of universal two-child policy[J]. Shanghai Journal of Preventive Medicine, 2022, 34(3): 231-234. DOI: 10.19428/j.cnki.sjpm.2022.21117

全面二孩政策实施前后上海市某区围产儿死因及相关因素分析

Causes of perinatal mortality and risk factors in a district of Shanghai after the implementation of universal two-child policy

  • 摘要:
    目的 分析全面二孩政策实施前后上海市长宁区围产儿死亡率变化趋势并分析原因,探讨降低围产儿死亡率的有效措施。
    方法 对2011—2020年上海市长宁区围产儿死亡资料进行回顾性分析,比较全面二孩政策前后5年围产儿死亡率、死亡原因及相关因素的变化。
    结果 2011—2020年上海市长宁区围产儿出生数为153 099例,死亡数为352例,围产儿死亡率为2.30‰,2011—2020年围产儿死亡率总体呈下降趋势(P<0.05)。非本市户籍围产儿死亡率在全面二孩政策前后均高于本市户籍围产儿死亡率,差异有统计学意义(P<0.05),而在全面二孩政策后总体呈上升趋势(χ2=5.481,P<0.05)。全面二孩政策前围产儿死亡原因分类前3位为胎儿及其附属物、优生引产、母亲孕产期疾病;全面二孩政策后围产儿死亡原因前3位为母亲孕产期疾病、胎儿及其附属物、新生儿疾病。全面二孩政策后发生围产儿死亡的产妇中高龄、经产、孕期合并症或并发症的产妇占比较政策前明显增高,差异有统计学意义(P<0.05)。全面二孩政策后孕期合并症或并发症前3位病因为妊娠期合并糖尿病、妊娠期高血压、妊娠期合并甲状腺功能减退,其中妊娠期高血压占比由政策前的6.56%(4/61)上升到二孩政策后的25.88%(22/85)。
    结论 全面二孩政策前后非本市户籍围产儿死亡率均高于本市户籍,且由全面二孩政策前的下降趋势转为全面二孩政策后的上升趋势。在围产儿死亡的产妇中,全面二孩政策后高龄、经产、孕期有合并症或并发症的产妇占较全面二孩政策前明显增多。加强孕产妇围产期的健康宣教,提高非户籍孕产妇自我保健和风险防范意识,强化孕产期重点孕妇的层级管理,积极治疗孕产妇并发症、合并症,可进一步降低围产儿死亡率。

     

    Abstract:
    Objective To determine the changing trend and causes of perinatal mortality in Changning District after the implementation of the universal two-child policy, and then explore effective interventions for preventing perinatal mortality.
    Methods Data of perinatal mortality in Changning District from 2011 to 2020 were retrospectively collected. Change of perinatal mortality, causes of death and related factors were compared in consecutive 5 years before and after the universal two-child policy.
    Results In total, there were 153 099 perinatal births from 2011 to 2020 in Changning District, in which 352 deaths were documented. The perinatal mortality was 2.30 per 1 000 births, showing an overall downward trend from 2011 to 2020 (P<0.05). Residents with local household registration had lower perinatal mortality, compared to those with non-local household registration, which was observed both before and after the universal two-child policy (P<0.05). Furthermore, the perinatal mortality showed an upward trend after the universal two-child policy (χ2trend=5.481, P<0.05). The major causes of perinatal death were fetus and its accessories, fetal malformation, and maternal diseases during pregnancy before the universal two-child policy; in contrast, the causes changed to maternal diseases during pregnancy, fetus and its accessories, and neonatal diseases after the policy. The proportion of pregnant women of advanced maternal age, menstrual delivery, and pregnancy complications or comorbidities were significantly higher after the policy than that before the policy (P<0.05). The most common pregnancy complication was gestational diabetes mellitus, gestational hypertension, and hypothyroidism during pregnancy after the universal two-child policy. Of them, the proportion of gestational hypertension increased from 6.56% (4/61) to 25.88% (22/85).
    Conclusion Before and after the universal two-child policy, the perinatal mortality in non-local residents remains high and further shows an upward trend. Moreover, pregnant women advanced maternal age and those with complications or comorbidities may increasingly contribute to perinatal deaths after the policy. Therefore, health education should be strengthened to improve the awareness of self-health care, especially for non-local women. Hierarchical perinatal health service, primary prevention and treatment of pregnancy complications or comorbidities should be improved to further reduce perinatal mortality.

     

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