摘要
目的探讨出生缺陷的影响因素。方法2009年4月1日-2010年3月31日，选择在青岛市妇女儿童医疗保健中心、青岛大学医学院附属医院、青岛市市立医院等75家医疗保健机构、孕龄为13周至产后7d内发现的缺陷儿为出生缺陷组；选取同期无出生缺陷的健康新生儿作为对照组。采用病例对照研究方法，利用出生缺陷三级监测网络信息，以专门设计的出生缺陷影响因素病例对照调查表，对两组胎婴儿的父母进行问卷调查。结果（1）青岛市妇女儿童医疗保健中心等75家医疗保健机构分娩围产儿数77231例，其中分娩围产期出生缺陷儿466例，围产儿出生缺陷发生率为60．34／万。前6位的出生缺陷病因依次是先天性心脏病112例、总唇裂（唇裂、唇裂合并腭裂）85例、多指（趾）53例、神经管畸形38例、先天性脑积水37例、肢体短缩28例，共计353例，占全部出生缺陷儿的54．48％（353／648）。（2）出生缺陷组母亲的大专及以上文化程度（25．6％）低于对照组（30．0％），两组比较，差异有统计学意义（P〈0．05）。（3）出生缺陷组中父母经常被动吸烟、经常饮酒、饲养宠物的比例高于对照组，两组比较，差异有统计学意义（P〈0．05）。（4）出生缺陷组母亲孕期有害化学物质及有害物理因素接触率（分别为13．9％及20．5％）与对照组（分别为1．1％及11．7％）比较，差异有统计学意义（P〈0．01）。出生缺陷组母亲孕期患感冒（34．3％）、发热（13．1％）及服用药物（33．8％）的发生率高于对照组（分别为13．5％、1．5％及9．9％），两组比较，差异有统计学意义（P〈0．01）。出生缺陷组母亲孕期有不良精神因素刺激的发生率（11．3％）高于对照组（1．4％），两组比较，差异有统计学意义（P〈0．01）。（5）出生缺陷组中有家族遗传病史者有19例（2．9％，19／648），对照组中无。两组比较，差异有统计学意义（P〈0．01）。出生缺陷组中母亲有异常生育史者有89例（13．7％，89／648），对照组有31例（4．8％，31／650）。两组比较，差异有统计学意义（P〈0．01）。（6）多因素条件logistic回归分析显示，母亲孕期接触有害化学物质（OR=13．46）、孕期患病（OR=3．37）、孕期服药（OR=2．20）、不良精神因素刺激（OR：5．44）、孕期挑食与偏食（OR=1．90）、孕期贫血（OR=1．52）、多胎（OR=4．40）及父亲饮酒（OR：1．55）是出生缺陷发生的主要危险因素，而孕期补充钙、铁等微量元素及营养素是保护性因素（OR=0．45）。结论（1）主要出生缺陷疾病依次是先天性心脏病、唇裂、多指（趾）、神经管畸形、先天性脑积水及肢体短缩。（2）母亲孕期接触有害化学物质、孕期患病、孕期服药、不良精神因素刺激、孕期挑食与偏食、孕期贫血、多胎及父亲饮酒是出生缺陷发生的主要危险因素；而孕期补充钙、铁等微量元素及营养素是保护性因素。（3）减少和控制孕期主要危险因素是预防出生缺陷的重要环节。
Objective To investigate the influence factors of birth defects. Methods The congenital malformational fetuses born from 13 week of gestation to 7 days after birth were selected as the study group between April 1st, 2009 and March 31st, 2010. The health born fetuses were set as control in the same period. Case-control and the three-level of monitor network of birth defects were used in the study in the participating 75 hospitals （Qingdao Women and Children＇s Medical Center, Affiliated Hospital of Medical College Qingdao University, Qingdao Municipal Hospital, etc. ）. The study and control group＇sparents were interviewed by an uniformed questionnaire which was designed specially with influence factors of birth defeets. Results （ 1 ） There are 466 congenital malformational fetuses in the total of 77 231 fetuses collected in 75 hospitals. The congenital malformational rate accounts for about 6. 034%. The top six defect diseases were congenital heart disease （ 112 cases）, total harelip （cleft lip; cleft lip with palate： 85 cases）, polydactyly （53 cases）, neural tube defects （38 cases）, congenital hydrocephalus （37 cases） and limb reduction defeet （27 cases） in turn, which amounts to 353 eases （54. 480/0 , 353/648）. （2） Their mother education level in the birth-defect group （25.6%） were significantly lower than that in control group （30. 0% , P 〈 0. 05 ）. （3） The rate of passive smoking, drinking, raising pets of the parents in birth-defect group were significantly higher than that in control group （P 〈 0. 05 ）. （4） The rate of exposure to harmful chemical and physical factors of mothers in birth defects group （13.9%0 and 20. 5%, respectively） was higher than that in control group （1.1% and 11.7%, respectively）, the difference between which were significant （P 〈0.01）. The rate of disease （34.3%）, fever （13.1%）, taking drugs （33.8%） in pregnancy period in birth defect group were higher than that in control group （ 13.5% , 1.5% and 9.9% , respectively） , the difference between whieh were significant （P 〈 0. 01 ）. The rate of bad moral irritation to the mother in pregnancy in birth defect group （ 11.3% ） was significantly higher than that in control group （ 1.4% , P 〈0. 01 ）. （5） There were 19 cases （2. 9% , 19/648） with family heredity medical history in birth defect group, but there were none in the control group, the difference between which were significant （P 〈0. 01 ）. There were 89 eases （13.7%, 89/648 ） with unusual birth history of their mothers in birth defect group, but there were 31 eases （4. 8% , 31/650） in control group, the difference between which were significant （P 〈 0. 01 ）. （6） Conditional Logistic Regression model was used for univalent and multivariate analysis. The results showed that main influence factors were identified as having important effect on birth defects, including mothers＇ exposure to harmful chemical factors （ OR = 13.46 ）, disease （ OR = 3.37 ）, taking drugs （ OR = 2. 20 ） , exposure to bad moral irritation （ OR = 5.44 ） , food-choosy （ OR = 1.90 ） , anemia （ OR = 1.52） in gestational period, polyembryony （ OR = 4.40）, father drinking （ OR = 1.55 ）. While it was protective factors to supplement microelements such as the calcium iron and nutrient, etc. in pregnancy period （OR = 0.45 ）. Conclusions First, the main birth defects were congenital heart disease, total harelip （cleft lip; cleft lip with palate） , polydaetyly, neural tube defects, congenital hydrocephalus and limb reduction defect in turn. Second, the main influence factors identified as having important effect on birth defects were mothers＇ exposure to harmful chemical factors, ill, taking drugs, exposure to bad moral irritation, food-choosy, anemia in gestational period, polyembryony, father drinking. But it is protective factors to supplement mieroelements such as the calcium iron and nutrient, etc. in pregnancy period. Finally, it is the important part to prevent the birth defects by reducing and controlling dangerous factors in pregnancy period.
出处
《中华妇产科杂志》
CAS
CSCD
北大核心
2011年第7期481-486,共6页
Chinese Journal of Obstetrics and Gynecology
关键词
先天畸形
病例对照研究
Congenital abnormalities
Case-eontrol studies
