Article(id=1324078414281441631, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1324078333767594037, articleNumber=null, orderNo=null, doi=10.20043/j.cnki.MPM.202508004, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=null, receivedDate=1753977600000, receivedDateStr=2025-08-01, revisedDate=null, revisedDateStr=null, acceptedDate=null, acceptedDateStr=null, onlineDate=1793614494151, onlineDateStr=2026-11-02, pubDate=1767974400000, pubDateStr=2026-01-10, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1793614494151, onlineIssueDateStr=2026-11-02, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1793614494151, creator=13701087609, updateTime=1793614494151, updator=13701087609, issue=Issue{id=1324078333767594037, tenantId=1146029695717560320, journalId=1227665162245664772, year='2026', volume='53', issue='1', pageStart='1', pageEnd='192', issueExtLink='null', onlineDate='null', pubDate='1767974400000', pubDateStr='2026-01-10', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=-1, specialIssue=0, createTime=1793614474956, creator='13701087609', updateTime=1793614571752, updator='13701087609', preIssue=null, nextIssue=null, articleTotal=null, ext={EN=IssueExt(id=1324078739914621270, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1324078333767594037, language=EN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=), CN=IssueExt(id=1324078739914621271, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1324078333767594037, language=CN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=)}, issueFiles=null, downloadFileDto=null}, startPage=94, endPage=99, ext={EN=ArticleExt(id=1324078414742815072, articleId=1324078414281441631, tenantId=1146029695717560320, journalId=1227665162245664772, language=EN, title=Comparison of the incidence of small for gestational age between Li and Han ethnic groups in Hainan Province, columnId=1228016568949474136, journalTitle=Modern Preventive Medicine, columnName=Child and Adolescent Health, Maternal and Child Health, runingTitle=null, highlight=null, articleAbstract=
Objective

To investigate the association between Li ethnicity and the risk of delivering small for gestational age(SGA).

Methods

Based on data from 1 472 940 live births recorded in the Hainan Provincial Birth Certificate System between 2010 and 2021, generalized linear models were employed to analyze the associations between different combinations of Han and Li parental ethnicity and the risk of SGA and its subtypes. Statistical interactions were assessed to examine the influence of demographic characteristics and perinatal factors on these associations.

Results

The SGA rate among Li parents was 22.99%,followed by Li father/Han mother (17.96%) and Han father/Li mother pairs (16.22%), all significantly higher than that of Han pairs (15.05%, P<0.001). The patterns for different SGA subtypes were generally consistent with the overall trend. Adjusted models showed a graded increase in SGA risk relative to Han pairs: Han father/Li mother (RR=1.041, 95% CI: 1.026-1.057), Li father/Han mother (RR=1.115, 95% CI: 1.094-1.136) and Li pairs (RR=1.385, 95% CI: 1.371-1.400). Multiplicative interaction models showed the association was significantly modified by parental age, multiplicity, residence, neonatal sex, and delivery hospital (P<0.05).

Conclusion

Our findings suggest that Li ethnicity may be an independent risk factor for SGA.Targeted interventions and optimized perinatal care tailored to the Li population are needed to improve maternal and infant health outcomes.

, authors=Qing LUO1, 2, 3, Jing LIANG1, 2, Nuo WANG1, 2, Wei-jia WU1, 3, Wen-qian LI1, 2, Li-chun FAN1, 3, authorsList=Qing LUO, Jing LIANG, Nuo WANG, Wei-jia WU, Wen-qian LI, Li-chun FAN, authorCompany=null, correspAuthors=Li-chun FAN, authorNote=null, correspAuthorsNote=null, copyrightStatement=null, copyrightOwner=null, extLink=null, articleAbsUrl=null, sourceXml=null, magXml=null, pdfUrl=null, pdf=null, pdfFileSize=null, pdfExtLink=null, richHtmlUrl=null, mobilePdfUrl=null, reviewReport=null, pdfFirstPage=null, abstractGraph=null, abstractGraphContent=null, abstractVideo=null, citation=null, cebUrl=null, magXmlContent=null, mapNumber=null, fund=null), CN=ArticleExt(id=1324078417301340520, articleId=1324078414281441631, tenantId=1146029695717560320, journalId=1227665162245664772, language=CN, title=海南省黎族与汉族小于胎龄儿发生情况比较, columnId=1228016570031604578, journalTitle=现代预防医学, columnName=儿少卫生与妇幼保健, runingTitle=null, highlight=null, articleAbstract=
目的

