胎儿先天畸形孕产妇高危因素分析

Analysis of the medical records and related factors in 558 pregnant and maternal women with congenital malformation fetuses

目的:探讨胎儿先天畸形发生的一般情况,并探讨其危险因素。方法:分析2014—2015年在复旦大学附属妇产科医院黄浦院区建卡就诊且发现胎儿先天畸形的558例孕产妇临床资料,并随机抽取该院同期560例正常孕产妇作为对照。采用单因素、多因素非条件logistic回归法分析胎儿先天畸形相关的危险因素。结果:558例胎儿先天畸形中,单系统畸形397例,多系统畸形161例;其中,多系统畸形以骨骼系统、心血管系统、神经系统和泌尿系统畸形的构成比最高。胎儿先天畸形主要危险因素是文化程度低(OR=2.355)、孕妇年龄≥35岁(OR=13.945)、多产次(OR=5.264)、异常生育史(OR=23.491)、情绪紧张抑郁(OR=6.929)、被动吸烟(OR=3.162)、饲养宠物(OR=3.840)、噪音环境(OR=2.485)、孕期接触化学制剂(OR=3.053)、孕期发热(OR=4.414)、孕期病毒感染(OR=6.603)、孕期服用药物(OR=4.228)及孕期贫血(OR=26.402),而孕期补充叶酸(OR=0.056)、钙和铁等微量元素(OR=0.115)是其保护性因素。结论:应通过减少与控制孕期主要危险因素,提高临床产前优生咨询、筛查诊断和综合评估的水平等一系列措施来降低胎儿先天畸形的发生率。

Objective：To explore the general situation of fetal congenital malformations, and to investigate their risk factors.Methods：The clinical data of 558 pregnant and maternal women with congenital malformation fetuses in Huangpu Branch of Obstetrics and Gynecology Hospital Affiliated to Fudan University in 2014-2015 were descriptively analyzed, while 560 pregnant women who had delivered normal newborns were randomly selected into the control group.The univariate and multivariate unconditional logistic regression models were used to analyze the risk factors of fetal congenital malformations.Results：Of the 558 cases of congenital malformations, 397 cases were single system abnormality, and 161 cases were multi-system abnormality.The incidence of multiple malformation, skeletal system malformation, cardiovascular system malformation, nervous system malformation and urinary tract system malformation were among the highest.The main risk factors of congenital malformations were educational level （OR=2.355）, maternal age ≥35 years （OR=13.945）, pluriparity （OR=5.264）, abnormal reproductive history （OR=23.491）, mother＇s emotion being nervous and melancholy （OR=6.929）, passive smoking （OR=3.162）, raising pets （OR=3.840）, exposure to noise （OR=2.485）, harmful chemical exposure （OR=5.700）, pregnancy fever （OR=4.414）, early viral infection （OR=6.603）, taking drugs （OR=4.228）, and anemia in gestational period （OR=26.402）.The protective factors were folic acid （OR=0.056）, calcium and iron （OR=0.115） supplements.Conclusions：The prevention of congenital malformations would be realized by reducing and controlling the dangerous factors in pregnancy, while improving eugenic counseling, screening, diagnosis and comprehensive evaluation.