生殖医学杂志

目的 探讨宫内节育器(IUD)对育龄妇女再生育时妊娠结局的影响。方法 采用回顾性队列研究，分析2016年1月至2018年12月在我院分娩二孩的15 031例研究对象的临床资料。根据避孕方式不同分为两组：采用IUD避孕的为IUD组(n=7 452),采用避孕套避孕的为避孕套组(n=7 579),比较两组的一般资料和停用避孕措施后的妊娠结局。由于年龄和带器时长均可能是妊娠结局的影响因素，又将IUD组根据年龄不同分为<35岁和≥35岁两个年龄段；按照带器时长不同分为3个亚组：<5年组、5～10年组和>10年组，比较不同年龄段各亚组取出IUD后再次妊娠时的妊娠结局。采用多因素Logistic回归分析不同因素对妊娠结局的影响。结果 IUD组和避孕套组的年龄、体质量指数(BMI)分布、第一胎分娩方式、第一胎异常分娩结局、未使用IUD和避孕套前流产次数、妊娠期糖尿病(GDM)发生率比较均无显著性差异(P>0.05);IUD组的妊娠期高血压发生率显著低于避孕套组(P<0.05)。停用避孕措施后，两组间流产次数、第二胎分娩方式、自然流产、稽留流产、发育异常引产、出生缺陷、死胎发生率比较均无显著性差异(P>0.05);IUD组的第二胎分娩孕周<37周、第二胎出生体重<2 500 g发生率显著高于避孕套组(P<0.05)。在<35岁年龄段中，各IUD带器时长亚组间流产、出生缺陷、死胎、早产、足月低体重儿、巨大儿发生率比较均无显著性差异(P>0.05);在≥35岁年龄段中，各IUD带器时长亚组间流产、出生缺陷、死胎、早产、足月低体重儿、巨大儿发生率比较亦无显著性差异(P>0.05)。多因素Logistic回归分析结果显示，年龄[OR=1.054,95%CI(1.038,1.069),P=0.000]、流产1～2次[OR=1.591,95%CI(1.377,1.840),P=0.000]、流产≥3次[OR=5.841,95%CI(4.914,6.944),P=0.000]、妊娠期高血压疾病[OR=1.521,95%CI(1.060,2.183),P=0.041]和BMI≥24.0 kg/m²[OR=1.780,95%CI(1.376,2.301),P=0.000]是妊娠结局的危险因素，而是否使用IUD、GDM和BMI<18.5 kg/m²对妊娠结局无显著影响(P>0.05)。结论 育龄妇女停用IUD后再生育结局受到年龄、流产史、妊娠期高血压疾病、肥胖多种因素影响，但未发现IUD及带器时长影响妊娠结局，故IUD取出后可以放心生育。

Objective:To investigate the effect of intrauterine contraceptive device(IUD) on the pregnancy outcome of women of childbearing age.Methods:A retrospective cohort analysis was performed on the clinical data of 15 031 patients who delivered the second child in our hospital from January 2016 to December 2018. The patients were divided into two groups according to different contraceptive methods: IUD group(n=7 452) and condom group(n=7 579). The general data and pregnancy outcomes after contraceptive withdrawal were compared between the two groups. Considering that age and the duration with IUD were the influencing factors of pregnancy outcome, the IUD group was divided into the age <35 years group and ≥35 years group, and 3 subgroups according to the duration with IUD:<5 years group, 5-10 years group and >10 years group. The pregnancy outcomes of re-preproduction after IUD removal were compared among the subgroups of different age groups. Multiple logistic regression was used to analyze the influence of different factors on pregnancy outcome.Results:There were no significant differences in age, the distribution of body mass index(BMI),delivery mode of the first birth, abnormal delivery outcome of the first birth, number of abortions before using IUD and condom and the incidence of gestational diabetes between the two groups with the different contraceptives(P>0.05). The incidence of gestational hypertension in IUD group was significantly lower than that in condom group(P<0.05). After discontinuing contraceptives use, there were no significant differences in the number of abortions, second delivery mode, spontaneous abortion, missed abortion, induced abortion with abnormal development, birth defects and stillbirth between the two groups(P>0.05). The gestational age(<37 weeks) and birth weight(<2 500 g) of the second fetus in IUD group were significantly higher than those in condom group(P<0.05). In the group <35 years old, the incidences of abortion, birth defects, stillbirth, premature birth, low birth weight to full term, and macrosomia were not significantly different among the subgroups(P>0.05). In the group ≥35 years old, the abortion, birth defects, stillbirth, premature birth, low birth weight to full term, and macrosomia were not significantly different among the subgroups(P>0.05). Multivariate logistic regression analysis showed that age[OR=1.054,95%CI(1.038,1.069),P=0.000],abortion 1-2 times[OR=1.591,95%CI(1.377,1.840),P=0.000],abortion times ≥3[OR=5.841,95%CI(4.914,6.944),P=0.000],gestational hypertension[OR=1.521,95%CI(1.060,2.183),P=0.041] and BMI≥24.0 kg/m²[OR=1.780,95%CI(1.376,2.301),P=0.000] were the risk factors for pregnancy outcome, while IUD usage, gestational diabetes mellitus and BMI<18.5 kg/m² had no significant influence on pregnancy outcome(P>0.05).Conclusions:Age, abortion history and gestational hypertension are the factors influencing outcome of pregnancy after IUD withdrawal. However, IUD usage and duration do not affect the pregnancy outcome, so it is safe to give birth after removing IUD.