1986年至2009年西澳大利亚州原住民及托雷斯海峡岛民母亲的孕产妇和新生儿健康特征及产科干预措施的趋势
Trends in maternal and newborn health characteristics and obstetric interventions among Aboriginal and Torres Strait Islander mothers in Western Australia from 1986 to 2009.
作者信息
Diouf Ibrahima, Gubhaju Lina, Chamberlain Catherine, Mcnamara Bridgette, Joshy Grace, Oats Jeremy, Stanley Fiona, Eades Sandra
机构信息
Aboriginal Health Department Baker IDI Heart and Diabetes Institute, Melbourne, Victoria, Australia.
Indigenous Health Equity Unit, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia.
出版信息
Aust N Z J Obstet Gynaecol. 2016 Jun;56(3):245-51. doi: 10.1111/ajo.12416. Epub 2015 Nov 3.
BACKGROUND
Detailed analyses of long-term trends in Aboriginal maternal and newborn health characteristics are lacking.
AIM
To examine trends in maternal and newborn health characteristics for all mothers who were recorded as Aboriginal in the Western Australian Midwives' Notification System from 1986 to 2009.
MATERIALS AND METHODS
Births were categorised into four-year time intervals (1986-1989, 1990-1993, 1994-1997, 1998-2001, 2002-2005, 2006-2009). Trends in maternal demographic characteristics, pre-existing medical conditions, pregnancy complications and neonatal characteristics were examined.
RESULTS
For 37 424 births recorded from 1986 to 2009, the proportion of births to mothers aged ≤19 years decreased (31-22%, P < 0.001) along with the prevalence of pre-eclampsia (6.8-4.0%, P < 0.001) and antepartum haemorrhage (4.8-3.2%, P < 0.001). There were increases in the prevalence of diabetes in pregnancy (3.8-6.6%, P < 0.001), induction of labour (17.8-21.4%, P < 0.001), elective caesarean (6.6-8.2%, P < 0.001) and emergency caesarean (9.5-14.9%, P < 0.001) deliveries. There were no changes in the overall prevalence of preterm births (15.4-15.9%, P = 0.32). However, increases were observed in the prevalence of medically indicated preterm births with and without prelabour rupture of membranes (1.0-1.7%; P < 0.001 and 3.3-4.3%; P = 0.005, respectively). There were no significant changes in the rates of smoking during pregnancy (51-52% from 1998 to 2009, P = 0.18), small-for-gestational age (16.9-17.2%, P = 0.07), suboptimal-birthweight (20.4-20.1%, P = 0.92), stillbirths (14.7 per 1000-12.1 per 1000, P = 0.22) and neonatal deaths (6.2 per 1000-5.5 per 1000, P = 0.68).
CONCLUSION
Encouraging trends include reduced rates of teenage pregnancy, pre-eclampsia and antepartum haemorrhage. The persistent high rates of smoking during pregnancy, preterm births, stillbirths, neonatal deaths and increasing rates of diabetes in pregnancy are of concern.
背景
缺乏对原住民孕产妇和新生儿健康特征长期趋势的详细分析。
目的
研究1986年至2009年在西澳大利亚助产士通报系统中记录为原住民的所有母亲的孕产妇和新生儿健康特征趋势。
材料与方法
将分娩分为四年时间段（1986 - 1989年、1990 - 1993年、1994 - 1997年、1998 - 2001年、2002 - 2005年、2006 - 2009年）。研究孕产妇人口统计学特征、既往疾病、妊娠并发症和新生儿特征的趋势。
结果
1986年至2009年记录的37424例分娩中，年龄≤19岁母亲的分娩比例下降（31% - 22%，P < 0.001），同时子痫前期患病率（6.8% - 4.0%，P < 0.001）和产前出血患病率（4.8% - 3.2%，P < 0.001）也下降。妊娠期糖尿病患病率（3.8% - 6.6%，P < 0.001）、引产率（17.8% - 21.4%，P < 0.001）、择期剖宫产率（6.6% - 8.2%，P < 0.001）和急诊剖宫产率（9.5% - 14.9%，P < 0.001）有所上升。早产总体患病率无变化（15.4% - 15.9%，P = 0.32）。然而，有医学指征的早产且有无胎膜早破的患病率均有所上升（分别为1.0% - 1.7%；P < 0.001和3.3% - 4.3%；P = 0.005）。孕期吸烟率（1998年至2009年为51% - 52%，P = 0.1）、小于胎龄儿（16.9% - 17.2%，P = 0.07）、低出生体重（20.4% - 20.1%，P = 0.92）、死产（每1000例中有14.7例 - 每1000例中有12.1例，P = 0.22）和新生儿死亡（每1000例中有6.2例 - 每1000例中有5.5例，P = 0.68）无显著变化。
结论
令人鼓舞的趋势包括青少年怀孕率、子痫前期和产前出血率降低。孕期吸烟率、早产率、死产率、新生儿死亡率持续居高不下以及妊娠期糖尿病患病率上升令人担忧。
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