婦幼保健學專科

婦幼保健學專科 一、機構介紹婦幼保健學專科是全市婦幼保健網頂部門，承擔全市12個區級婦幼保健機構、152家助產機構、197家家社群衛生服務中心/鎮衛生院產科、兒科及婦幼保健業務指導、技術培訓及督導質控工作。在廣州市衛生和計劃生育委員會和廣州市婦女兒童醫療中心的領導下，通過監測和調研，分析全市婦女兒童健康狀況，評估婦幼保健服務供需存在的問題，為政府決策提供科學依據，並落實相關措施，持續改進工作，帶領全市婦幼保健機構實現廣州市婦女發展綱要和兒童發展綱要健康領域相關指標。二、主要事蹟（一）深入調研，為科學決策提供準確的參考依據。通過開展廣州市控制和降低孕產婦、嬰兒死亡率及服務需求調研等，為全市婦幼衛生決策提供依據。（二）科學管理，不斷提高婦幼衛生工作效果。從2012年起，以實施廣州市母嬰安康行動計劃為契機，構建新的區域危重孕產婦和兒童救治體系，有效提高救治成功率，全市孕產婦死亡率、嬰兒死亡率分別由2010年的15.2/10萬、4.04‰下降到2014年的7.34/10萬、3.30‰；以百日幫扶、骨幹培訓等方式，指導基層助產機構標準化建設，夯實產兒科服務基礎。（三）夯實基層工作，忠實守護婦女兒童健康。大力推進公共衛生服務下沉到基層，指導社群衛生服務中心/鎮衛生院每年為7萬餘農村婦女提供免費宮頸癌和乳腺癌篩查；為10萬餘孕產婦提供規範的圍產保健和產後訪視服務，為80多萬 7歲以下兒童提供系統保健服務。（四）開拓進取，快速提高團隊工作能力。通過科研推動學科發展，團隊堅持每天早交班學習#!新進展，2011年至今獲省級科研立項6項，市科信局重大專案7項，累計獲科研資助超1300萬；接受基層醫療機構進修及中山大學、南方醫科大學等本科生實習70餘人。5年來累計舉辦婦幼保健培訓班37類、235期，培訓2萬餘人次。完成國家、省級繼續教育專案26項，市級16項，為推動婦幼保健專業發展做出貢獻。三、獲取榮譽2012年分別獲“2006-2010年廣東省實施婦女兒童發展規劃先進集體”和 “2001-2010年廣州市實施婦女兒童發展規劃先進集體”；2012年獲得廣東省 “十二五”醫學重點學科榮譽；2014年獲廣州市“巾幗文明崗”及廣東省“巾幗文明崗”稱號。Study Protocol for Analysis on Prevalence and Related Factors for Adverse Birth Outcomes in Guangzhou， ChinaBackgroundMaternal and children health in China have been improved dramaticallyduring last several decades， especially in Guangzhou that experiencing rapid economic development and social transition。 The maternal and infant mortality rates have fallen significantly in Guangzhou following a series of strengthened maternal and child health programs。 As one of theimportant indicators of prenatal and postnatal health，small for gestational age （SGA） or large for gestational age （LGA） means a higher risk of infant mortality and morbidity in later life。 The surveillance for changing of birth weight and trends in SGA or LGA births in Guangzhou is important。On the other hand， China’s family planning policy has also changed from one-child for one couple in the late1970s to conditionaltwo-child policy， and to a general two-child policy in 2015.Problems caused by this policy adjustment may emerge soon after a boom of the second child， such as upward inter-pregnancy intervals （IPIs） and maternal age， which may have adverse effects on maternal and newborns’ health including preterm birth， low birth weight， SGAand perinatal death。 Littlewas known about the effects of policy adjustment on perinatal outcomes in Chinese population。ObjectivesA retrospective cohort study was conducted to examine the trends in birth weight z- score， prevalence of SGA and LGA among singleton births from 2001to 2015 based on the INTERGROWTH-21st birth weight standard， and to investigate the effects of policy adjustment on preterm birth， SGA and LGA during the period of 2000-2015in Guangzhou， China， and to determine maternal age and the optimal IPIs among Chinese pregnant women。Data sourceThe delivery information was abstracted from the Guangzhou Perinatal Health Care and Delivery Surveillance System （GPHCDSS）， which in brief is the electronic database that covers over 97% of deliveries in Guangzhou from 2000。 GPHCDSS routinely collected data on maternal characteristic， conditions during pregnancy and birth characteristics。 All of these information was approved of usage after application according to corresponding standard procedure。Within this surveillance system， 2，419，184 babies were born in Guangzhou between 2000 and 2015。 There were 2，329，389 were singleton live birth during this period， among which 227，352 women were multiple pregnancies。Statistical strategiesWe applied the international standard for newborn weight， proposed by theInternational Fetal and Newborn Growth Consortium forthe 21st Century （INTERGROWTH-21st） to define small-for-gestational-age（SGA） and large-for-gestational-age（LGA） infants and calculate birth weight z-score。 As regard to preterm delivery， it is defined as gestational age less than 37 completed weeks。 Preterm birth （PTB） was further subdivided into early PTB （24 to 31 weeks），middle PTB （32 to 33 weeks） and late PTB（34 to 36 weeks）.The inter-pregnancy intervals（IPI） were calculated from the records as the time in months between the first delivery date and date of conception for the second pregnancy。Thisinternational standard of INTERGROWTH-21stproject provides an opportunity for the comparisons in different time periods or among different populations.We first attempt to examine trends in birth weight z-score， prevalence of SGA and LGA among singleton births form 2001 to 2015 based on the INTERGROWTH-21st birth weight standard。 Then we will further explore these trends by maternal characteristics to identify subgroups that need more attentions。Next， we will ascertain the effect of inter-pregnancy intervals （IPI） on perinatal outcomes， like SGA， LGA and preterm birth as mentioned above。 Stratified analysis by maternal age at second pregnancy was also explored。Expectations of results（1） As the dramatic improvement in women and children’s health care service in China during the last decade， we expected to find that the prevalence of SGA and LGA would decline。（2） On the base of physiology， the relationship between IPI and perinatal outcomes should U-shaped， with both shorter and longer IPI associated with increased risk of SGA， AGA and preterm birth。