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Article(id=1241034447269720649, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1241034441380917539, articleNumber=null, orderNo=null, doi=10.20043/j.cnki.MPM.202412461, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=null, receivedDate=1735142400000, receivedDateStr=2024-12-26, revisedDate=null, revisedDateStr=null, acceptedDate=null, acceptedDateStr=null, onlineDate=1773815269534, onlineDateStr=2026-03-18, pubDate=1749484800000, pubDateStr=2025-06-10, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1773815269534, onlineIssueDateStr=2026-03-18, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1773815269534, creator=13701087609, updateTime=1773815269534, updator=13701087609, issue=Issue{id=1241034441380917539, tenantId=1146029695717560320, journalId=1227665162245664772, year='2025', volume='52', issue='11', pageStart='1921', pageEnd='2112', issueExtLink='null', onlineDate='null', pubDate='null', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=-1, specialIssue=null, createTime=1773815268130, creator=13701087609, updateTime=1773815340947, updator=13701087609, preIssue=null, nextIssue=null, ext={EN=IssueExt(id=1241034746873049765, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1241034441380917539, language=EN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=), CN=IssueExt(id=1241034746873049766, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1241034441380917539, language=CN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=)}, issueFiles=null}, startPage=1997, endPage=2002, ext={EN=ArticleExt(id=1241034447643013740, articleId=1241034447269720649, tenantId=1146029695717560320, journalId=1227665162245664772, language=EN, title=Distribution characteristics of parity and their impact on maternal and neonatal outcomes, columnId=1228016568949474136, journalTitle=Modern Preventive Medicine, columnName=Child and Adolescent Health, Maternal and Child Health, runingTitle=null, highlight=null, articleAbstract=
Objective

To analyze the distribution characteristics of mothers with different parities in Hebei Province and their impact on pregnancy outcomes.

Methods

Data from 398 111 mothers who delivered in 22 hospitals across 10 cities in Hebei Province were analyzed. Based on previous delivery counts (excluding the current hospitalization), mothers were categorized into three groups:primipara (parity=0), multipara (parity=1), and grand multipara (parity≥2). The distribution characteristics of mothers by parity were analyzed, and the influence of different parities on pregnancy outcomes was assessed using multifactorial logistic regression.

Results

From 2014 to 2022, the average age of mothers in all three groups showed an upward trend, as did the proportion of grand multipara mothers. With the increase in hospital level, the proportion of primipara mothers rose, while the proportions of multipara and grand multipara mothers declined. The proportion of primipara mothers in provincial and municipal hospitals was higher than that in county and township hospitals, where the proportions of multipara and grand multipara mothers were lower. As parity increased, the incidence rates of anemia, placenta previa, placental abruption, preterm birth, cesarean delivery, macrosomia, low Apgar scores, and perinatal mortality also increased. Conversely, the incidence rates of gestational diabetes, gestational hypertension, abnormal fetal position, soft birth canal lacerations, postpartum hemorrhage, and low birth weight exhibited a “U” trend. Using primipara (parity=0) mothers as the reference group, the results of the multifactorial logistic regression analysis indicated that parity≥1 was a risk factor for anemia (OR=1.041, 95%CI: 1.024-1.058), gestational diabetes (OR=1.301, 95% CI: 1.237-1.375), placenta previa (OR=1.565, 95% CI: 1.359-1.802), soft birth canal lacerations (OR=1.394, 95% CI: 1.157-1.681), and macrosomia (OR=1.222, 95%CI: 1.189-1.257). In contrast, it was a protective factor against gestational hypertension (OR=0.677, 95% CI: 0.651-0.703),abnormal fetal position (OR=0.650, 95% CI: 0.617-0.684), cesarean delivery (OR=0.296, 95% CI: 0.290-0.301), and low birth weight (OR=0.872, 95% CI: 0.830-0.917). Parity≥2 was identified as a risk factor for preterm birth (OR=1.470, 95% CI: 1.372-1.575) and postpartum hemorrhage (OR=1.242, 95% CI: 1.086-1.420).

Conclusion

The risk of adverse pregnancy outcomes varies with parity. Targeted prevention of gestational complications and comorbidities should be implemented during prenatal care for mothers of different parities to reduce the risk of adverse maternal and infant outcomes.

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目的

分析河北省不同产次产妇的分布特征及其对妊娠结局的影响。

方法

对河北省10个地市22家医院分娩的398 111例产妇资料进行分析，根据既往分娩次数（不包括此次住院分娩），将产妇分为一胎（产次=0）、二胎（产次=1）和三胎及以上（产次≥2次），分析不同产次产妇的分布特征，应用多因素logistic回归分析不同产次对妊娠结局的影响。

