中度早产的增长趋势：巴西一个地区的生态研究

The Growing Trend of Moderate Preterm Births: An Ecological Study in One Region of Brazil.

作者信息

Oliveira Rosana Rosseto de, Melo Emiliana Cristina, Falavina Larissa Pereira, Mathias Thais Aidar de Freitas

机构信息

Department of Nursing, Graduate Nursing Program, State University of Maringá, Paraná, Brazil.

Department of Nursing, Northern Paraná State University, Bandeirantes, Paraná, Brazil.

出版信息

PLoS One. 2015 Nov 3;10(11):e0141852. doi: 10.1371/journal.pone.0141852. eCollection 2015.

DOI:10.1371/journal.pone.0141852

PMID:26529097

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC4631340/

Abstract

BACKGROUND

Preterm birth is a serious public health problem, as it is linked to high rates of neonatal and child morbidity and mortality, with Brazil listed among the countries with the ten highest numbers of premature births. Nonetheless, knowledge is scarce regarding prematurity and associated factors in mid-sized cities. The objective of this study was to analyze the trend of preterm births and associated factors in a municipality located in the state of Paraná, Brazil.

METHODS

This was an ecological time series study of births recorded into the Live Birth Information System for residents of Maringá, Paraná, Brazil, between 2000 and 2013. The polynomial regression model was used for trend analysis of preterm birth, characteristics of the mother, gestation and delivery, and newborn. The association with preterm birth was analyzed using odds ratio (OR).

RESULTS

A total of 61,634 live births were analyzed, of which 5,632 were preterm births. Prematurity increased from 7.9% in 2000 to 11.2% in 2013 -an average increase of 0.54% per year (r2 = 0.93)-with a growing share of moderate preterm births (32 to <37 weeks), which rose from 7.0% in 2000 to 9.7% in 2013. Between 2011 and 2013, multiple pregnancy (OR = 16.64; CI = 13.24-20.92), inadequate number of prenatal visits (OR = 2.81; CI = 2.51-3.15), Apgar score below 7 at 1 (OR = 4.07; CI = 3.55-4.67) and 5 minutes (OR = 10.88; CI = 7.71-15.36), low birth weight (OR = 38.75; CI = 33.72-44.55) and congenital malformations (OR = 3.18; CI = 2.14-4.74) were associated with preterm birth. A growing trend was observed for multiple pregnancies, with an average annual increase of 0.32% (r2 = 0.90), as well as for C-section birth (2.38% yearly increase). Of all newborn characteristics, Apgar score below 7 at 5 minutes (-0.19% per year) and low birth weight (-1.43%) decreased, whereas congenital malformations rose (0.20% per year).

CONCLUSIONS

Efforts are required to prevent premature delivery, particularly during the moderate period, as well as greater care during the prenatal period towards expectant mothers bearing multiple pregnancies, birth defects, in addition to reducing C-section birth as it may be linked to preterm birth.

摘要

背景

早产是一个严重的公共卫生问题，因为它与新生儿和儿童的高发病率及死亡率相关，巴西是早产数量位居前十的国家之一。然而，关于中等规模城市的早产及其相关因素的知识却很匮乏。本研究的目的是分析巴西巴拉那州一个城市的早产趋势及其相关因素。

方法

这是一项对2000年至2013年间巴西巴拉那州马林加市居民在活产信息系统中记录的出生情况进行的生态时间序列研究。多项式回归模型用于早产、母亲特征、妊娠和分娩以及新生儿特征的趋势分析。使用比值比（OR）分析与早产的关联。

结果

共分析了61634例活产，其中5632例为早产。早产率从2000年的7.9%上升至2013年的11.2%，平均每年上升0.54%（r2 = 0.93），中度早产（32至<37周）的比例不断增加，从2000年的7.0%升至2013年的9.7%。2011年至2013年间，多胎妊娠（OR = 16.64；CI = 13.24 - 20.92）、产前检查次数不足（OR = 2.81；CI = 2.51 - 3.15）、1分钟（OR = 4.07；CI = 3.55 - 4.67）和5分钟时阿氏评分低于7分（OR = 10.88；CI = 7.71 - 15.36）、低出生体重（OR = 38.75；CI = 33.72 - 44.55）以及先天性畸形（OR = 3.18；CI = 2.14 - 4.74）与早产相关。多胎妊娠呈上升趋势，平均每年增加0.32%（r2 = 0.90），剖宫产分娩也呈上升趋势（每年增加2.38%）。在所有新生儿特征中，5分钟时阿氏评分低于7分（每年下降0.19%）和低出生体重（每年下降1.43%）有所下降，而先天性畸形则呈上升趋势（每年增加0.20%）。