寒区军人子女出生缺陷的流行病学调查与影响因素分析

Epidemiological investigation and influencing factors of birth defects in military children in cold region

目的 分析寒区军人子女全孕期出生缺陷的发生情况,探讨其流行病学特征和影响因素。方法 采用病例对照研究,选取2017-2020年北部战区总医院分娩登记的所有军人胎儿1 883例(妊娠满12周至产后7 d,包括活产、死产及死胎、引产)为医院层面出生缺陷监测对象,选取沈阳及其周边部分驻地军人于2017-2020年分娩的胎儿2 198例(妊娠满12周以上,包括活产、死产及死胎、引产)为人群层面出生缺陷监测对象,通过填写《寒区军人子女出生缺陷流行病学调查表》收集数据,分析医院监测和人群监测下全孕期出生缺陷发生率、顺位及其影响因素。结果 (1)2017-2020年医院监测下寒区军人子女全孕期出生缺陷发生率为175.25/万(33/1 883),医院监测下寒区地方群众子女全孕期出生缺陷发生率为175.47/万(480/27 355),人群监测下寒区军人子女全孕期出生缺陷发生率为218.38/万(48/2 198)。(2)医院监测和人群监测下出生缺陷的前3顺位为外耳畸形、并指(趾)和/或多指(趾)、先天性心脏病。(3)出生缺陷儿母亲文化程度及牛奶摄入量≥500 mL/周比例均低于正常新生儿母亲(P<0.05)。双亲一方或双方存在雷达暴露、无线电波暴露和高电磁辐射暴露的缺陷儿出生率高于正常双亲(P<0.05)。多因素Logistic回归分析显示,母亲文化程度在大专及以下(OR=2.218)、双亲一方或双方有雷达暴露(OR=2.179)、无线电波暴露(OR=3.446)、高电磁辐射暴露(OR=2.687)是寒区军人子女发生出生缺陷的危险因素,母亲牛奶摄入量≥500 mL/周(OR=0.546)是保护性因素。结论 寒区军人子女全孕期出生缺陷发生率与本地地方群众基本相同,出生缺陷发生顺位前3位分别是外耳畸形、并指(趾)和/或多指(趾)、先天性心脏病。母亲文化程度低,双亲的雷达、无线电波和高电磁辐射暴露是寒区军人子女发生出生缺陷的危险因素。

Objective To analyze the incidence of birth defects during whole pregnancy in military children in cold region,and explore its epidemiological characteristics and influencing factors.Methods A case-control trial was conducted on 1 883 military fetuses(from 12 weeks of gestation to 7 d after birth,including live birth,stillbirth and odinopoeia) delivered in our hospital from January 2017 to December 2020,and they were selected for birth defect detection at hospital level.A total of 2 198 military fetuses(from 12 weeks of gestation,including live births,stillbirths,odinopoeia and children) delivered in Shenyang and its surrounding areas from January 2017 to December 2020 were selected for birth defect detection at population level.Data were collected by filling the Birth Defects Epidemiological Questionnaire for Military Children in Cold Region.The incidence,sequence and influencing factors of birth defects during whole pregnancy under hospital surveillance and population surveillance were analyzed.Results(1) From 2017 to 2020,the incidence of birth defects during whole pregnancy was 175.25/10 000(33/1 883) in military children in cold region under hospital surveillance,was 175.47/10 000(480/27 355) in local people in cold region under hospital surveillance,and was 218.38/10 000(48/2 198) in military children in cold region under population surveillance.(2) The top 3 birth defects in hospital surveillance and population surveillance were external ear malformation,syndactyly and/or polydactyly,and congenital heart disease.(3) Lower education level and proportion of milk intake ≥500 mL/week were observed in the mothers delivering infants with birth defects than those with normal neonates(P<0.05).Higher birth defects were also seen among one or both parents exposure to radar,radio wave and high electromagnetic radiation than the parents in normal environment(P<0.05).Multivariate logistic regression analysis showed that maternal education level of junior college or below(OR=2.218),one or both parents with radar exposure(OR=2.179),radio exposure(OR=3.446) and high electromagnetic radiation exposure(OR=2.687) were risk factors for birth defects,and maternal milk intake ≥500 mL/week(OR=0.546) was a protective factor.Conclusion The incidence of birth defects in military children in cold region is basically similar to that in local people.The top 3 birth defects are external ear malformation,syndactyly and/or polydactyly,and congenital heart disease.Low maternal education level,parents' exposure to radar,radio waves and high electromagnetic radiation are risk factors for birth defects in military children in cold region.