结果

2014—2022年三组产妇平均分娩年龄均呈上升趋势，三胎及以上产妇占比也呈上升趋势。伴随着医院级别的升高，一胎产妇占比呈上升趋势，二胎和三胎及以上产妇占比呈下降趋势，省市级医院一胎产妇占比高于县乡级医院，二胎和三胎及以上产妇占比低于县乡级医院。随着产次组的增加，贫血、前置胎盘、胎盘早剥、早产、剖宫产、巨大儿、低Apgar评分及围生儿死亡的发生率均呈上升趋势，妊娠期糖尿病、妊娠期高血压疾病、异常胎位、软产道裂伤、产后出血、低出生体重的发生率呈“U”趋势。以一胎（产次=0）产妇为参照组，多因素logistic回归分析结果显示：产次≥1是发生贫血（OR=1.041，95%CI：1.024～1.058）、妊娠期糖尿病（OR=1.301，95%CI：1.237～1.375）、前置胎盘（OR=1.565，95%CI：1.359～1.802）、软产道裂伤（OR=1.394，95%CI：1.157～1.681）、巨大儿（OR=1.222，95%CI：1.189～1.257）的危险因素，而是妊娠期高血压疾病（OR=0.677，95%CI：0.651～0.703）、异常胎位（OR=0.650，95%CI：0.617～0.684）、剖宫产（OR=0.296，95%CI：0.290～0.301）、低出生体重（OR=0.872，95%CI：0.830～0.917）的保护因素；产次≥2是发生早产（OR=1.470，95%CI：1.372～1.575）、产后出血（OR=1.242，95%CI：1.086～1.420）的危险因素。

结论

不同产次发生不良妊娠结局的风险不同，对不同产次孕妇产检过程中应对妊娠期合并症与并发症有针对性进行预防，以降低不良母婴结局的发生风险。

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霍琰，E-mail:
, copyrightStatement=本刊刊出的所有文章不代表中华预防医学会和本刊编委会的观点，除非特别声明。, copyrightOwner=中华预防医学会和四川大学华西公共卫生学院, extLink=null, articleAbsUrl=null, sourceXml=RnQ2JEr+PzBmvV9zF7bTIQ==, magXml=fj1/ltQccA07pVNgl+XG9w==, pdfUrl=null, pdf=88NP7jhtEsGsKAqLVJGE0A==, pdfFileSize=912910, pdfExtLink=null, richHtmlUrl=null, mobilePdfUrl=null, reviewReport=null, pdfFirstPage=null, abstractGraph=ppAY+16ePMxhvWJd/41suQ==, abstractGraphContent=null, abstractVideo=null, citation=null, cebUrl=null, magXmlContent=4Uqg6cMczcLZs+OXguI0aA==, mapNumber=null, authorCompany=null, fund=null, authors=

李思思（1986—），女，硕士，主治医师，研究方向:妊娠期并发症

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李思思（1986—），女，硕士，主治医师，研究方向:妊娠期并发症

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李思思（1986—），女，硕士，主治医师，研究方向:妊娠期并发症

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The likelihood of placenta previa with greater number of cesarean deliveries and higher parity[J].Obstetrics and Gynecology, 2002, 99(6): 976-980., articleTitle=The likelihood of placenta previa with greater number of cesarean deliveries and higher parity, refAbstract=null), Reference(id=1241050848713830636, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241034447269720649, doi=null, pmid=null, pmcid=null, year=2008, volume=111, issue=4, pageStart=875, pageEnd=880, url=null, language=null, rfNumber=[27], rfOrder=32, authorNames=Witkop CT, Zhang J, Sun W, journalName=Obstetrics and Gynecology, refType=null, unstructuredReference=Witkop CT, Zhang J, Sun W, et al. Natural history of fetal position during pregnancy and risk of nonvertex delivery[J]. Obstetrics and Gynecology, 2008, 111(4): 875-880., articleTitle=Natural history of fetal position during pregnancy and risk of nonvertex delivery, refAbstract=null)], funds=[Fund(id=1241050841591902234, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241034447269720649, awardId=20241704, language=CN, fundingSource=河北省医学科研项目(20241704), fundOrder=null, country=null), Fund(id=1241050841721925663, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241034447269720649, awardId=20190325, language=CN, fundingSource=河北省医学科研项目(20190325), fundOrder=null, country=null)], companyList=[AuthorCompany(id=1241050829646524865, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241034447269720649, xref=1., ext=[AuthorCompanyExt(id=1241050829667496385, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241034447269720649, companyId=1241050829646524865, language=EN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=Department of Obstetrics, Hebei Provincial People’s Hospital, Shijiazhuang, Hebei 050051, China), AuthorCompanyExt(id=1241050829680079299, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241034447269720649, companyId=1241050829646524865, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=1.河北省人民医院产科，河北 石家庄 050051)]), AuthorCompany(id=1241050829847851467, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241034447269720649, xref=2., ext=[AuthorCompanyExt(id=1241050829864628686, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241034447269720649, companyId=1241050829847851467, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=2.河北省妇幼保健中心信息管理科)]), AuthorCompany(id=1241050830011429334, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241034447269720649, xref=3., ext=[AuthorCompanyExt(id=1241050830015623639, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241034447269720649, companyId=1241050830011429334, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=3.河北省顺平县医院妇产科)])], figs=[ArticleFig(id=1241050838060299149, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241034447269720649, language=EN, label=Figure 1, caption=The number and proportion of maternal women in different parity in Hebei Province from 2014 to 2022, figureFileSmall=W67KXgw6adUJrnzNw37kMA==, figureFileBig=EIQTo3yp5Fz2d3BIcMkSmw==, tableContent=null), ArticleFig(id=1241050838232265624, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241034447269720649, language=CN, label=图1, caption=2014—2022年河北省不同产次孕产妇数量及比例, figureFileSmall=W67KXgw6adUJrnzNw37kMA==, figureFileBig=EIQTo3yp5Fz2d3BIcMkSmw==, tableContent=null), ArticleFig(id=1241050838488118180, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241034447269720649, language=EN, label=Figure 2, caption=The average age of maternal women with different parity in Hebei Province from 2014 to 2022, figureFileSmall=7/mSTSRK9ffFrj5mf5gMEg==, figureFileBig=a0+U3Y+wFdO1zCISJmj9BQ==, tableContent=null), ArticleFig(id=1241050838597170090, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241034447269720649, language=CN, label=图2, caption=2014—2022年河北省不同产次产妇平均分娩年龄, figureFileSmall=7/mSTSRK9ffFrj5mf5gMEg==, figureFileBig=a0+U3Y+wFdO1zCISJmj9BQ==, tableContent=null), ArticleFig(id=1241050838794302391, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241034447269720649, language=EN, label=Figure 3, caption=Forest plot of the effects of different parities on adverse maternal and neonatal outcomes, figureFileSmall=FKc6Z029Iwbdrm+zYS36CA==, figureFileBig=+J85ARdRM5BBoMkfCHDc6g==, tableContent=null), ArticleFig(id=1241050839251481542, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241034447269720649, language=CN, label=图3, caption=不同产次对不良母婴结局影响的森林图, figureFileSmall=FKc6Z029Iwbdrm+zYS36CA==, figureFileBig=+J85ARdRM5BBoMkfCHDc6g==, tableContent=null), ArticleFig(id=1241050839758992336, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241034447269720649, language=EN, label=Table 1, caption=

