摘要
目的:探究南通部分地区新生儿先天性心脏病(congenital heart disease,CHD)母体妊娠环境的危险因素,从而科学预防新生儿CHD,以期达到降低南通地区CHD发病率并提高出生人口素质的目的。方法:采用回顾性病例对照研究方法,纳入2019年1月—2022年12月在南通海安、海门地区定期进行产检并于当地医院分娩的孕母,将经当地分娩机构“双指标”法筛查阳性,诊断为CHD的活产新生儿的孕母497例为病例组(CHD组),随机选取同一时期当地分娩经CHD筛查阴性,无CHD的新生儿的孕母400例作为对照组(健康组)。分别从社会人口学、生活环境、妊娠期疾病、妊娠期使用药物、生产过程方面对两组孕母进行比较,使用t检验、χ^(2)检验、ROC曲线和Logistic回归分析等方法探究分娩CHD新生儿的危险因素。结果:CHD组孕母的初次产检BMI显著高于健康组[(23.06±3.87)kg/m^(2) vs(22.43±3.55)kg/m^(2),P=0.01],将孕妇产前BMI与初次产检BMI进行差值计算,得出ΔBMI,CHD组孕母ΔBMI显著高于健康组,ROC曲线分析发现初次产检BMI和ΔBMI对胎儿是否发生心脏病的预测能力不佳(AUC=0.547、0.540,P=0.015、0.037)。两组孕母主动或被动吸烟、饮酒、养宠物的发生率差异有统计学意义(P<0.01),Logistic回归分析显示主动或被动吸烟、养宠物为胎儿心脏病的危险因素(P<0.01)。两组的妊娠期疾病史中,糖尿病、高血压、甲状腺疾病、带状疱疹、强烈精神刺激、感冒发热的发生率差异有统计学意义(P<0.01),Logistic回归分析发现糖尿病、高血压、甲状腺疾病、强烈精神刺激和感冒发热是导致胎儿心脏病的危险因素(P<0.01)。两组之间妊娠、流产及既往生产次数差异无统计学意义。两组孕母分娩相关因素的Logistic回归分析发现,严重孕吐、先兆流产、脐带绕颈、胎位不正、胎膜早破及羊水污染是胎儿心脏病的危险因素(P<0.01)。结论:新生儿CHD发病的相关危险因素包括孕母肥胖、主动或被动吸烟、养宠物、糖尿病、高血压、甲状腺疾病、强烈精神刺激、感冒发热等,妊娠过程中避免暴露于上述危险因素中将可能降低新生儿CHD发病率,补充铁剂、复合维生素、二十二碳六烯是降低新生儿CHD发病率的保护因素。
Objective:To investigate maternal pregnancy environmental risk factors of newborn congenital heart disease(CHD)in some areas of Nantong,with the goal of enabling scientifically informed prevention strategies to reduce the incidence of CHD and improve birth outcomes in the region.Methods:A retrospective case-control study was conducted involving pregnant women who received regular prenatal examinations and delivered in Haian and Haimen cities between January 2019 and December 2022.The case group(CHD group)consisted of 497 mothers whose live-born infants were diagnosed with CHD through positive screening using the“two-indicator”method at local delivery institutions.The control group(healthy group)included 400 mothers of infants who screened negative and were confirmed to be free of CHD during the same period,selected randomly.The two groups were compared across sociodemographic characteristics,living environments,pregnancy-related illnesses,medication use during pregnancy,and labor and delivery factors.Statistical analyses included t-tests,χ^(2) tests,ROC curve analysis,and Logistic regression to identify significant risk factors for CHD in newborns.Results:The CHD group had a significantly higher pre-pregnancy BMI at the first prenatal visit compared with the healthy group[(23.06±3.87)kg/m2 vs(22.43±3.55)kg/m2,P=0.01].The change in BMI(ΔBMI,calculated as the difference between pre-delivery BMI and BMI at the first prenatal visit)was also significantly higher in the CHD group than healthy group.However,ROC curve analysis showed that both initial BMI andΔBMI had limited predictive value for fetal CHD(AUC=0.547,0.540;P=0.015,0.037).Significant differences were found between the groups in terms of maternal exposure to active/passive smoking,alcohol consumption,and pet ownership(P<0.01).Logistic regression identified active/passive smoking and pet ownership as significant risk factors for fetal CHD(P<0.01).A history of gestational diseases,including diabetes,hypertension,thyroid disorders,herpes zoster,severe psychological stress,and common cold accompanied by fever,also differed significantly between the groups(P<0.01).Logistic regression analysis further identified diabetes,hypertension,thyroid disorders,severe psychological stress,and febrile illness as significant risk factors(P<0.01).No significant differences were observed in prior pregnancy,abortion,or delivery history.However,delivery-related factors such as severe vomiting during pregnancy,threatened miscarriage,cord around the neck,abnormal fetal position,premature rupture of membranes,and amniotic fluid contamination were significantly associated with increased CHD risk(P<0.01).Conclusions:Relative risk factors significantly associated with neonatal CHD include maternal obesity,exposure to active or passive smoking,pet ownership,diabetes,hypertension,thyroid disorders,intensive mental stimulation,and febrile illness during pregnancy.Avoidance of these risk factors may contribute to lowering the incidence of neonatal CHD.Furthermore,supplementation with iron,multivitamins,and docosahexaenoic acid appears to have a protective effect.
作者
王燕
杨立娟
韩莉
黄中伟
祁雷
WANG Yan;YANG Lijuan;HAN Li;HUANG Zhongwei;QI Lei(Haian Maternal and Child Health Care and Family Planning Service Center,Jiangsu 226600;Department of Emergency,Affiliated Hospital of Nantong University)
出处
《南通大学学报(医学版)》
2025年第3期280-285,共6页
Journal of Nantong University(Medical sciences)
基金
南通市妇幼健康专科联盟科研项目(TFM202103)。
关键词
先天性心脏病
新生儿
妊娠
危险因素
南通
congenital heart disease
newborn
pregnancy
risk factors
Nantong