探讨黎族与小于胎龄儿(small for gestational age, SGA)发生风险的关联性。

方法

基于2010—2021年海南省出生登记系统中1 472 940例活产婴儿数据,采用广义线性模型分析父母汉族和黎族组合与SGA及不同SGA亚型的风险关联,并通过交互作用比较人口学特征及围产因素对该关联的影响。

结果

父黎母黎组SGA发生率最高,为22.99%,其次为父黎母汉组和母黎父汉组,分别为17.96%和16.22%;父汉母汉组最低,为15.05%(P<0.001),各亚型发生率趋势与总体基本一致。调整混杂因素后,与父汉母汉相比,母黎父汉组(RR=1.041, 95% CI:1.026~1.057)、父黎母汉组(RR=1.115, 95% CI:1.094~1.136)及父黎母黎组(RR=1.385, 95% CI:1.371~1.400)发生SGA的风险呈阶梯式升高。相乘交互作用模型分析结果显示,父母年龄、多胎、居住地、性别、分娩医院与不同民族组合对SGA具有相乘交互作用(P<0.05)。

结论

黎族可能是SGA的独立危险因素,需针对黎族人群制定针对性干预措施,优化围产期保健,以改善母婴健康结局。

, authors=罗庆1, 2, 3, 梁靖1, 2, 王诺1, 2, 吴维佳1, 3, 李文倩1, 2, 樊利春1, 3, authorsList=罗庆, 梁靖, 王诺, 吴维佳, 李文倩, 樊利春, authorCompany=null, correspAuthors=樊利春, authorNote=

罗庆(1987—),女,硕士,主治医师,研究方向:儿童保健

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樊利春,E-mail:
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(In Chinese), articleTitle=Li farmers' reproduction concept in a gender perspective: A case study of Toutang Village of Hainan Province, refAbstract=null)], funds=[Fund(id=1324078421202043299, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324078414281441631, awardId=821QN415; 824QN399, language=CN, fundingSource=海南省自然科学基金资助(821QN415; 824QN399), fundOrder=null, country=null), Fund(id=1324078421285929380, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324078414281441631, awardId=LCYX202405, language=CN, fundingSource=海南省临床医学研究中心项目(LCYX202405), fundOrder=null, country=null), Fund(id=1324078421369815461, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324078414281441631, awardId=QRCBT202121, language=CN, fundingSource=海南省优秀人才团队资助(QRCBT202121), fundOrder=null, country=null), Fund(id=1324078421449507238, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324078414281441631, awardId=QWYH202175, language=CN, fundingSource=海南省临床医学中心建设项目资助(QWYH202175), fundOrder=null, country=null)], companyList=[AuthorCompany(id=1324078417552998761, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324078414281441631, xref=1., ext=[AuthorCompanyExt(id=1324078417561387370, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324078414281441631, companyId=1324078417552998761, language=EN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=Department of Research Service, Hainan Women and Children’s Medical Center, Haikou, Hainan 570312, China), AuthorCompanyExt(id=1324078417569775979, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324078414281441631, companyId=1324078417552998761, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=1.海南省妇女儿童医学中心科研科,海南 海口 570312)]), AuthorCompany(id=1324078417653662060, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324078414281441631, xref=2., ext=[AuthorCompanyExt(id=1324078417662050669, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324078414281441631, companyId=1324078417653662060, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=2.海南医科大学公共卫生学院,海南 海口 571199)]), AuthorCompany(id=1324078417754325358, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324078414281441631, xref=3., ext=[AuthorCompanyExt(id=1324078417762713967, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324078414281441631, companyId=1324078417754325358, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=3.海南医科大学儿科学院,海南 海口 571199)])], figs=[ArticleFig(id=1324078420304462235, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324078414281441631, language=EN, label=Figure 1, caption=Association of parental Han-Li ethnicity with SGA subtypes, figureFileSmall=ICGB9eieLIZ/IiSkjlxSdg==, figureFileBig=vgoImyYYgHes5e/fZJZbqQ==, tableContent=null), ArticleFig(id=1324078420400931228, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324078414281441631, language=CN, label=图1, caption=不同父母汉黎民族组合与SGA亚型的关联分析

