孕前丙氨酸氨基转移酶异常、高龄生育与早产低出生体重关联的队列研究

庾静云; 张新建; 姜碧; 刘宇炜; 梁煜; 曾思良; 甘展鹏

doi:10.16462/j.cnki.zhjbkz.2024.03.016

孕前丙氨酸氨基转移酶异常、高龄生育与早产低出生体重关联的队列研究

doi: 10.16462/j.cnki.zhjbkz.2024.03.016

1.
东莞市妇幼保健院保健部, 东莞 523000
2.
东莞市妇幼保健院院长室, 东莞 523000
3.
东莞市妇幼保健院纪检监察室, 东莞 523000
4.
东莞市妇幼保健院科教科, 东莞 523000

基金项目:

广东省医学科学技术研究基金 B2020071

详细信息

通讯作者:
曾思良，E-mail：420861858@qq.com

中图分类号: R173
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- 被引次数: 0
出版历程
- 收稿日期: 2022-10-26
- 修回日期: 2023-01-17
- 网络出版日期: 2024-04-08
- 刊出日期: 2024-03-10

A cohort study on the relationship between women′s pre-pregnancy abnormal alanine aminotransferase, advanced age delivery and preterm low birth weight of newborns

1.
Health Care Department, Dongguan Maternal and Child Health Care Hospital, Dongguan 523000, China
2.
Deanery of Dongguan Maternal and Child Health Care Hospital, Dongguan 523000, China
3.
Discipline Inspection and Supervision Office, Dongguan Maternal and Child Health Care Hospital, Dongguan 523000, China
4.
Science and Education Division, Dongguan Maternal and Child Health Care Hospital, Dongguan 523000, China

Funds:

Guangdong Medical Science and Technology Research B2020071

More Information

Corresponding author: ZENG Siliang, E-mail: 420861858@qq.com

摘要

摘要: 目的探讨母亲孕前丙氨酸氨基转移酶(alanine aminotransferase, ALT)异常、高龄生育与新生儿早产低出生体重的关联。方法采用历史性队列研究，选取2015年1月―2020年9月在东莞市参加免费婚前健康检查和孕前优生健康检查项目的育龄女性，获取受检对象基本情况及相关检查结果，追踪随访获取其妊娠结局情况。采用多因素logistic回归分析母亲孕前ALT异常、高龄生育对新生儿早产低出生体重发生的影响，并进行亚组和敏感性分析检验结果的稳定性。结果共纳入23 620名母亲，新生儿早产低出生体重发生率为2.90%。多因素logistic回归分析结果显示，校正了协变量后母亲孕前ALT异常(RR=1.527, 95% CI: 1.133~2.016, P=0.004)、高龄生育(RR=1.257, 95% CI: 1.006~1.562, P=0.042)均可增加新生儿早产低出生体重发生风险。各亚组的效应值方向未发生改变，且组间异质性差异均无统计学意义(均P＞0.05)。依次剔除了母亲孕前血糖(blood glucose, GLU)异常和孕前乙型肝炎表面抗原(hepatitis B surface antigen, HBsAg)阳性人群，效应值较为稳定。结论母亲孕前ALT异常和高龄生育与新生儿早产低出生体重相关。
- 丙氨酸氨基转移酶 /
- 高龄 /
- 分娩 /
- 早产 /
- 出生体重 /
- 队列研究
Abstract: Objective To explore the relationship between women′s pre-pregnancy abnormal alanine aminotransferase(ALT), advanced age delivery and preterm low birth weight of newborns. Methods A historical cohort study was conducted to select women of childbearing age who participated in free pre-marital health check-ups and pre-pregnancy eugenic health check-ups in Dongguan from January 2015 to September 2020. The basic information and relevant examination results of the subjects were obtained, and their pregnancy outcomes were followed up. Multivariate logistic regressions were used to analyze the effects of women′s pre-pregnancy abnormal ALT and advanced age delivery on preterm low birth weight of newborns. The stability of the results was tested by subgroup analysis and sensitivity analysis. Results A total of 23 620 subjects were included in the analysis. The incidence of preterm low birth weight of newborns was 2.90%. Multivariate logistic regression analysis showed that after adjusting covariates, women′s pre-pregnancy abnormal ALT could increased the risk of preterm low birth weight (RR=1.527, 95% CI: 1.133-2.016, P=0.004). Delivery at an advanced age increased the risk of preterm low birth weight (RR=1.257, 95% CI: 1.006-1.562, P=0.042). Effect sizes were similar in subgroups of infant gender, mother′s delivery history and mode of delivery, and there was no statistically significant difference in heterogeneity between groups(all P>0.05). After excluding people with abnormal blood glucose(GLU) before pregnancy and hepatitis B surface antigen(HBsAg) positive before pregnancy, the effects remained. Conclusions Women′s pre-pregnancy abnormal ALT and advanced age delivery are associated with preterm low birth weight.
- Alanine aminotransferase /
- Advanced age /
- Delivery /
- Preterm birth /
- Birth weight /
- Cohort study

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图 1 样本筛选流程图

ALT: 丙氨酸氨基转移酶。

Figure 1. Sample screening flow chart

ALT: alanine aminotransferase.

