小儿脑性瘫痪母亲妊娠期危险因素的Meta分析

Meta-analysis of risk factors for childhood cerebral palsy during pregnancy

目的探讨小儿脑性瘫痪母亲妊娠期的主要危险因素,为今后防治工作提供依据。方法以"小儿脑性瘫痪""妊娠期""危险因素"和"病例对照"等为检索词,收集1998～2011年关于小儿脑性瘫痪发病危险因素的研究文献,应用Meta分析的固定效应模型及Dersimonion-Laird随机效应模型,综合定量评价小儿脑瘫妊娠期相关危险因素的作用。结果共18篇文献纳入研究,累计病例11050例,对照15941例。小儿脑瘫妊娠期危险因素的多因素分析结果如下:孕母高龄(≥35岁)(OR=4.172,95%CI:1.670～10.426,P<0.05)、多胎妊娠(OR=8.402,95%CI:2.386～29.584,P<0.05)、母孕早期用药(OR=3.974,95%CI:2.217～7.123,P<0.05)、有害环境(OR=3.299,95%CI:1.058～10.289,P<0.05)、孕母反复阴道流血(OR=4.736,95%CI:1.792～12.517,P<0.05)、孕期感染性疾病(OR=1.238,95%CI:0.284～5.395,P>0.05)、妊娠高血压综合征(OR=4.096,95%CI:2.246～7.469,P<0.05)、进食肉类(OR=1.436,95%CI:0.382～5.393,P>0.05)、父亲吸烟(OR=2.376,95%CI:0.801～7.049,P>0.05)。结论孕母高龄(≥35岁)、多胎妊娠、母孕早期用药、有害环境、孕母反复阴道流血、妊娠高血压综合征是小儿脑性瘫痪发病的母亲妊娠期主要危险因素。

Objective To investigate major risk factors for childhood cerebral palsy （CP） during pregnancy and to provide evidence for the prevention of CP. Methods Using the search terms of ＂cerebral palsy＂, ＂pregnancy＂, ＂risk factor＂, and ＂case-control＂, a search was performed to collect case-control studies on the risk factors for childhood CP from 1998 to 2011. The obtained data were subjected to meta-analysis using fixed effects model and Dersimonion-Laird random effects model to quantitatively evaluate risk factors for childhood CP during pregnancy. Results Eighteen studies involving 11050 cases and 15941 controls were collected. The results of the multivariate analysis for risk factors of childhood CP during pregnancy were as follows： maternal age （ I〉35 years） （ OR = 4. 172, 95% CI = 1. 670-10. 426, P 〈 0.05） , multiple pregnancy （ OR = 8. 402, 95% CI = 2. 386 - 29. 584, P 〈 0.05 ）, medicine use in early pregnancy （ OR = 3.974, 95% CI = 2. 217 - 7. 123, P 〈 0.05）, harmful environment （ OR = 3. 299, 95% CI = 1. 058 - 10. 289, P 〈 0.05 ）, recurrent vaginal bleeding during pregnancy （OR = 4. 736, 95% C1 = 1. 792 - 12. 517, P 〈 0.05） ,pregnancy infectious diseases （ OR = 1. 238,95%CI：0. 284 - 5. 395, P 〉 0. 05 ） , pregnancy induced hypertension （ OR = 4. 096,95% CI： 2. 246 - 7. 469, P 〈 0.05 ）, meat intake （ OR = 1. 436,95% CI：O. 382 - 5. 393 ,P 〉 0.05 ）, father smoking （ OR = 2. 376,95% CI： O. 801 - 7. 049 ,P 〉 0.05 ）. Conclusions The major risk factors for childhood CP during pregnancy include advanced maternal age （/〉35 years）, multiple pregnancy, medicine use in early pregnancy, harmful environment, recurrent vaginal bleeding during pregnancy and pregnancy-induced hypertension.