Objective: To investigate the incidence of preterm birth in Guangxi Zhuang Autonomous Region and explore the related factors and their combined effects. Methods: The study subjects were women giving birth to live babies at the monitoring points of critical maternal hospital monitoring system in Guangxi Zhuang Autonomous Region from January 1, 2017 to December 31, 2019. The data of general characteristics (age and marital status), pregnancies (parity, number of previous cesarean delivery, the number of prenatal check and number of fetuses in this pregnancy) and disease conditions (placenta previa, placental abruption, hypertension, diabetes, anemia, and heart disease) were collected, and the incidence of preterm birth were calculated according to the definition of preterm birth set by WHO and China, respectively. Logistic regression model was used to explore the factors associated with premature birth and their combined effects. Results: According to definitions of WHO and China, the cumulative incidence of preterm birth in Guangxi from 2017 to 2019 was 7.45% (16 819/225 727) and 7.34% (16 559/225 727), respectively. Advanced age [≤34 years old as reference, OR (95%CI) of 35-39 and ≥40 years old were 1.36 (1.30-1.42) and 1.61 (1.50-1.74), respectively], unmarried (including divorced or widowed) [OR (95%CI): 1.28 (1.17-1.40)], primiparae [OR (95%CI): 1.34 (1.29-1.40)], previous cesarean section [no previous cesarean section as reference, OR (95%CI) of 1 and ≥2 times of previous cesarean section were 1.30 (1.24-1.36) and 1.85 (1.65-2.08), respectively], antenatal examination<8 [OR (95%CI): 2.72 (2.62-2.81)], multiple pregnancies [OR (95%CI): 15.00 (14.01-16.06)], placenta previa [OR (95%CI): 6.90 (6.35-7.50)], placental abruption [OR (95%CI): 8.18 (7.36-9.10)], gestational hypertension [OR (95%CI): 2.29 (2.17-2.42)], gestational diabetes mellitus [OR (95%CI): 1.43 (1.37-1.49)], anemia [OR (95%CI): 1.10 (1.07-1.14)], and heart diseases [OR (95%CI): 2.98(2.43-3.65)] were all positively correlated with preterm birth. The risk of preterm birth in pregnant women exposed to 1, 2, 3, 4, 5, 6 and ≥7 preterm birth related factors was 1.51, 2.29, 4.49, 9.69, 20.87, 46.88 and 192.11 times that of non-exposed women, respectively (all P values<0.001). Conclusion: Preterm birth is associated with maternal general characteristics, pregnancy and disease status, and the combined effect of preterm birth related factors significantly increases the risk of preterm birth.
目的： 了解广西壮族自治区早产发生率，探索早产发生的相关因素及其联合作用。 方法： 以2017年1月1日至2019年12月31日中国危重孕产妇医院监测系统广西壮族自治区监测点分娩活产儿的产妇为对象。收集对象一般特征（年龄和婚姻状况）、妊娠情况（产次、既往剖宫产次数、产前检查次数和本次妊娠胎儿数）和患病情况（前置胎盘、胎盘早剥、高血压、糖尿病、贫血和心脏疾病）等资料，分别依据世界卫生组织（WHO）和中国对早产的定义计算早产发生率，采用logistic回归模型探索早产相关因素及其联合作用。 结果： 依据WHO和中国定义，2017—2019年广西累积早产发生率分别为7.45%（16 819/225 727）和7.34%（16 559/225 727）；高龄[以≤34岁为参照，35~39和≥40岁的OR(95%CI）分别为1.36（1.30~1.42）和1.61（1.50~1.74）]、未婚（含离异或丧偶）[OR(95%CI)：1.28（1.17~1.40）]、初产妇[OR(95%CI)：1.34（1.29~1.40）]、既往剖宫产[以无既往剖宫产为参照，1次和≥2次的OR(95%CI）分别为1.30（1.24~1.36）和1.85（1.65~2.08）]、产检<8次[OR(95%CI)：2.72（2.62~2.81）]、多胎妊娠[OR(95%CI)：15.00（14.01~16.06）]、前置胎盘[OR(95%CI)：6.90（6.35~7.50）]、胎盘早剥[OR(95%CI)：8.18（7.36~9.10）]、妊娠期高血压[OR(95%CI)：2.29（2.17~2.42）]、妊娠期糖尿病[OR(95%CI)：1.43（1.37~1.49）]、贫血[OR(95%CI)：1.10（1.07~1.14）]和心脏病[OR 95%CI：2.98（2.43~3.65）]等均与早产正相关；暴露于1、2、3、4、5、6和≥7个早产相关因素的孕妇早产风险分别是无暴露孕妇的1.51、2.29、4.49、9.69、20.87、46.88和192.11倍（均P<0.001）。 结论： 早产与产妇的一般特征、妊娠情况和患病情况等因素相关，早产相关因素联合作用明显增加早产风险。.
Keywords: Combined effects; Premature birth; Risk factors; Surveillance.