| 朱微波,李奇迅,孔令蕤,等.基于限制性立方样条模型探索妊娠间隔与分娩方式关系[J].安徽医药,2026,30(7):1349-1353. |
| 基于限制性立方样条模型探索妊娠间隔与分娩方式关系 |
| Relationship between interpregnancy interval and delivery mode: a study based on a restricted cubic spline model |
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| DOI：10.3969/j.issn.1009-6469.2026.07.015 |
| 中文关键词: 分娩 剖宫产 妊娠间隔 妊娠方式 限制性立方样条回归 身体质量指数 |
| 英文关键词: Parturition Cesarean section Pregnancy interval Pregnancy type Restricted cubic spline regression Body mass index |
| 基金项目:国家自然青年科学基金项目( 82004503) |
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| 中文摘要: |
| 目的探索妊娠间隔与分娩方式间关系。方法回顾性收集 2015年 6月至 2024年 5月在北京市门头沟区医院建档并分娩的 2 060例经产妇的年龄、前一次和本次分娩方式、孕前身体质量指数( body mass index，BMI)和妊娠间隔等临床基本资料。首先采用 logistic回归分析，建立不同的模型探索妊娠间隔和分娩方式间的关系；然后采用限制性立方样条回归校正混杂因素后，探索全年龄组和是否高龄经产妇亚组人群中妊娠间隔与分娩方式间的剂量 -反应关系；最后按照是否高龄进行分层分析，采用似然比检验探索交互效应。结果阴道分娩组经产妇妊娠间隔为( 48.90±28.87)个月，剖宫产组经产妇妊娠间隔为(55.00±31.89)个月。按照校正不同混杂因素建立 3个模型均显示:与妊娠间隔 18~59个月组比较， <18个月组和 >59个月组均是分娩方式为剖宫产的危险因素( P<0.05)。限制性立方样条回归分析结果显示，校正混杂因素后，无论是全年龄组人群，还是按照是否高龄分层后，经产妇妊娠间隔与分娩方式间均呈近似 “U”型关系( P非线性 <0.05)。阈值效应分析结果显示 3个人群的拐点值分别为 24.44个月、 24.00个月和 25.95个月，低于拐点值妊娠间隔与分娩方式均呈负相关( P<0.05)高于拐点值二者均呈正相关( P<0.05)。进一步亚组分析结果显示，调整混杂因素后，年龄对妊娠间隔和分娩方式间的关联有修饰效应( P<0.05)。结论 过长或者过短的妊娠间隔均会增加经产妇剖宫产率。 |
| 英文摘要: |
| Objective To explore the relationship between pregnancy interval and delivery mode.Methods Clinical data of 2,060multiparous women who registered and delivered in Beijing Mentougou District Hospital from June 2015 to May 2024 were retrospec-tively collected, including age, previous and current delivery modes, pre-pregnancy body mass index (BMI), and interpregnancy inter-val. Logistic regression models were used to explore the relationship between interpregnancy interval and delivery mode. Subsequently,,after adjusting for confounders via restricted cubic spline regression, the dose-response relationship between interpregnancy intervaland delivery mode was investigated in the entire cohort and in subgroups of multiparous women stratified according to advanced mater-nal age. Finally, stratified analyses by age were performed, and likelihood ratio tests assessed interaction effects.Results The inter.pregnancy interval of multiparous women was (48.90±28.87) months in the vaginal delivery group and (55.00±31.89) months in the ce-sarean section group. All three models, adjusted for different confounding factors, showed that compared with the 18-to 59-month inter.pregnancy interval group, the <18-month and >59-month groups were risk factors for cesarean section (P<0.05). Restricted cubic spline regression analysis results indicated that after adjusting for confounders, there was a near U-shaped relationship between interpregnan-cy interval and delivery mode in the entire cohort and in subgroups stratified by advanced maternal age (Pnon-linear<0.05). Threshold-ef-fect analysis results showed critical values of 24.44, 24.00, and 25.95 months for the three groups. Below these values, interpregnancyinterval was negatively correlated with delivery mode (P<0.05), and above them, a positive correlation existed (P<0.05). Subgroup anal-ysis results further indicated that after adjusting for confounders, age modified the association between interpregnancy interval and de-livery mode (P<0.05).Conclusion Both prolonged and short interpregnancy intervals increase the cesarean section rate in multipa-rous women. |
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