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目的 探索高龄产妇(advanced maternal age, AMA)产后体力活动(physical activity, PA)水平变化轨迹类别及影响因素。方法 采用便利抽样法，选取2022年8—12月在苏州市某三甲医院产科分娩的433例AMA为研究对象，采用一般资料问卷、国际PA问卷长卷、爱丁堡产后抑郁量表、匹兹堡睡眠质量指数量表、家庭支持评定量表，在产妇产后42 d(T1)、产后3个月(T2)、产后6个月(T3)、产后12个月(T4)进行随访调查。采用增长混合模型(growth mixture modeling, GMM)拟合变化轨迹类别、无序多分类logistic回归分析其影响因素。结果 共399例AMA完成本研究，研究过程中失访34例，失访率为7.9%。AMA产后PA水平变化轨迹可分为“低水平-缓慢改善组”(55.4%)、“低水平-较快改善组”(38.8%)、“中水平-明显改善组”(5.8%)。logistic回归分析结果显示：产妇孕前BMI高是产后PA水平变化轨迹属于“低水平-较快改善组”与“中水平-明显改善组”的阻碍因素(OR值分别为0.565和0.570,均P<0.001);睡眠质量得分低是产妇PA水平变化轨迹属于“中水平-明显改善组”的阻碍因素(OR=0.569,P=0.045);产妇孕前运动习惯≥4次/周是PA水平变化轨迹属于“中水平-明显改善组”的阻碍因素(OR=0.178,P=0.020)。结论 AMA产后PA可分为3种不同变化轨迹，存在群体异质性，医务工作者可通过识别PA水平变化轨迹特征为起始水平低、改善程度欠佳的危险人群并给予针对性护理措施，以提高AMA产后PA水平。
Abstract：Objective To investigate the categories of changes in postpartum physical activity(PA)levels among advanced maternal age(AMA) and its influencing factors. Methods Convenience sarnpling method was used to select a total of 433 AMA who gave birth in the obstetrics department of a grade 3A hospital in Suzhou from August to December 2022 were selected as the survey subjects, and the baseline data were collected by a general information questionnaire, follow-up surveys at 42 days(T1), 3 months(T2), 6 months(T3), and 12 months(T4) after delivery were completed by international PA questionnaire, Edinburgh postnatal depression scale, Pittsburgh sleep quality index, and family support scale. The growth mixture modeling(GMM) was used to fit the change trajectory categories, and disordered multi-classification logistic regression was used to analysis the influencing factors. Results A total of 399 MAM cases completed this study, with 34 cases lost to follow-up, resulting in a loss-to-follow-up rate of 7.99%.Three different trajectories of postpartum physical activity level of maternal advanced age with different characteristics were fitted as "Low level-Slow improvement Group"(55.4%), "Low level-Fast improvement group"(38.8%),and "Medium level-Significant improvement group"(5.8%). Disordered multi-classification logistic regression results showed that, high pre-pregnancy BMI was a risk factor for the trajectory of maternal advanced age physical activity level belonging to "Low level-Fast improvement group" and "Medium level-Significant improvement group"(OR were 0.565 and 0.570,P<0.001). Poor sleep quality was a risk factor for the trajectory of maternal advanced age physical activity level belonging to "Medium level-Significant improvement group"(OR=0.569,P=0.045). Exercise habit≥4 days/week before pregnancy was a risk factor for the trajectory of maternal advanced age physical activity level belonging to "Medium level-Significant improvement group"(OR=0.178,P=0.020). Conclusion There are 3 different change trajectories of PA after AMA, and there is population heterogeneity. Healthcare workers can identify the characteristics of the trajectories of changes in PA level and provide targeted nursing interventions for high-risk groups with low starting levels and poor improvement to improve the PA level of AMA after childbirth.
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基本信息:
DOI：10.16821/j.cnki.hsjx.2025.12.002
中图分类号:R473.71
引用信息:
[1]朱颖妮,孙施静,张彦等.高龄产妇产后体力活动的变化轨迹及影响因素研究[J].护士进修杂志,2025,40(12):1241-1248.DOI:10.16821/j.cnki.hsjx.2025.12.002.
基金信息:
中国疾病预防控制中心妇幼保健中心母婴营养与健康研究项目(编号：2023FYH006); 江苏省妇幼健康科研项目(编号：F2021 08); 苏州市姑苏卫生人才科研项目(编号：GSWS2023061); 南京医科大学教育研究课题(编号：2023LX095)