产前保健与文化程度对低出生体重风险的交互作用

戴琳琳; 胡文斌; 罗晓明; 沈月平

Abstract

戴琳琳,胡文斌,罗晓明,沈月平.产前保健与文化程度对低出生体重风险的交互作用[J].Chinese journal of Epidemiology,2014,35(5):533-536

产前保健与文化程度对低出生体重风险的交互作用

Interaction of prenatal care and level of maternal education on the risk of neonatal low birthweight D

Received:September 11, 2013

DOI：10.3760/cma.j.issn.0254-6450.2014.05.014

KeyWord: 低出生体重产前保健文化程度交互作用

English Key Word: Low birth weight Prenatal care Educational level Interaction

FundProject:

Author Name	Affiliation	E-mail
Dai Linlin	Department of Public Health，Soochow University，Suzhou 215123，China
Hu Wenbin	Kunshan Center for Disease Control and Prevention，Jiangsu Province
Luo Xiaoming	Department of Public Health，Soochow University，Suzhou 215123，China
Shen Yueping	1.Department of Public Health，Soochow University，Suzhou 215123，China 2. Kunshan Center for Disease Control and Prevention，Jiangsu Province 3.Kunshan Maternal and Child Health Care Hospital，Jiangsu Province	shenyueping@suda.edu.cn

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Abstract:

目的研究产前保健利用指标（初次产检孕周、产前检查次数）与产妇文化程度对低出生体重（LBW）风险的交互作用。方法利用昆山市2001－2009年“围产保健监测系统”的数据，将孕妇按文化程度分层（初中及以下、高中和大专及以上），对产前保健利用指标按正常体重儿组四分位法进行重新赋值，拟合logistic回归模型，以最低四分位作为参照，估计其他3个水平LBW 的 OR 值及 95%CI，通过引入乘积项，评估产前保健利用指标和产妇文化程度对 LBW 发生风险。结果孕妇文化程度不论分层前还是分层后，随着产前检查次数增多，新生儿LBW的风险先降后升，呈“U”形曲线趋势。与参比组相比，其中产前检查次数第三分位对LBW发生的OR值及95%CI 分别为不分层组：0.48（0.35～0.64）、初中及以下组：0.55（0.32～0.95）、高中组：0.50（0.32～0.80）、大专及以上组：0.36（0.20～0.66），随着文化程度的提高 OR 值明显降低，产前检查次数和产妇文化程度对LBW风险有明显的交互作用（χ2＝4.650 2，P＝0.031 1）。未发现初次产检孕周与文化程度对LBW发生风险有交互作用（χ2＝0.929 7，P＝0.334 9）。结论产前检查次数与产妇文化程度对LBW发生具有协同保护作用。需要加强低文化群体的产前保健。

English Abstract:

Objective To investigate the interaction of prenatal care indexes including weeks of initiation of prenatal care，number of prenatal care visits and maternal educational level on the risk of neonatal low birth weight （LBW）. Methods Logistic Regression Model was performed to estimate the association including the interaction with OR and 95%CI between prenatal care indexes and LBW risk in all the subjects. Three educational levels（junior high，senior high，junior college）of mothers were also assessed. New variables of the prenatal care indexes were transformed using thequartiles，according to the distribution of the original variables on pregnant women with newborns of normal birth weight. Results Whether the pregnant women were stratified by educational level，with the increasing number of prenatal care visits，LBW risk was shown a U-type tendency in different strata of educational levels，when comparing with the reference group，respectively. Compared to the baseline group，the OR and 95% CI of the third quartile on number of prenatal care visits were 0.48（0.35-0.64），0.55（0.32-0.95），0.50（0.32-0.80），0.36（0.20-0.66）in all subjects who had receivededucational levels as junior middle school，senior middle school or junior college degree ect.respectively. A significant interaction was shown between the number of prenatal care visits and maternal educational level on the neonatal LBW risk（χ2＝4.650 2，P＝0.031 1）. However，no interaction was found between the week of initiation of prenatal care and maternal educational level onthe neonatal LBW risk（χ2＝0.929 7，P＝0.334 9）. Conclusion Data from our study indicated thatthere was a protective interaction on reducing the neonatal LBW risk between maternal educationallevel and the number of prenatal care visits，but not the weeks on the initiation of prenatal care. Moreprenatal care programs should be implemented among the pregnant women with lower educational level.

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