Distribution of maternal women with different parity in cities of Hebei Province during 2014 and 2022 ［n（%）］

, figureFileSmall=null, figureFileBig=null, tableContent=
城市一胎二胎三胎及以上
保定37 460（48.15）36 688（47.16）3 648（4.69）
沧州4 345（40.59）5 684（53.10）675（6.31）
承德4 031（38.71）5 347（51.34）1 036（9.95）
邯郸10 762（33.35）16 755（51.93）4 750（14.72）
衡水5 316（32.14）9 623（58.17）1 603（9.69）
秦皇岛7 546（28.65）15 316（58.14）3 480（13.21）
石家庄83 080（49.85）74 375（44.63）9 196（5.52）
唐山9 553（55.63）7 280（42.39）339（1.97）
邢台6 828（30.67）13 474（60.52）1 961（8.81）
张家口7 940（44.21）8 203（45.67）1 817（10.12）
), ArticleFig(id=1241050840220365784, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241034447269720649, language=CN, label=表1, caption=

2014—2022年不同胎次在河北省各城市分布［n（%）］

, figureFileSmall=null, figureFileBig=null, tableContent=
城市一胎二胎三胎及以上
保定37 460（48.15）36 688（47.16）3 648（4.69）
沧州4 345（40.59）5 684（53.10）675（6.31）
承德4 031（38.71）5 347（51.34）1 036（9.95）
邯郸10 762（33.35）16 755（51.93）4 750（14.72）
衡水5 316（32.14）9 623（58.17）1 603（9.69）
秦皇岛7 546（28.65）15 316（58.14）3 480（13.21）
石家庄83 080（49.85）74 375（44.63）9 196（5.52）
唐山9 553（55.63）7 280（42.39）339（1.97）
邢台6 828（30.67）13 474（60.52）1 961（8.81）
张家口7 940（44.21）8 203（45.67）1 817（10.12）
), ArticleFig(id=1241050840388137951, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241034447269720649, language=EN, label=Table 2, caption=

Regional distribution of maternal women with different parity in Hebei Province during 2014 and 2022 ［n（%）］

, figureFileSmall=null, figureFileBig=null, tableContent=
医院情况一胎二胎三胎及以上χ2值P值
医院级别10 111.266<0.001
省市级103 468（52.13）84 628（42.65）10 349（5.22）
县乡级73 393（36.77）108 117（54.15）18 156（9.09）
医院等级3 837.269<0.001
一级医院1 168（23.11）2 921（57.81）964（19.08）
二级医院123 957（42.53）145 754（50.01）21 750（7.46）
三级医院51 736（50.92）44 070（43.38）5 791（5.70）
), ArticleFig(id=1241050840509772776, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241034447269720649, language=CN, label=表2, caption=

2014—2022年不同胎次在河北省的地区分布［n（%）］

, figureFileSmall=null, figureFileBig=null, tableContent=
医院情况一胎二胎三胎及以上χ2值P值
医院级别10 111.266<0.001
省市级103 468（52.13）84 628（42.65）10 349（5.22）
县乡级73 393（36.77）108 117（54.15）18 156（9.09）
医院等级3 837.269<0.001
一级医院1 168（23.11）2 921（57.81）964（19.08）
二级医院123 957（42.53）145 754（50.01）21 750（7.46）
三级医院51 736（50.92）44 070（43.38）5 791（5.70）
), ArticleFig(id=1241050840748848112, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241034447269720649, language=EN, label=Table 3, caption=

Demographic characteristics of maternal women in Hebei Province, China from 2014 to 2022 ［n（%）］

