围孕期患病及心理状态与婴儿出生缺陷的关系

Association between illness and mental status in pregnant women and birth defects

目的 了解陕西省出生缺陷患病水平及其主要危险因素,分析母亲围孕期患病及其心理状态与出生缺陷患病的关系.方法 采用多阶段分层随机抽样方法调查陕西省30个区（县）2010年1月至2013年11月怀孕且明确结局的育龄妇女及婴幼儿.采用多阶段复杂抽样logistic回归分析孕期患病及心理状态和出生缺陷的关系.结果 陕西省出生缺陷患病率为195.04/万.在29121例调查对象中,围孕期患病者占51.1%,围孕期发生心理状态改变者占6.8%.控制混杂后,围孕期患感冒（OR=1.33,95%CI：1.10-1.61）、发热（OR=1.54,95%CI：1.09-2.16）、肝内胆汁淤积症（OR=32.77,95%CI：4.08-263.04）等疾病及存在情绪低落、烦躁易怒、焦虑等精神状态（OR=1.60,95%CI：1.19-2.15）及家庭关系不和（OR=2.07,95%CI：1.12-3.79）等心理因素与出生缺陷的发生有关.对各时期（孕前及孕早中晚期）患病分析发现：孕早期患感冒（OR=1.59,95%CI：1.28-1.98）、孕早期发热（OR=1.43,95%CI：1.48-4.00）、孕中期情绪不良（OR=1.52,95%CI：1.05-2.19）、孕晚期情绪不良（OR=1.63,95%CI：1.05-2.19）、孕晚期关系不和（OR=2.89,95%CI：1.16-7.20）与出生缺陷相关.对患病频率分析发现：4个时期只有1个时期患感冒（OR=1.24,95%CI：1.02-1.52）、有2个时期患感冒（OR=2.06,95%CI：1.30-3.26）、1个时期有发热（OR=1.49,95%CI：1.04-2.13）、1个时期存在情绪不良（OR=1.71,95%CI：1.19-2.45）、1个时期关系不和（OR=2.67,95%CI：1.32-5.39）与出生缺陷相关.结论 陕西省出生缺陷患病率处于较高水平,围孕期感冒、发热、情绪问题及关系不和可能增加出生缺陷的罹患风险.

Objective To understand the prevalence of birth defects, related diseases and mental status of women during pregnancy in Shaanxi province and to analyse the major risk factors on birth defects and congenital heart disease. Possible association between maternal diseases or mental status and the risk of birth defects, was also explored. Methods A cross-sectional design was used in this study and stratified multistage random sampling method was used. The whole survey was from Jury 2013 to November 2013. Logistic regression method was used to analyze the association between maternal diseases, mental status during pregnancy and birth defects. Results The overall prevalence of birth defects was 195.04 per 10000 in Shaanxi. Among the 29121 mothers participating in this study, 51.1% developed illness and 6.8%＂changed their mental status during pregnancy. After adjusting all the confounding factors, results showed that, histories of cold＂, fever, and intrahepatic cholestasis were （OR=1.33, 95%CI：1.10-1.61, OR=1.54, 95%CI：1.09-2.16, and OR=32.77, 95%CI：4.08-263.04） respectively, during pregnancy that related to birth defects. Self-reported unstable mental status （OR=1.60, 95%CI： 1.19-2.15） and family friction （OR=2.07, 95%CI： 1.12-3.79） were both related to the birth rates. Histories of cold and fever （OR=1.59, 95%CI：1.28-1.98;OR=1.43, 95%CI：1.48-4.00）, during early pregnancy, unstable mental status during mid-pregnant period （OR=1.52, 95%CI：1.05-2.19）, unstable mental status during late-pregnant period （OR=1.63, 95%CI：1.05-2.19） and family friction during late-pregnant period （OR=2.89, 95%CI：1.16-7.20） were found to be related to birth defects. Compared with those without history of cold, those with the history of cold during first （OR=1.24, 95%CI： 1.02-1.52） and second stages （OR=2.06, 95%CI： 1.30-3.26） of pregnancy were more likely to bear fetus with birth defects. Compared with those without these histories, those with histories of fever （OR=1.49, 95%CI：1.04-2.13）, emotional problem （OR=1.71, 95%CI：1.19-2.45） and related diseases （OR=2.67, 95%CI： 1.32-5.39） during the first period of pregnancy were more likely to bear fetus with birth defects. Conclusion The incidence of birth defects in Shaanxi was high. Histories of cold, fever, unstable mental status and family friction during pregnancy, seemed to have increased the risks of bearing child with birth defects.