注:M1(参照组:父汉母汉组)、M2(母黎父汉组)、M3(父黎母汉组)、M4(父黎母黎组);所有模型均调整了性别、是否多胎、胎方位、父母年龄、居住地及分娩医院。

, figureFileSmall=ICGB9eieLIZ/IiSkjlxSdg==, figureFileBig=vgoImyYYgHes5e/fZJZbqQ==, tableContent=null), ArticleFig(id=1324078420610646429, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324078414281441631, language=EN, label=Figure 2, caption=The multiplicative interaction between parental age, multiple birth, residence, neonatal sex, delivery hospital and ethnic group on small for gestational age, figureFileSmall=xy0rHHFGhkZW9HimAxTSuQ==, figureFileBig=2X1hJSaTSFEBsT4PgF6oRg==, tableContent=null), ArticleFig(id=1324078420698726814, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324078414281441631, language=CN, label=图2, caption=父母年龄、多胎、居住地、性别、分娩医院与不同民族组合对SGA的相乘交互作用

注:A调整了性别、是否多胎、胎方位、母亲年龄、分晚医院及居住地;B调整了性别、是否多胎、胎方位、父亲年龄、分娩医院及居住地;C调整了性别、胎方位、父亲年龄、母亲年龄、分娩医院及居住地;D调整了性别、是否多胎、胎方位、父亲年龄、母亲年龄及分娩医院;E调整了居住地、是否多胎、胎方位、父亲年龄、母亲年龄及分娩医院;F调整了居住地、性别、是否多胎、胎方位、父亲年龄及母亲年龄。

, figureFileSmall=xy0rHHFGhkZW9HimAxTSuQ==, figureFileBig=2X1hJSaTSFEBsT4PgF6oRg==, tableContent=null), ArticleFig(id=1324078420791001503, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324078414281441631, language=EN, label=Table 1, caption=

Baseline characteristics of Hainan neonates by parental ethnic combination [n=1 472 940,n(%)]

, figureFileSmall=null, figureFileBig=null, tableContent=
变量总体
(n=1 472 940)
父汉母汉
(n=1 171 737)
母黎父汉
(n=96 450)
父黎母汉
(n=57 379)
父黎母黎
(n=147 380)
性别
男803 824(54.57)641 943(54.79)52 185(54.11)31 088(54.18)78 608(53.34)
女669 116(45.43)529 788(45.21)44 265(45.89)26 291(45.82)68 772(46.66)
母亲年龄(岁)
<2086 935(5.90)63 645(5.43)5 983(6.20)4 579(7.98)12 728(8.64)
≥20~351 236 823(83.97)988 331(84.35)80 440(83.40)48 111(83.85)119 941(81.38)
≥35149 182(10.13)119 755(10.22)10 027(10.40)4 689(8.17)14 711(9.98)
父亲年龄(岁)
<22岁77 936(5.29)57 435(4.90)5 215(5.41)3 705(6.46)11 581(7.86)
≥22~401 289 491(87.55)1 029 910(87.90)83 026(86.08)50 189(87.47)126 366(85.74)
≥40105 513(7.16)84 386(7.20)8 209(8.51)3 485(6.07)9 433(6.40)
是否多胎
否1 437 282(97.58)1 142 535(97.51)94 274(97.74)56 026(97.64)144 447(98.01)
是33 852(2.30)27 588(2.35)2 103(2.18)1 313(2.29)2 848(1.93)
缺失值1 806(0.12)1 608(0.14)73(0.08)40(0.07)85(0.06)
居住地
城镇708 463(48.10)582 699(49.73)49 646(51.47)28 039(48.87)48 079(32.62)
农村663 295(45.03)492 877(42.06)46 140(47.84)25 152(43.83)99 126(67.26)
缺失值101 182(6.87)96 155(8.21)664(0.69)4 188(7.30)175(0.12)
分娩医院
非三甲1 230 436(83.54)960 732(81.99)82 057(85.08)50 298(87.66)137 349(93.19)
三甲240 698(16.34)209 391(17.87)14 320(14.85)7 041(12.27)9 946(6.75)
缺失值1 806(0.12)1 608(0.14)73(0.08)40(0.07)85(0.06)
孕周
足月1 389 276(94.32)1 106 452(94.43)90 472(93.80)54 080(94.25)38 272(93.81)
早产83 664(5.68)65 279(5.57)5 978(6.20)3 299(5.75)9 108(6.18)
胎方位
左枕前位1 364 686(92.65)1 087 024(92.77)89 654(92.95)52 981(92.34)135 027(91.62)
其他81 650(5.54)60 910(5.20)5 413(5.61)3 824(6.66)11 503(7.80)
缺失值26 604(1.81)23 797(2.03)1 383(1.43)574(1.00)850(0.58)
), ArticleFig(id=1324078420870693280, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324078414281441631, language=CN, label=表1, caption=