, figureFileSmall=null, figureFileBig=null, tableContent=
项目一胎二胎三胎及以上χ2值P值
产妇年龄32 022.83<0.001
<203 906(2.20)414(0.22)41(0.15)
20～34165 560(94.9)156 507(82.34)19 244(68.71)
≥354 939(2.80)33 146(17.44)8 723(31.14)
婚姻状况121.595<0.001
单身997(0.56)634(0.33)102(0.36)
已婚175 816(99.44)192 071(99.67)28 400(99.64)
教育水平18 207.620<0.001
大专及以上87 139(50.03)63 648(33.46)4 988(17.71)
初中85 056(48.83)122 970(64.66)21 628(76.73)
小学及以下1 993(1.14)3 575(1.88)1 566(5.56)
胎儿性别471.344<0.001
男性89 242(50.48)97 669(50.69)16 309(57.25)
女性87 547(49.42)95 013(49.31)12 178(42.75)
产检次数(次)3 731.755<0.001
≤8105 973(62.51)130 745(70.16)21 420(77.34)
>863 568(37.49)55 603(29.84)6 277(22.66)
剖宫产史108 039.629<0.001
是0(0)87 350(45.37)14 999(52.66)
否176 679(100)105 179(54.63)13 485(47.34)
流产史12 893.971<0.001
是38 361(21.70)73 927(38.37)11 102(38.97)
否138 448(78.30)118 736(61.63)173 085(61.03)
), ArticleFig(id=1241050840845317111, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241034447269720649, language=CN, label=表3, caption=

2014—2022年中国河北省孕产妇的人口统计特征［n（%）］

, figureFileSmall=null, figureFileBig=null, tableContent=
项目一胎二胎三胎及以上χ2值P值
产妇年龄32 022.83<0.001
<203 906(2.20)414(0.22)41(0.15)
20～34165 560(94.9)156 507(82.34)19 244(68.71)
≥354 939(2.80)33 146(17.44)8 723(31.14)
婚姻状况121.595<0.001
单身997(0.56)634(0.33)102(0.36)
已婚175 816(99.44)192 071(99.67)28 400(99.64)
教育水平18 207.620<0.001
大专及以上87 139(50.03)63 648(33.46)4 988(17.71)
初中85 056(48.83)122 970(64.66)21 628(76.73)
小学及以下1 993(1.14)3 575(1.88)1 566(5.56)
胎儿性别471.344<0.001
男性89 242(50.48)97 669(50.69)16 309(57.25)
女性87 547(49.42)95 013(49.31)12 178(42.75)
产检次数(次)3 731.755<0.001
≤8105 973(62.51)130 745(70.16)21 420(77.34)
>863 568(37.49)55 603(29.84)6 277(22.66)
剖宫产史108 039.629<0.001
是0(0)87 350(45.37)14 999(52.66)
否176 679(100)105 179(54.63)13 485(47.34)
流产史12 893.971<0.001
是38 361(21.70)73 927(38.37)11 102(38.97)
否138 448(78.30)118 736(61.63)173 085(61.03)
), ArticleFig(id=1241050841067615232, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241034447269720649, language=EN, label=Table 4, caption=

Adverse maternal and neonatal outcomes at different parity from 2014 to 2022 ［n（%）］

, figureFileSmall=null, figureFileBig=null, tableContent=
不良结局一胎二胎三胎及以上χ2值P值
贫血56 814(32.12)71 815(37.26)11 831(41.5)1 586.092<0.001
妊娠期糖尿病11 504(6.50)13 802(7.16)1 643(5.76)112.101<0.001
妊娠期高血压疾病9 978(5.64)9 550(4.95)1 962(6.88)217.830<0.001
前置胎盘433(0.24)964(0.50)340(1.19)542.851<0.001
胎盘早剥492(0.28)562(0.29)125(0.44)21.637<0.001
异常胎位5 453(3.08)4 371(2.27)787(2.76)237.483<0.001
早产10 129(5.73)11 280(5.85)2 539(8.91)456.709<0.001
剖宫产82 450(46.68)109 045(56.64)16 159(56.79)3 912.030<0.001
软产道裂伤289(0.16)230(0.12)37(0.13)13.062<0.001
产后出血2 635(1.49)1 773(0.92)344(1.21)254.126<0.001
产科感染924(0.52)1 010(0.52)176(0.62)4.4560.108
巨大儿13 583(7.68)18 008(9.34)3 173(11.13)541.746<0.001
低出生体重8 111(4.59)7 655(3.97)1 609(5.64)204.022<0.001
低Apgar评分344(0.19)418(0.22)94(0.33)21.016<0.001
围生儿死亡135(0.08)169(0.09)35(0.12)6.5070.039
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2014— 2022年不同产次孕产妇的母婴不良结局［n（%）］