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图 2 亚组分析和敏感性分析森林图

GLU: 血糖; HBsAg: 乙型肝炎表面抗原; ALT: 丙氨酸氨基转移酶。

Figure 2. Forest map of subgroup analysis and sensitivity analysis

GLU: blood glucose; HBsAg: hepatitis B surface antigen; ALT: alanine aminotransferase.

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表 1 新生儿早产低出生体重影响因素

Table 1. The influencing factors of preterm low birth weight of newborns

特征Feature	总人数 ^①Total ^①(n=23 620)	早产低出生体重儿 ^①Preterm low birth weight ^①(n=684)	χ²值value	P值value
婴儿性别Infant gender			0.316	0.574
男Male	12 319(52.16)	349(2.83)
女Female	11 301(47.84)	335(2.96)
母亲民族Mother′s ethnic			0.004	0.949
汉族Han nationality	23 355(98.88)	677(2.90)
少数民族Minority nationality	265(1.12)	7(2.64)
母亲户口所在地Mother′s household registration location			0.802	0.371
本地市Local city	19 751(83.62)	581(2.94)
外地市Non local cities	3 869(16.38)	103(2.66)
母亲分娩史Mother′s delivery history			2.209	0.137
无None	13 069(55.33)	398(3.05)
有Had	10 551(44.67)	286(2.71)
孕前GLU异常Pre-pregnancy abnormal GLU			1.056	0.304
否No	21 971(93.02)	629(2.86)
是Yes	1 649(6.98)	55(3.34)
孕前HBsAg阳性Pre-pregnancy HBsAg positive			0.128	0.721
否No	22 025(93.25)	635(2.88)
是Yes	1 595(6.75)	49(3.07)
孕前ALT异常Pre-pregnancy abnormal ALT			9.597	0.002
否No	22 386(94.78)	630(2.81)
是Yes	1 234(5.22)	54(4.38)
分娩方式Delivery method			25.214	<0.001
阴道分娩Vaginal delivery	15 471(65.50)	386(2.50)
剖宫产分娩Cesarean section delivery	8 149(34.50)	298(3.66)
高龄生育Advanced age delivery			3.053	0.081
否No	19 562(82.82)	549(2.81)
是Yes	4 058(17.18)	135(3.33)
注：GLU, 血糖; HBsAg, 乙型肝炎表面抗原; ALT, 丙氨酸氨基转移酶。①以人数(占比/%)表示。 Note: GLU, blood glucose; HBsAg, hepatitis B surface antigen; ALT, alanine aminotransferase.①Number of people(proportion/%).

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表 2 母亲孕前ALT异常、高龄生育与新生儿早产低出生体重的关系

Table 2. Relationship between women′s pre-pregnancy abnormal ALT, advanced age delivery and preterm low birth weight of newborns

暴露因素Exposure factors	早产低出生体重Preterm low birth weight
暴露因素Exposure factors	RR值 ^① value ^①(95% CI)	P值 ^① value ^①	aRR值value (95% CI)	aP值value
孕前ALT异常Pre-pregnancy abnormal ALT		0.002		0.004 ^②
否No	1.000		1.000
是Yes	1.580(1.177~2.079)		1.527 ^②(1.133~2.016)
高龄生育Advanced age delivery		0.072		0.042 ^③
否No	1.000		1.000
是Yes	1.192(0.981~1.438)		1.257 ^③(1.006~1.562)
注：GLU, 血糖; HBsAg, 乙型肝炎表面抗原; ALT, 丙氨酸氨基转移酶。①未校正；②校正了婴儿性别、母亲孕前HBsAg阳性、分娩方式、高龄生育、母亲分娩史、孕前GLU异常；③校正了婴儿性别、母亲孕前HBsAg阳性、分娩方式、孕前ALT异常、母亲分娩史、孕前GLU异常。 Note: GLU, blood glucose; H BsAg, hepatitis B surface antigen; ALT, alanine aminotransferase.① Not corrected; ② Corrected for infant gender, pre-pregnancy HBsAg positive of mother, delivery method, advanced age delivery, mother′s delivery history, and pre-pregnancy abnormal GLU; ③ Corrected for infant gender, pre-pregnancy HBsAg positive of mother, delivery method, pre-pregnancy abnormal ALT, mother′s delivery history, and pre-pregnancy abnormal GLU.

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