海南省活产新生儿父母不同汉黎民族组合的基本情况[n=1 472 940,n(%)]

, figureFileSmall=null, figureFileBig=null, tableContent=
变量总体
(n=1 472 940)
父汉母汉
(n=1 171 737)
母黎父汉
(n=96 450)
父黎母汉
(n=57 379)
父黎母黎
(n=147 380)
性别
男803 824(54.57)641 943(54.79)52 185(54.11)31 088(54.18)78 608(53.34)
女669 116(45.43)529 788(45.21)44 265(45.89)26 291(45.82)68 772(46.66)
母亲年龄(岁)
<2086 935(5.90)63 645(5.43)5 983(6.20)4 579(7.98)12 728(8.64)
≥20~351 236 823(83.97)988 331(84.35)80 440(83.40)48 111(83.85)119 941(81.38)
≥35149 182(10.13)119 755(10.22)10 027(10.40)4 689(8.17)14 711(9.98)
父亲年龄(岁)
<22岁77 936(5.29)57 435(4.90)5 215(5.41)3 705(6.46)11 581(7.86)
≥22~401 289 491(87.55)1 029 910(87.90)83 026(86.08)50 189(87.47)126 366(85.74)
≥40105 513(7.16)84 386(7.20)8 209(8.51)3 485(6.07)9 433(6.40)
是否多胎
否1 437 282(97.58)1 142 535(97.51)94 274(97.74)56 026(97.64)144 447(98.01)
是33 852(2.30)27 588(2.35)2 103(2.18)1 313(2.29)2 848(1.93)
缺失值1 806(0.12)1 608(0.14)73(0.08)40(0.07)85(0.06)
居住地
城镇708 463(48.10)582 699(49.73)49 646(51.47)28 039(48.87)48 079(32.62)
农村663 295(45.03)492 877(42.06)46 140(47.84)25 152(43.83)99 126(67.26)
缺失值101 182(6.87)96 155(8.21)664(0.69)4 188(7.30)175(0.12)
分娩医院
非三甲1 230 436(83.54)960 732(81.99)82 057(85.08)50 298(87.66)137 349(93.19)
三甲240 698(16.34)209 391(17.87)14 320(14.85)7 041(12.27)9 946(6.75)
缺失值1 806(0.12)1 608(0.14)73(0.08)40(0.07)85(0.06)
孕周
足月1 389 276(94.32)1 106 452(94.43)90 472(93.80)54 080(94.25)38 272(93.81)
早产83 664(5.68)65 279(5.57)5 978(6.20)3 299(5.75)9 108(6.18)
胎方位
左枕前位1 364 686(92.65)1 087 024(92.77)89 654(92.95)52 981(92.34)135 027(91.62)
其他81 650(5.54)60 910(5.20)5 413(5.61)3 824(6.66)11 503(7.80)
缺失值26 604(1.81)23 797(2.03)1 383(1.43)574(1.00)850(0.58)
), ArticleFig(id=1324078420967162273, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324078414281441631, language=EN, label=Table 2, caption=

Distribution of SGA subgroups among parental ethnic combinations [n=1 472 940,n(%)]

, figureFileSmall=null, figureFileBig=null, tableContent=
组别SGA孕周分类体型分类严重程度分类
早产SGA足月SGASGRAGR重度SGA非重度SGA
父汉母汉176 305(15.05)a6 363(0.54)a169 942(14.50)a77 756(6.64)a98 549(8.41)a54 859(4.68)a121 446(10.36)a
母黎父汉15 644(16.22)b634(0.66)b15 010(15.56)b6 984(7.24)b8 660(8.98)b5 013(5.20)b10 631(11.02)b
父黎母汉10 307(17.96)c366(0.64)b9 941(17.33)c4 585(7.99)c5 722(9.97)c3 584(6.25)c6 723(11.72)c
父黎母黎33 883(22.99)d1 269(0.86)c32 614(22.13)d13 586(9.22)d20 297(13.77)d12 607(8.55)d21 276(14.44)d
合计236 139(16.03)8 632(0.59)227 507(15.45)102 911(6.99)133 228(9.05)76 063(5.16)160 076(10.87)
P值<0.001<0.001<0.001<0.001<0.001<0.001<0.001
), ArticleFig(id=1324078421084602786, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324078414281441631, language=CN, label=表2, caption=

不同汉黎民族组合的SGA亚型发生情况[n=1 472 940,n(%)]