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不良结局一胎二胎三胎及以上χ2值P值
贫血56 814(32.12)71 815(37.26)11 831(41.5)1 586.092<0.001
妊娠期糖尿病11 504(6.50)13 802(7.16)1 643(5.76)112.101<0.001
妊娠期高血压疾病9 978(5.64)9 550(4.95)1 962(6.88)217.830<0.001
前置胎盘433(0.24)964(0.50)340(1.19)542.851<0.001
胎盘早剥492(0.28)562(0.29)125(0.44)21.637<0.001
异常胎位5 453(3.08)4 371(2.27)787(2.76)237.483<0.001
早产10 129(5.73)11 280(5.85)2 539(8.91)456.709<0.001
剖宫产82 450(46.68)109 045(56.64)16 159(56.79)3 912.030<0.001
软产道裂伤289(0.16)230(0.12)37(0.13)13.062<0.001
产后出血2 635(1.49)1 773(0.92)344(1.21)254.126<0.001
产科感染924(0.52)1 010(0.52)176(0.62)4.4560.108
巨大儿13 583(7.68)18 008(9.34)3 173(11.13)541.746<0.001
低出生体重8 111(4.59)7 655(3.97)1 609(5.64)204.022<0.001
低Apgar评分344(0.19)418(0.22)94(0.33)21.016<0.001
围生儿死亡135(0.08)169(0.09)35(0.12)6.5070.039
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产次的分布特点及对母婴结局的影响
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李思思 1 , 刘丽 1 , 杜立燕 2 , 肖远革 1 , 王新玲 1 , 尤红娜 3 , 齐英芳 3 , 张艳赏 1 , 霍琰 1
现代预防医学 | 儿少卫生与妇幼保健 2025,52(11): 1997-2002
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现代预防医学 | 儿少卫生与妇幼保健 2025, 52(11): 1997-2002
产次的分布特点及对母婴结局的影响
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李思思1, 刘丽1, 杜立燕2, 肖远革1, 王新玲1, 尤红娜3, 齐英芳3, 张艳赏1, 霍琰1
作者信息
  • 1.河北省人民医院产科，河北 石家庄 050051
  • 2.河北省妇幼保健中心信息管理科
  • 3.河北省顺平县医院妇产科

    • 李思思（1986—），女，硕士，主治医师，研究方向:妊娠期并发症

通讯作者:

霍琰，E-mail:
Distribution characteristics of parity and their impact on maternal and neonatal outcomes
Si-si LI1, Li LIU1, Li-yan DU2, Yuan-ge XIAO1, Xin-ling WANG1, Hong-na YOU3, Ying-fang QI3, Yan-shang ZHANG1, Yan HUO1
Affiliations
  • Department of Obstetrics, Hebei Provincial People’s Hospital, Shijiazhuang, Hebei 050051, China
出版时间: 2025-06-10 doi: 10.20043/j.cnki.MPM.202412461
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摘要
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目的

分析河北省不同产次产妇的分布特征及其对妊娠结局的影响。

方法

对河北省10个地市22家医院分娩的398 111例产妇资料进行分析，根据既往分娩次数（不包括此次住院分娩），将产妇分为一胎（产次=0）、二胎（产次=1）和三胎及以上（产次≥2次），分析不同产次产妇的分布特征，应用多因素logistic回归分析不同产次对妊娠结局的影响。

结果

2014—2022年三组产妇平均分娩年龄均呈上升趋势，三胎及以上产妇占比也呈上升趋势。伴随着医院级别的升高，一胎产妇占比呈上升趋势，二胎和三胎及以上产妇占比呈下降趋势，省市级医院一胎产妇占比高于县乡级医院，二胎和三胎及以上产妇占比低于县乡级医院。随着产次组的增加，贫血、前置胎盘、胎盘早剥、早产、剖宫产、巨大儿、低Apgar评分及围生儿死亡的发生率均呈上升趋势，妊娠期糖尿病、妊娠期高血压疾病、异常胎位、软产道裂伤、产后出血、低出生体重的发生率呈“U”趋势。以一胎（产次=0）产妇为参照组，多因素logistic回归分析结果显示：产次≥1是发生贫血（OR=1.041，95%CI：1.024～1.058）、妊娠期糖尿病（OR=1.301，95%CI：1.237～1.375）、前置胎盘（OR=1.565，95%CI：1.359～1.802）、软产道裂伤（OR=1.394，95%CI：1.157～1.681）、巨大儿（OR=1.222，95%CI：1.189～1.257）的危险因素，而是妊娠期高血压疾病（OR=0.677，95%CI：0.651～0.703）、异常胎位（OR=0.650，95%CI：0.617～0.684）、剖宫产（OR=0.296，95%CI：0.290～0.301）、低出生体重（OR=0.872，95%CI：0.830～0.917）的保护因素；产次≥2是发生早产（OR=1.470，95%CI：1.372～1.575）、产后出血（OR=1.242，95%CI：1.086～1.420）的危险因素。

结论

不同产次发生不良妊娠结局的风险不同，对不同产次孕妇产检过程中应对妊娠期合并症与并发症有针对性进行预防，以降低不良母婴结局的发生风险。

产次  /  分布特点  /  产妇结局  /  新生儿结局
Objective

To analyze the distribution characteristics of mothers with different parities in Hebei Province and their impact on pregnancy outcomes.

Methods

Data from 398 111 mothers who delivered in 22 hospitals across 10 cities in Hebei Province were analyzed. Based on previous delivery counts (excluding the current hospitalization), mothers were categorized into three groups:primipara (parity=0), multipara (parity=1), and grand multipara (parity≥2). The distribution characteristics of mothers by parity were analyzed, and the influence of different parities on pregnancy outcomes was assessed using multifactorial logistic regression.

