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目的了解中国高海拔地区15~49岁藏族育龄妇女自然流产状况。方法采用横断面调查设计和分层多阶段抽样法获得样本,采用问卷调查西藏地区15~49岁藏族育龄妇女的生育史。结果共调查3741名15~49岁的藏族育龄妇女,共计10245次妊娠,报告的自然流产386次,自然流产发生率为3.8%,城市妇女显著高于农村妇女,农牧区之间差异无统计学意义,育龄妇女发生自然流产的风险在控制了可能的影响因素后随着海拔高度的增加而增高。居住在海拔4500m以上的育龄妇女发生自然流产的风险是居住在海拔3500m以下妇女的近2倍多。年龄和妊娠的次数显著与自然流产的发生有正相关关系,35岁以上的育龄妇女和多次妊娠的妇女发生自然流产的风险增大。结论高海拔可能独立的影响藏族妇女自然流产的发生,在高海拔地区更应加强健康教育和育龄妇女孕产期保健与营养,减少妊娠次数,延长生育间隔,以减少自然流产的发生。此外,回顾性的生育史调查可能会因回忆偏性等因素而低估了自然流产的发生,但西藏地区育龄妇女的自然流产水平不一定比平原地区高很多。
Objective To understand the status of spontaneous abortion among Tibetan women of childbearing age from 15 to 49 years old in high altitude of China. Methods Cross-sectional survey design and stratified multistage sampling were used to obtain samples. Questionnaires were used to survey the fertility history of Tibetan women of childbearing age from 15 to 49 years old in Tibet. Results A total of 3741 Tibetan women of childbearing age from 15 to 49 years old were investigated. A total of 10,245 pregnancies were reported, 386 spontaneous abortions were reported, the incidence of spontaneous abortion was 3.8%, and urban women were significantly higher than rural women. Significance, women of childbearing age the risk of spontaneous abortion in the control of the possible factors that increase with the altitude increased. The risk of spontaneous abortion among women of childbearing age who live above 4,500 meters above sea level is nearly twice as high as that of women living below 3,500 meters above sea level. There was a positive correlation between age and number of pregnancies and spontaneous abortion. Women of childbearing age and multiple pregnancies over the age of 35 were at increased risk of spontaneous abortion. Conclusions High altitude may affect the spontaneous abortion of Tibetan women independently. At high altitude, health care and nutrition during pregnancy and childbirth should be strengthened, the number of pregnancy should be reduced and the interval of childbirth should be prolonged so as to reduce the incidence of spontaneous abortion. In addition, a retrospective survey on fertility history may underestimate the incidence of spontaneous abortion due to factors such as recall bias. However, the level of spontaneous abortion of women of childbearing age in Tibet is not necessarily much higher than that of the plain.