, figureFileSmall=null, figureFileBig=null, tableContent=
组别SGA孕周分类体型分类严重程度分类
早产SGA足月SGASGRAGR重度SGA非重度SGA
父汉母汉176 305(15.05)a6 363(0.54)a169 942(14.50)a77 756(6.64)a98 549(8.41)a54 859(4.68)a121 446(10.36)a
母黎父汉15 644(16.22)b634(0.66)b15 010(15.56)b6 984(7.24)b8 660(8.98)b5 013(5.20)b10 631(11.02)b
父黎母汉10 307(17.96)c366(0.64)b9 941(17.33)c4 585(7.99)c5 722(9.97)c3 584(6.25)c6 723(11.72)c
父黎母黎33 883(22.99)d1 269(0.86)c32 614(22.13)d13 586(9.22)d20 297(13.77)d12 607(8.55)d21 276(14.44)d
合计236 139(16.03)8 632(0.59)227 507(15.45)102 911(6.99)133 228(9.05)76 063(5.16)160 076(10.87)
P值<0.001<0.001<0.001<0.001<0.001<0.001<0.001
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海南省黎族与汉族小于胎龄儿发生情况比较
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罗庆 1, 2, 3 , 梁靖 1, 2 , 王诺 1, 2 , 吴维佳 1, 3 , 李文倩 1, 2 , 樊利春 1, 3
现代预防医学 | 儿少卫生与妇幼保健 2026,53(1): 94-99
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现代预防医学 |儿少卫生与妇幼保健 2026 , 53 (1) : 94 -99
海南省黎族与汉族小于胎龄儿发生情况比较
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罗庆1, 2, 3, 梁靖1, 2, 王诺1, 2, 吴维佳1, 3, 李文倩1, 2, 樊利春1, 3
作者信息
  • 1.海南省妇女儿童医学中心科研科,海南 海口 570312
  • 2.海南医科大学公共卫生学院,海南 海口 571199
  • 3.海南医科大学儿科学院,海南 海口 571199
通讯作者:
樊利春,E-mail:
作者简介:

罗庆(1987—),女,硕士,主治医师,研究方向:儿童保健

Comparison of the incidence of small for gestational age between Li and Han ethnic groups in Hainan Province
Qing LUO1, 2, 3, Jing LIANG1, 2, Nuo WANG1, 2, Wei-jia WU1, 3, Wen-qian LI1, 2, Li-chun FAN1, 3
Affiliations
  • Department of Research Service, Hainan Women and Children’s Medical Center, Haikou, Hainan 570312, China
出版时间: 2026-01-10 doi: 10.20043/j.cnki.MPM.202508004
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目的

探讨黎族与小于胎龄儿(small for gestational age, SGA)发生风险的关联性。

方法

基于2010—2021年海南省出生登记系统中1 472 940例活产婴儿数据,采用广义线性模型分析父母汉族和黎族组合与SGA及不同SGA亚型的风险关联,并通过交互作用比较人口学特征及围产因素对该关联的影响。

结果

父黎母黎组SGA发生率最高,为22.99%,其次为父黎母汉组和母黎父汉组,分别为17.96%和16.22%;父汉母汉组最低,为15.05%(P<0.001),各亚型发生率趋势与总体基本一致。调整混杂因素后,与父汉母汉相比,母黎父汉组(RR=1.041, 95% CI:1.026~1.057)、父黎母汉组(RR=1.115, 95% CI:1.094~1.136)及父黎母黎组(RR=1.385, 95% CI:1.371~1.400)发生SGA的风险呈阶梯式升高。相乘交互作用模型分析结果显示,父母年龄、多胎、居住地、性别、分娩医院与不同民族组合对SGA具有相乘交互作用(P<0.05)。

结论

黎族可能是SGA的独立危险因素,需针对黎族人群制定针对性干预措施,优化围产期保健,以改善母婴健康结局。

小于胎龄儿  /  黎族  /  民族
Objective

To investigate the association between Li ethnicity and the risk of delivering small for gestational age(SGA).

Methods

Based on data from 1 472 940 live births recorded in the Hainan Provincial Birth Certificate System between 2010 and 2021, generalized linear models were employed to analyze the associations between different combinations of Han and Li parental ethnicity and the risk of SGA and its subtypes. Statistical interactions were assessed to examine the influence of demographic characteristics and perinatal factors on these associations.