Results

From 2014 to 2022, the average age of mothers in all three groups showed an upward trend, as did the proportion of grand multipara mothers. With the increase in hospital level, the proportion of primipara mothers rose, while the proportions of multipara and grand multipara mothers declined. The proportion of primipara mothers in provincial and municipal hospitals was higher than that in county and township hospitals, where the proportions of multipara and grand multipara mothers were lower. As parity increased, the incidence rates of anemia, placenta previa, placental abruption, preterm birth, cesarean delivery, macrosomia, low Apgar scores, and perinatal mortality also increased. Conversely, the incidence rates of gestational diabetes, gestational hypertension, abnormal fetal position, soft birth canal lacerations, postpartum hemorrhage, and low birth weight exhibited a “U” trend. Using primipara (parity=0) mothers as the reference group, the results of the multifactorial logistic regression analysis indicated that parity≥1 was a risk factor for anemia (OR=1.041, 95%CI: 1.024-1.058), gestational diabetes (OR=1.301, 95% CI: 1.237-1.375), placenta previa (OR=1.565, 95% CI: 1.359-1.802), soft birth canal lacerations (OR=1.394, 95% CI: 1.157-1.681), and macrosomia (OR=1.222, 95%CI: 1.189-1.257). In contrast, it was a protective factor against gestational hypertension (OR=0.677, 95% CI: 0.651-0.703),abnormal fetal position (OR=0.650, 95% CI: 0.617-0.684), cesarean delivery (OR=0.296, 95% CI: 0.290-0.301), and low birth weight (OR=0.872, 95% CI: 0.830-0.917). Parity≥2 was identified as a risk factor for preterm birth (OR=1.470, 95% CI: 1.372-1.575) and postpartum hemorrhage (OR=1.242, 95% CI: 1.086-1.420).

Conclusion

The risk of adverse pregnancy outcomes varies with parity. Targeted prevention of gestational complications and comorbidities should be implemented during prenatal care for mothers of different parities to reduce the risk of adverse maternal and infant outcomes.

