| ObjectiveTo understand the prevalence of preterm birth(PTB)in China,analyze the influencing factors of preterm birth,and provide reference for the prevention of preterm birth.MethodsThe research subjects were from the Chinese Pregnant Women Cohort Study(CPWCS).The sociodemographic characteristics,obstetric characteristics,psychological characteristics,behavioral characteristics,gestational weight gain(GWG)and delivery outcome of pregnant women were collected through questionnaire surveys and hospital information system(HIS).The group based trajectory model(GBTM)was used to construct the trajectory of the sleep duration of pregnant women in the first,second,and third trimesters.The chi-square test and binary logistic regression were used to analyze the influencing factors of preterm birth,and the restricted cubic spline(RCS)was used to explore the dose-response relationship of GWG and PTB.All statistical analysis were performed in SPSS and SAS.ResultsA total of 3252 pregnant women were included in the study,and the incidence rate of PTB was 4.2%.Pregnant women of advanced age accounted for 9.4%,with pregnancy plan accounted for 71.1%and who give birth naturally accounted for 58.6%.The incidence of depression in the first,second and third trimesters was 26.9%,23.4%and 25.1%.The trajectory of night sleep duration of pregnant women consisted of three subgroups,which were sustained stable group(84.8%),sustained decline group(9.1%)and sustained high group(6.1%).The GWG of pregnant women were classified as suitable,insufficient and excessive,accounting for 36.6%,22.3%and 41.I%,respectively.Logistic regression results showed that advanced age(OR:1.703,95%CI:1.017～2.850),living in the southern region(OR:1.718,95%CI:1.185～2.491),history of premature birth(OR:28.037,95%CI:7.029～11842),premature rupture of membranes(OR:6.220,95%CI:1.896～20.399),abruption of placenta(OR:5.016,95%CI:3.420～7.356),twins(OR:21.402,95%CI:8.659～52.900),gestational hypertension(OR:6.020,95%CI:3.160～11.468)and insufficient GWG(OR:1.62,95%CI:1.037～2.535)are all risk factors for PTB,and planned pregnancy(OR:0.622,95%CI:0.426～0.910)is a protective factor for PTB.Night sleep trajectory has no significant effect on the incidence of PTB(P>0.05),but the total sleep duration of 8 to 10 hours in the third trimester significantly reduced the risk of PTB(OR:0.576,95%CI:0.369-0.900).In the stratified analysis,among pregnant women who give birth naturally,excessive GWG was a protective factor for PTB(OR:0.327,95%CI:0.143～0.746).In pregnant women who are overweight before pregnancy,excessive GWG can reduce the risk of PTB,the OR and 95%CI are 0.339(0.126～0.916),respectively.The RCS showed that there is a linear dose-response relationship between GWG and PTB.When GWG is in the range of 5 to 16 kg,the risk of PTB gradually decreases as the GWG increases.When the GWG is less than 5kg or more than 16kg,there is no statistical correlation.ConclusionThere are many factors affecting PTB.Advanced age,living in the southern region,history of premature birth,premature rupture of membranes,abruption of placenta,twins,gestational hypertension,insufficient GWG are all risk factors for PTB,and planned pregnancy is a protective factor for PTB.The total sleep duration of 8 to 10 hours in the third trimester is a protective factor for PTB.To ensure sufficient night sleep time,or to achieve the appropriate total sleep time by taking a nap,may be a measure to prevent PTB.There is a linear dose-response relationship between GWG and PTB.Exploring the range of GWG that is suitable for the Chinese pregnant women will become one of the effective measures to prevent PTB. |
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