Results

The SGA rate among Li parents was 22.99%,followed by Li father/Han mother (17.96%) and Han father/Li mother pairs (16.22%), all significantly higher than that of Han pairs (15.05%, P<0.001). The patterns for different SGA subtypes were generally consistent with the overall trend. Adjusted models showed a graded increase in SGA risk relative to Han pairs: Han father/Li mother (RR=1.041, 95% CI: 1.026-1.057), Li father/Han mother (RR=1.115, 95% CI: 1.094-1.136) and Li pairs (RR=1.385, 95% CI: 1.371-1.400). Multiplicative interaction models showed the association was significantly modified by parental age, multiplicity, residence, neonatal sex, and delivery hospital (P<0.05).

Conclusion

Our findings suggest that Li ethnicity may be an independent risk factor for SGA.Targeted interventions and optimized perinatal care tailored to the Li population are needed to improve maternal and infant health outcomes.

Small for gestational age  /  Li ethnicity  /  Ethnicity
罗庆, 梁靖, 王诺, 吴维佳, 李文倩, 樊利春. 海南省黎族与汉族小于胎龄儿发生情况比较. 现代预防医学, 2026 , 53 (1) : 94 -99 . DOI: 10.20043/j.cnki.MPM.202508004
Qing LUO, Jing LIANG, Nuo WANG, Wei-jia WU, Wen-qian LI, Li-chun FAN. Comparison of the incidence of small for gestational age between Li and Han ethnic groups in Hainan Province[J]. Modern Preventive Medicine, 2026 , 53 (1) : 94 -99 . DOI: 10.20043/j.cnki.MPM.202508004
小于胎龄儿(small for gestational age, SGA)围生期面临更高的不良结局和远期并发症风险,严重影响人口素质[1]。我国少数民族SGA发生率普遍高于汉族[2],且黎族平均出生体重远低于其他少数民族[3]。黎族作为海南省的原住少数民族,占全省少数民族总人口的88.03%[4]。因琼州海峡阻隔及热带岛屿气候,黎族形成独特的遗传、文化及饮食行为可能影响围产结局[5]。本研究基于2010—2021年海南省出生数据,比较父母均汉族与黎族家庭及汉黎混血家庭的SGA发生率,分析民族差异对SGA风险的影响,为黎族围产保健提供依据。
本研究数据来源于海南省出生医学登记信息系统。回顾性提取2010—2021年活产记录1 539 569条。排除胎龄>42周及父母为非汉族和黎族的婴儿后,最终纳入1 472 940名(95.67%)活产婴儿作为研究对象。本研究经海南省妇女儿童医学中心伦理委员会审核通过(No.22,2022.)。
SGA为出生体质量小于同胎龄同性别出生体质量第十百分位数的新生儿[6]。本研究参照由国家卫生健康委员会发布的《中国不同出生胎龄新生儿出生体重的百分位参照标准表》进行诊断[6]。重度SGA为出生体质量小于同胎龄同性别第三百分位数的新生儿[7]。根据出生胎龄,将SGA分为早产SGA(出生胎龄<37周)、足月SGA(出生胎龄≥37周)。基于数据可得性并参考2020年中国不同出生胎龄新生儿重量指数参考标准[8],本研究采用重量指数进行体型分类:重量指数>参照标准第10百分位为匀称型SGA(disproportionate or asymmetric growth restriction,AGR)。
计算公式:[9]