Parity  /  Distribution characteristics  /  Maternal outcomes  /  Neonatal outcomes
李思思, 刘丽, 杜立燕, 肖远革, 王新玲, 尤红娜, 齐英芳, 张艳赏, 霍琰. 产次的分布特点及对母婴结局的影响. 现代预防医学, 2025 , 52 (11) : 1997 -2002 . DOI: 10.20043/j.cnki.MPM.202412461
Si-si LI, Li LIU, Li-yan DU, Yuan-ge XIAO, Xin-ling WANG, Hong-na YOU, Ying-fang QI, Yan-shang ZHANG, Yan HUO. Distribution characteristics of parity and their impact on maternal and neonatal outcomes[J]. Modern Preventive Medicine, 2025 , 52 (11) : 1997 -2002 . DOI: 10.20043/j.cnki.MPM.202412461
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产次是母体经历妊娠、分娩过程的次数，对妊娠结局具有重要影响。伴随着生育政策的改变，我国不同产次产妇的分布结构发生变化。然而，我国评估胎次对孕产妇和新生儿不良结局影响的研究有限，且存在流行病学研究资料相对缺乏、样本量小、研究深度不够等问题，国外对此研究稍多，但结果不一致。一些研究[1-2]显示初产妇发生不良妊娠结局的风险高于经产妇，而Dai等[3]发现经产妇不良妊娠结局较多。且之前研究大多为比较初产妇和经产妇对妊娠结局的影响，但关于二胎和三胎以上对妊娠结局影响的研究尚未查找到。本研究基于河北省近9年的大样本监测数据，旨在评估不同产次对不良母婴结局的影响，以期为我国现行三胎政策下孕产妇管理策略提供科学依据，改善不良妊娠结局。
1　资料与方法
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1.1　临床资料
本研究数据来源于河北省妇幼保健中心的孕产妇监测信息管理系统。资料收集采用全国妇幼卫生监测办公室设计的《孕产妇个案调查表》进行，所有出院孕产妇数据均由科室内经过统一培训的产科医师负责填写和上报。河北省妇幼保健中心工作人员对数据进行核对。监测系统包括在河北省分层随机抽取的22个监测点（医院），分布在河北省10个地市，涵盖不同级别医院（包括三级、二级和一级医院）。2014年1月1日—2022年12月31日住院分娩数据共419 992例。纳入标准：28周及以上单胎分娩的数据。排除标准：孕周<28周（14 995例）、双胎或多胞胎（6 207例）、资料缺失（679例）的分娩数据。最终共398 111例分娩数据纳入研究。本研究通过河北省人民医院伦理委员会批准，伦理编号:2024-LW-0175。
1.2　定义
产次指既往分娩的次数，不包括本次住院分娩。产妇根据产次分为一胎（产次=0）、二胎（产次=1）和三胎及以上（产次≥2次）。产妇根据分娩年龄分为<20岁、20～34岁和≥35岁三组。按照受教育年限将受教育程度分为大专及以上（≥13年）、初中（7～12年）和小学及以下（≤6年）。本研究中的不良孕产妇结局包括：剖宫产、贫血、妊娠期糖尿病、妊娠期高血压疾病、前置胎盘、胎盘早剥、软产道裂伤、产后出血、产科感染。本研究中的不良围生儿结局包括：异常胎位、早产、巨大儿、低出生体重、新生儿低Apgar评分、围生儿死亡。贫血定义为血红蛋白<110 g/L[4]；产后出血定义为阴道分娩后失血量≥500 ml或剖宫产后失血量≥1 000 ml[5]。早产指妊娠28～36+6周分娩[6]。巨大儿指出生体重大于4 000 g，低体重儿指出生体重不足2 500 g[7]。死产指妊娠27+6周以上，胎儿体重1 000 g及以上宫内死亡。异常胎位指除头位外的其他胎位。围生儿死亡指死产和产妇出院前的新生儿死亡。低Apgar评分指5 min新生儿Apgar评分≤7分。
1.3　统计学方法
符合正态分布的计量资料以（均数±标准差）表示，组间比较采用方差分析(F检验)。计数资料以n(%)表示，组间比较采用χ2检验。以一胎为参考，采用多因素logistic回归比较不同产次对不良妊娠结局的影响。所有统计假设检验均为双侧。使用GraphPad Prism 6绘制森林图。检验水准α=0.05。
2　结果
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2.1　分布特征
2.1.1　时间分布
在398 111名产妇中,一胎产妇176 861例（44.43%）,二胎产妇192 745例（48.41%），三胎及以上产妇28 505例（7.16%）。2014—2022年不同产次占比有所变化，伴随年份变化，三胎及以上产妇占比呈上升趋势（P<0.001）。见图1。
2.1.2　年龄分布
2014—2022年河北省产妇平均分娩年龄为（28.90±4.64）岁，随着产次的增加,分娩年龄呈上升趋势，一胎、二胎、三胎及以上产妇平均分娩年龄分别为（26.59±3.83）、（30.49±4.34）和（32.57±4.36）岁。2014—2022年，三个产次组平均分娩年龄均呈上升趋势。一胎组平均分娩年龄由（25.78±3.64）岁上升至（27.96±4.05）岁（趋势F=5 785.81，P<0.001）；二胎组平均分娩年龄由（29.42±4.39）岁上升至（31.70±4.12）岁（趋势F=3 731.13，P<0.001）；三胎及以上组，平均分娩年龄由（31.72±4.76）岁上升至（33.79±4.03）岁（趋势F=447.10，P<0.001）。见图2。
2.1.3　地区分布
不同胎次在各市分布见表1。唐山市一胎占比最高，为55.63%，秦皇岛市一胎占比最低，为28.65%。邢台市二胎占比最高，为60.52%，唐山市二胎占比最低，为42.39%。邯郸市三胎及以上占比最高，为14.72%，唐山市三胎及以上占比最低，为28.65%。各地区之间胎次差异有统计学意义(χ2=14 596.330，P<0.01) 。
2.1.4　城乡分布
一胎占比省市级医院（52.13%）高于县乡级医院（36.77%），二胎和三胎及以上占比省市级医院（42.65%、5.22%）分别低于县乡级医院（54.15%、9.09%）。伴随着医院级别的升高，一胎占比呈上升趋势，二胎和三胎及以上占比均呈下降趋势。见表2。
2.2　一般人口特征
不同产次产妇及新生儿特征比较见表3。随着产次组的增加,产检次数≤8、初中及以下学历的产妇占比呈现上升趋势，产检次数>8、大专及以上学历的产妇占比呈下降趋势。
2.3　不同产次孕产妇的母婴不良结局
随着产次组的增加，贫血、前置胎盘、胎盘早剥、早产、剖宫产、巨大儿、低Apgar评分及围生儿死亡的发生率均呈上升趋势，妊娠期糖尿病、妊娠期高血压疾病、异常胎位、软产道裂伤、产后出血、低出生体重的发生率呈“U”趋势。见表4。
2.4　不同产次对不良母婴结局影响的logistic回归分析
在调整产妇年龄、婚姻状况、教育水平、胎儿性别、产检次数、医院等级、剖宫产史和流产史，是否发生妊娠期并发症后，产次≥1是发生贫血（OR=1.041，95%CI：1.024～1.058）、妊娠期糖尿病（OR=1.301，95%CI：1.237～1.375）、前置胎盘（OR=1.565，95%CI：1.359～1.802）、软产道裂伤（OR=1.394，95%CI：1.157～1.681）、巨大儿（OR= 1.222，95%CI：1.189～1.257）的危险因素，而是妊娠期高血压疾病（OR=0.677，95%CI：0.651～0.703）、异常胎位（OR=0.650，95%CI：0.617～0.684）、剖宫产（OR=0.296，95%CI：0.290～0.301）、低出生体重（OR=0.872，95%CI：0.830～0.917）的保护因素；产次≥2是发生早产（OR=1.470，95%CI：1.372～1.575）、产后出血（OR=1.242，95%CI：1.086～1.420）的危险因素。多因素logistic回归模型Hosmer-Lemeshow拟合优度检验χ2=8.113，P=0.423，回归模型与实际情况拟合较好。见图3。
