우리나라 단태아, 쌍태아의 임신기간 변화 추이: 1997~99, 2011~13
Secular Trends of Gestational Length Distribution in Korean Singleton and Twin Birth: 1997~99, 2011~13
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초록
본 연구대상은 통계청의 1997~1999년(1,850,236 건), 2011~2013년(1,325,301건) 출생신고 원시자료 (쌍태아 이하, 출산 연령 20세 이상, 의료기관 출생아, 혼인 내 출생아)를 이용하여 조기조기분만, 후기조기분 만, 만삭분만 및 과숙분만의 발생 빈도 추이와 각 임신 구간별 발생 위험도 분석을 위해 로지스틱 회귀분석을 시행하였다. 단태아의 평균 임신기간은 1997~99년(phase I) 39.4주, 2011~13년(phase II) 38.7주로 0.7주 단축되었고, 쌍태아의 경우는 각각 36.9주, 35.7주로 1.2 주 단축되어 쌍태아의 임신기간의 감소폭이 더 크게 나타났다, phase I에서는 단태아의 임신기간 분포모양은 임신 40주에 최고점인 우측으로 기울어진 형태였 고, phase II에서는 39주를 중심으로 완만한 형태로 변화되면서 임신 주령 분포 형태가 왼쪽으로 이동하였 다. 쌍태아의 경우 phase I에서는 임신 37주에 정점을 이루는 밋밋한 분포에서 phase II에서는 임신 37주에 정점을 이루는 더 뾰족한 형태로 변화되었다. 단태아의 임신 구간별 발생 빈도(기준군: phase I) 에서 phase II의 조기조기분만 교차비는 1.138, 후기조 기분만은 1.556, 만삭분만 1.094, 과숙분만은 0.113 으로 나타났고, 쌍태아에서는 phase II의 각 임신 구간별 교차비는 각각 1.495, 2.110, 0.444, 0.055로 통계적으로 유의하였다(p<0.01). 조기조기분만과 후기 조기분만의 경우 쌍태아에서 발생 빈도의 증가폭이 더크게 나타났고, 반면 만삭분만 및 과숙분만에서는 발생 빈도의 감소폭이 쌍태아에서 더 크게 나타났다. Phase I, II의 구간 동안 쌍태아에서 조기분만 발생 위험도가 더 증가하였고, 임신 37주 이상 만삭분만이나 과숙분만의 경우 발생 빈도의 감소폭이 쌍태아에서 더크게 나타났다. 이는 같은 기간 동안 단태아보다 쌍태아 에서 불리한 임신 결과에 대한 노출 위험도가 더 크다는 것을 의미하며, 쌍태아 집단에 대한 보다 체계적인 산전 관리 모니터링 시스템 구축이 필요할 것으로 사료된다.
Abstract
Purpose: To compare the secular trends of gestational length distribution in singleton and twin birth by analyzing the birth certificated data of Statistics Korea. Methods: The birth certificated data of Statistics Korea was used for this analysis (1997~99: 1,850,236 births, 2011~13: 1,325,301 births). The data of triplet birth cases, extra-marital birth, non-hospital birth cases, teenage birth, and gestational length information missing cases were excluded. Odds ratio and 95% confidence intervals were calculated from multinomial logistic regression analyses to describe the secular trend (1997~99 and 2011~13) of early preterm birth rate (≤33 weeks), late preterm birth rate (34~36 weeks), term birth rate (37~41 weeks), and post-term birth rate (≥42 weeks) adjusted for maternal age (20, 25, 30, 35, 40), birth order (1st=1, 2nd=2, ≧3rd=3), infantile gender (male=1, female=0), maternal occupation (none=1, yes=0), and education (≤middle=1, high=2, college/university=3). Results: From phase I (1997~99) to phase II (2011~13), the gestational length distribution in singleton and twin births shifted the left and toward shorter gestational distribution, and mean gestational length decreased from 39.4 weeks to 38.7 weeks in singleton birth, and decreased from 36.9 weeks to 35.7 weeks in twin birth, During the period, the term birth rate of singleton birth was unchanged at 95 percent, but the term birth rate of twin birth was decreased from 65.7 percent to 46.1 percent. The odds ratio of early preterm birth, late preterm birth, term birth rate, and post-term birth rate in singleton birth for phase II were, respectively, 1.138 (95% confidence interval: 1.106~1.171), 1.556 (1.532~1.581), 1.094 (1.081~1.107), and 0.113 (0.109~0.118), compared with rate of each gestational length for phase I. The odds ratio of each gestational length in twin birth of phase II, comparing phase I, were 1.495 (1.405~1.590) for early preterm birth, 2.110 (2.029~2.194) for late preterm birth, 0.444 (0.428~0.461) for full term birth, and 0.055 (0.026-0.117) for post-term birth. Conclusion: The risk of early preterm birth, late preterm birth between phase I & II increased higher in twin birth than that of singleton birth. The rise in early and late preterm birth, and decrease in mean gestational length in singleton and twin birth during the period. There was a need to more research in this area to understand the contributing factors to gestational length.
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