采用R 4.4.3软件进行统计分析。分类变量以频数(%)表示,组间比较采用χ2检验,两两比较采用Bonferroni校正检验。本研究采用广义线性模型下的泊松回归(family = Poisson, link = “log”)来分析父母民族组合与SGA亚型之间的关联。为修正潜在过离散或模型设定偏误所导致的标准误低估,所有分析均使用了稳健标准误。父母民族组合被定义为四个类别:父汉母汉、母黎父汉、父黎母汉和父黎母黎。通过相乘交互作用检验评估新生儿性别、多胎妊娠、居住地、分娩医院、父母年龄对不同汉黎民族组合与SGA发生风险的关联性。所有检验为双侧,显著性水平设为α=0.05。
本研究共纳入1 472 940例活产儿,父亲平均年龄为(29.97±6.07)岁,母亲平均年龄为(27.24±5.37)岁。其中男婴居多,占54.47%;父母年龄主要集中在20~40岁,其中母亲 ≥20~35岁占83.97%,父亲≥22~40岁占87.55%。足月儿占94.32%,胎方位以左枕前位为主,占92.65%。在非三甲医院分娩的占83.54%,城乡分布接近1∶1。见表1。
结果表明,不同父母民族组合的SGA发生率存在显著差异。父黎母黎组SGA发生率为22.99%,显著高于父母单方黎族组(父黎母汉组:17.96%;母黎父汉组:16.22%),且均高于父汉母汉组的15.05%,差异有统计学意义(P<0.001)。这种关联在SGA亚型(足月SGA、SGR、AGA、重度SGA、非重度SGA)中均存在,在父母单方为黎族组别中,除早产SGA亚组外,父黎母汉组的各SGA亚型发生率均高于母黎父汉组(P<0.001)。见表2。
结果显示,与父汉母汉组相比,其他民族组合的SGA发生风险均显著升高,呈现明显的梯度递增趋势。母黎父汉组风险RR=1.041(95% CI:1.026~1.057),父黎母汉组风险RR=1.115(95% CI:1.094~1.136),父黎母黎组风险RR=1.385(95% CI:1.371~1.400)。除早产SGA(母黎父汉组RR=1.239;父黎母汉组RR=1.231)外,这种关联在所有SGA亚型中均存在。见图1。
结果显示,农村地区父黎母黎组合的SGA风险(RR=1.615)显著高于城镇地区(RR=1.504);多胎妊娠黎族组合的SGA风险(RR=2.684)显著高于单胎妊娠(RR=1.389);男婴父黎母黎组合的SGA风险(RR=1.421)显著高于女婴(RR=1.317);三甲医院分娩父黎母黎组合的SGA风险(RR=1.056)显著低于非三甲医院分娩(RR=1.387)。见图2。
在不同遗传背景下,胎儿的生长潜力存在显著差异。海南黎族作为我国少数民族之一,其SGA的发生情况及影响因素尚不明确。深入探究黎族对SGA发生率的影响,对降低该地区SGA发生率及改善不良结局具有重要意义。
本研究首次在省级大规模人群中系统揭示黎族与SGA风险的关系,父母均为黎族的新生儿SGA风险最高,显著高于父母单方为黎族的混合家庭及汉族家庭。这一关联在调整多重混杂因素后依然稳健,提示黎族可能是独立于常规社会经济学变量的SGA危险因素。
从遗传因素来看,海南黎族作为长期生活在热带岛屿环境的隔离人群,其FADS1基因rs174547的C等位基因和rs174540的T等位基因频率显著较高[5],这两个等位基因均与FADS1的下调相关,可能导致内源性长链多不饱和脂肪酸(LC-PUFA)的合成能力下降。日本母婴队列研究发现[10],当母婴双方均为CC基因型时,会对胎儿头围与胎盘重量产生协同性负向影响,而母体膳食n-3 PUFA摄入则可部分补偿这一遗传缺陷,这提示SGA发生风险的升高可能源于遗传易感性与营养因素的交互作用。此外,黎族人群乙肝、地中海贫血和葡萄糖-6-磷酸脱氢酶缺乏症(glucose-6-phosphate dehydrogenase deficiency,G6PD)等疾病发病率方面均显著高于汉族及全国平均水平[11-14],可能协同加剧胎盘功能异常,共同增加SGA风险[15-17]。值得注意的是,父系黎族遗传因素对SGA发生的影响可能超过母系,可能与黎族男性平均身高、体重低于汉族[18-19],导致胎儿生长潜力较低有关。研究现察到,单胎妊娠中父黎母汉SGA发生风险高于母黎父汉,这可能与黎族男性平均身高体重较黎族女性更低于汉族,导致胎儿生长潜力较低有关[18-19],也可能与父系基因多态性和疾病易感性的独特作用有关[10,20]。在不同民族组合中,男性胎儿的SGA风险普遍高于女性,尤其在父黎母汉与父母均为黎族的组合中差异最为显著。这可能与男性胎儿因性染色体遗传易感性,在黎族家庭中更易受遗传代谢病等疾病影响,且母体免疫调节差异可能加剧胎盘功能脆弱性相关[21]。
