社区儿童的出生缺陷影响因素探讨

Risk factors for birth defects: A community-based child survey

目的:了解以社区为基础的出生缺陷发生水平和有关影响因素,为出生缺陷的预防和孕期保健提供依据。方法:采用多阶段分层整群抽样方法,从我国东、中、西部地区9个中等发达省份中各抽取1个国家人口计生委信息采集抽样县,每个县抽取2个乡镇,再从中各抽取2～4个居委(村),调查其中所有已婚育龄妇女≤9岁子女的出生缺陷发生及相关信息,通过单因素分析和多元logistic回归分析,探讨出生缺陷的影响因素。结果:调查对象共3958例,出生缺陷发生率为1.80%。单因素卡方检验发现母亲产龄、文化程度、流产史、孕期微量营养素补充、产检机构与出生缺陷发生有关(P<0.05)。多元logistic回归分析显示,产龄16～20岁(OR=2.53,95%CI:1.25～5.10)、有人工流产史(OR=3.32,95%CI:1.69～6.51)、吸烟(OR=3.34,95%CI:1.04～10.75)、孕期未补充微量元素(OR=1.84,95%CI:1.07～3.16)、在乡镇及以下机构产前检查(OR=1.70,95%CI:1.06～2.74)的母亲生育出生缺陷儿的危险较高。结论:出生缺陷预防干预应重点关注既往有人工流产史、低龄、吸烟孕妇对象,重视基层产前检查机构服务能力建设,提供优质孕期监测与营养保健咨询服务。

To explore the prevalence and risk factors for birth defects （BD） among children in 9 provinces of China. Methods： By using stratified, random cluster sampling methods, 17 townships and 36 rural villages and urban neighbourhood were sampled from 9 provinces of China. All married women aged between 20 - 49 years old were investigated and a questionnaire survey on birth defects of their children under 9 year - old was conducted. Chi - square test and multivariate logistic regression analysis were used to evaluate the association between BD and maternal risk factors. Results： There were 3 958 respondents, and the prevalence of BI） was 1.80%. Results of chi - square tests indicated that maternal age, education level, history of abortion, micro - nutrients supplementation during pregnancy, and hospital grade for pregnancy check - up were associated with the likelihood of BD （P 〈 0.05 ）. Logistic regression analysis showed that mothers aged 16 to 20 （OR = 2. 53, 95 % CI： 1.25 - 5.10）, those with a history of abortion （ OR = 3.32, 95 % CI： 1.69 - 6.51 ）, smoking during preg- nancy （ OR=3.34, 95% CI： 1.04 - 10.75 ）, without micro - nutrients supplementation during pregnancy （ OR = 1.84, 95% CI ： 1.07 - 3.16）, and performing pregnancy check - up at township hospital or below （ OR = 1.70, 95 % Cl： 1.06 - 2.74） were associated with significantly higher risks of BD. Conclusion： Women with a history of abortion, being pregnant at very young age, or having a habit of smoking should be the focus of BD prevention. It is helpful to enhance the service capability of pregnancy health check - up at primary maternity hospitals and provide high quality of antenatal examinations to decline the likelihood of BD.