3　讨论
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随着我国三胎政策的实施，经产妇再次妊娠的比例明显升高。生育政策的改变对于缓解老龄化问题和促进国民经济发展均具有积极重大意义[8]。然而，生育政策的调整为孕产妇年龄构成带来了变化，本研究中，三胎及以上的产妇平均分娩年龄为32.57岁，远高于初产妇26.59岁的平均分娩年龄。2014—2022年平均分娩年龄也呈上升趋势，与生育政策的调整相一致，且与之前研究结果一致[9-10]。
在省市级医院分娩二胎及以上的产妇占比低于县乡级医院，医院级别越高，分娩二胎及以上的产妇占比越低，既往研究表明[11]，城市人群受教育程度普遍偏高，有正规职业人群较大，由于生育和养育子女不可避免地要占用大量的时间和精力，而影响职业发展，抑制了她们的生育意愿。
剖宫产发生率在世界范围内迅速上升，其中我国2008—2014年的剖宫产率由28.8%上升至34.9%[12]，远高于世界卫生组织(WHO)推荐的10%～15%[13]。本研究发现，经产妇剖宫产率高于初产妇，但调整混杂因素后，随着产次增加剖宫产风险降低。很多初产妇由于对阴道分娩缺乏信心、对产痛或顺产转剖宫产的恐惧，要求进行无医学指征的剖宫产术[14]。经产妇产程相对较短[6]，且既往分娩时已经历过顺产产痛，故可以耐受，因此经产妇女因产痛主动要求剖宫产的发生率降低。DAI等[3]研究发现经产妇女是剖宫产的危险因素，而ALSHAMMARI等[15]研究发现产次与剖宫产无关联，与既往研究结果不同,瘢痕子宫再次妊娠孕妇经阴道分娩发生子宫破裂风险较高，故大部分仍选择剖宫产终止妊娠[13]，但DAI等和ALSHAMMARI等研究均未调整既往剖宫产史，导致与本研究结果的差异。
本研究和既往研究[16-17]均表明，经产妇比初产妇更容易在妊娠期间发生贫血。在调整可能的混杂因素后，产次是妊娠期贫血的一个危险因素，贫血的发生率随产次增加而增加。归其原因可能为多次妊娠使得体内合成血红蛋白原料被大量消耗，还未充分补充就再次妊娠，最终导致贫血发生[16]。所以，有再次妊娠计划的妇女应及时注意营养状况，及时纠正贫血。
本研究发现产次与妊娠期糖尿病存在正相关，随着产次组的升高，妊娠期糖尿病的发生率增加，既往研究[18]也表明，产次越多，妊娠期糖尿病的发生风险越高。可能原因为妊娠期糖尿病女性再次妊娠时，胰岛素受体底物1（IRS1）水平降低及IRβ自磷酸化水平降低，导致胰岛素敏感性降低[19]，使妊娠期糖尿病的风险增加。
本研究显示，妊娠期高血压疾病的发生率随着产次的增加而降低；经产妇女发生巨大儿的风险增加，但分娩低体重儿的风险降低，均与之前研究的结果一致[2，20]。可能与经产妇宫腔大[21]、子宫胎盘血流阻力小[22]有关。
该研究中初产妇会阴裂伤的发生率高于经产妇，但调整可能的混杂因素后，经产妇是会阴裂伤的危险因素。可能原因为经产妇分娩时产程快，会阴多未充分扩张，且随着产次和年龄的增加，盆底会阴组织的柔韧性降低，易导致会阴裂伤[23]，且多次妊娠，胎儿体重随产次呈上升趋势[24]，这些均可能是经产妇为会阴裂伤高危因素的原因。
我们发现产次与产褥感染之间无关联。关于产次与产褥感染关系的研究较少，YUAN等[25]对268 311例妇女的研究结果表明产次与产褥感染无关，与我们的研究结果一致。本研究表明随着产次组的升高，前置胎盘的概率增加，这与GILLIAM M等的研究结果一致[26]，子宫内膜损伤是前置胎盘的主要原因，流产、分娩、剖宫产均可能导致子宫内膜损伤，且随产次增加而加重。WITKOP等[27]观察发现，初产妇胎位不正的发生率是经产妇的两倍，这与我们的结果是一致的，这可能是由于经产妇腹部及子宫肌肉较松弛有关。
本研究时间跨度长，范围为2014—2022年，经历了单独二胎、全面二胎及全面三胎等生育政策改变。且人群覆盖范围广，包括河北省22所医院，共398 111名产妇纳入研究，数据样本量大且具有代表性。在数据均由经过培训的医师进行收集，数据也经过反复核对，数据可以真实地反映产次对不良妊娠结局风险的影响，结果可信度高。然而，数据库中缺少一些必要的母亲特征，如家庭住址、饮食习惯和吸烟习惯等，这可能导致我们的研究出现一些偏倚。在进一步的研究中，我们将完善更多的母体特征。综上所述，不同产次发生不良妊娠结局的风险不同，针对性的对不同产次的相应不良妊娠结局进行预防，并及时发现妊娠期合并症与并发症，确保母婴健康。
基金
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  • 河北省医学科研项目(20241704)
  • 河北省医学科研项目(20190325)
文献
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doi: 10.20043/j.cnki.MPM.202412461
  • 接收时间：2024-12-26
  • 首发时间：2026-03-18
  • 出版时间：2025-06-10
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  • 收稿日期：2024-12-26
基金
河北省医学科研项目(20241704)
河北省医学科研项目(20190325)
作者信息
    1.河北省人民医院产科，河北 石家庄 050051
    2.河北省妇幼保健中心信息管理科
    3.河北省顺平县医院妇产科

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霍琰，E-mail:
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https://castjournals.cast.org.cn/joweb/xdyfyx/CN/10.20043/j.cnki.MPM.202412461
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2种不同金属材料的力学参数
科
Family		 属数
Number of
genus		 种数
Number of
species		 占总种数比例
Percentage of
total species (%)		 属
Genus		 种数
Number of
species		 占总种数比例
Percentage of total
species (%)
鹅膏菌科Amanitaceae 2 11 5.26 鹅膏菌属 Amanita 10 4.78
小菇科 Mycenaceae 2 12 5.74 丝盖伞属 Inocybe 5 2.39
多孔菌科 Polyporaceae 8 14 6.70 蜡蘑属 Laccaria 5 2.39
红菇科 Russulaceae 3 23 11.00 小皮伞属 Marasmius 6 2.87
小菇属 Mycena 11 5.26
光柄菇属 Pluteus 5 2.39
红菇属 Russula 17 8.13
栓菌属 Trametes 5 2.39
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