环境因素与遗传背景存在显著交互作用。本研究发现,农村地区黎族家庭的SGA风险显著高于城镇,凸显出医疗资源可及性的关键影响。在三甲医院分娩是SGA的保护因素,其原因可能并非源于分娩过程本身,而更多得益于孕妇在孕期内持续获得系统、规范的产前检查及科学的营养指导。黎族聚居区多位于山地丘陵,经济发展滞后[22-23],导致孕期保健服务覆盖不足,女性文化程度普遍偏低[24],营养认知水平较低[25]。具体表现为黎族孕妇贫血患病率(17.13%)为汉族2.1倍[26],维生素A缺乏率高达70%[27],炎热气候下,以稀饭为主[28]的低营养密度饮食模式可能进一步恶化胎儿供能[29-30]。这些环境劣势与遗传易感性形成叠加效应,这种效应在多胎妊娠中尤为显著,导致风脸增加进一步印证了生物与环境压力的协同放大。同时,黎族存在早婚早育传统,年轻父母生理心理尚未完全成熟,加之缺乏稳定经济支持和适当医疗保健,孕期管理能力较弱,显著增加SGA发生风险[31-32]。尽管生育年龄随社会发展有所推迟,但其低龄生育率仍高于汉族[33]。此外,年轻父母则可能因生殖系统发育未完全成熟、社会支持不足或营养状况欠佳,导致类似的妊娠风险[31-32]。20~35岁及>35岁父母通常经济基础更稳定,能获得更系统优质的产前保健,可在相当程度上减轻高龄对妊娠结局的负面影响。然而,在涉及黎族的组合中,这种保护模式被削弱或改变。提示黎族背景可能部分抵消了因年龄增长带来的生理成熟性与经济稳定性优势。
本研究发现黎族遗传背景与环境因素的叠加效应可能增加SGA发生风险,尤其是父母均为黎族的新生儿。这可能与基因的选择性变化及其他遗传因素相关,同时受到饮食结构和社会经济条件等环境因素的叠加影响。为降低SGA发生率,针对海南黎族地区SGA高发因素,提出以下干预措施和政策建议:首先,加强农村健康教育活动,提高黎族家庭对孕期保健和早产预防的重视程度,鼓励孕妇定期产检,减少高危妊娠行为。其次,针对黎族聚居地区,优先改善医疗资源分配,提高三甲医院的覆盖率和可及性,确保孕妇能够获得高质量的孕期保健服务。最后,针对父母均为黎族的家庭,加强孕期监测和干预,尤其是对SGA发生风险较高的孕妇,提供个性化的健康管理服务。
本研究存在一定局限性。一是,研究设计基于回顾性队列,尽管已对多项关键协变量进行了调整。且由于数据的限制,缺乏关于新生儿父母教育水平、孕期具体营养摄入、职业环境暴露等详细信息的系统记录,模型中可能存在残余混杂,从而对SGA发生风险的解释产生一定偏倚。二是,父母民族分类主要依赖自我报告,且仅划分为四种类别组合,未能进一步考虑民族融合中的代际差异、文化认同程度等社会文化维度,这些因素亦可能对SGA风险产生影响。尽管如此,我们通过一致性分析验证了主要结果的稳健性。但本研究亦具有重要优势,包括覆盖全省的大样本量、长达十二年的观察时间,首次系统揭示了黎族与SGA风险的关联,为该地区SGA防控及民族健康差异研究提供了关键基线证据,对今后开展更具针对性的前瞻性研究及制定精准妇幼健康政策具有重要参考价值。未来需采用更细致的不同汉黎民族组合指标,结合多组学技术开展前瞻性队列研究,深度解析黎族人群SGA的分子标志物,从基因层面揭示黎族与SGA发生风险的遗传机制,并通过质性研究挖掘黎族文化习俗对SGA的影响,为制定贴合黎族文化特点的“文化敏感型”干预措施提供证据。
本研究揭示了黎族与SGA发生风险的关联不仅具有稳定的流行病学证据支持,更存在明确的生物学与社会学因素,对制定基于民族敏感性的产前保健方案、优化民族聚居区围产期资源配置等精准公共卫生策略以及改善黎族母婴健康结局提供科学依据。
  • 海南省自然科学基金资助(821QN415; 824QN399)
  • 海南省临床医学研究中心项目(LCYX202405)
  • 海南省优秀人才团队资助(QRCBT202121)
  • 海南省临床医学中心建设项目资助(QWYH202175)
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2026年第53卷第1期
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doi: 10.20043/j.cnki.MPM.202508004
  • 接收时间:2025-08-01
  • 首发时间:2026-11-02
  • 出版时间:2026-01-10
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  • 收稿日期:2025-08-01
基金
海南省自然科学基金资助(821QN415; 824QN399)
海南省临床医学研究中心项目(LCYX202405)
海南省优秀人才团队资助(QRCBT202121)
海南省临床医学中心建设项目资助(QWYH202175)
作者信息
    1.海南省妇女儿童医学中心科研科,海南 海口 570312
    2.海南医科大学公共卫生学院,海南 海口 571199
    3.海南医科大学儿科学院,海南 海口 571199

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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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