二胎政策下怀孕年龄及胎次变化对胎儿畸形患病率的影响

Analysis of the changes of pregnant age and parity under the two-child policy and investigation of the effects on prevalence rate of fetal malformation from the perspective of birth defects

目的从出生缺陷视角调查分析妇女怀孕年龄、胎次对胎儿畸形患病率的影响。方法回顾性分析成都医学院第一附院2012年1月~2013年10月妇产科4500个生育记录资料,依据全国出生缺陷监测方案统计胎儿畸形患病率及疾病种类,统计记录妇女年龄、胎次、居住地、患病、相关有害物质接触、婚检等情况,分析上述情况与胎儿畸形患病率的关系。结果 4500例妇女中年龄25~30岁者3712例,占82.49%,<19岁者7例,占0.16%;1胎妇女1765例,占39.22%,≥4胎465例,占10.33%。胎儿畸形患病572例(12.71%),其中最多为死胎(163例);年龄<19岁妇女胎儿畸形患病率最高,为71.43%(5/7),其次是36~45岁,占41.07%(35/56例),25~30岁患病率最低,为8.70%(323/3712例);妇女胎次≥4胎畸形患病率最高,为17.20%(80/465例)。不同居住地(城市与农村)、孕早期患病(感冒发烧与非感冒发烧)、有害物质接触(放射线、噪音接触与非放射线、正常环境接触)、婚产前检查(否与是)孕妇胎儿畸形患病率比较差异均有统计学意义(P<0.05)。结论孕妇年龄太小或太大,其胎儿畸形患病几率高,但胎次对胎儿畸形患病率影响相对复杂,受年龄段影响,由于孕妇年龄多在25~30岁,为此二胎政策下对我国人口质量影响不大。此外,胎儿畸形患病还与孕期婚产前检查、孕期患病、环境因素等有关。

Objective To analyze the effects of pregnant age and parity on the prevalence of fetal malformation from the perspective of birth defects. Methods 4500 birth records in our hospital between January 2012 and October 2013 in Department of Obstetrics and Gynecology were retrospectively analyzed. According to the national birth defect monitoring program, the prevalence rate of fetal malformation and the types of diseases were statistically analyzed. Women＇s age, parity, residence, history of disease, exposure of relevant harmful substances and premarital examination etc. were also statistically analyzed. The relationship between the above situations and the prevalence rate of fetal malformation was analyzed. Results Among 4500 women, there were 3712 cases who were 25 to 30 years old, accounting for 82.49%, 7 cases＜ 19 years old, accounting for 0.16%. Among 4500 women, 1765 cases had 1 child, accounting for 39.22%, and 465 cases had more than 4 children, accounting for 10.33%. There were 572 cases （12.71%） with fetal malformation, and the most were stillbirth （163 cases）. The prevalence rate of fetal malformation in women＜ 19 years old was the highest ［71.43% （5/7）］, followed by 36 ~ 45 years old ［41.07% （35/56）］. The prevalence rate of women who were 25 to 30 years old was the lowest ［8.70% （323/3712）］. The prevalence rate of fetal malformation in women who had ≥ 4 parity was the highest ［17.20% （80/465）］. The differences in prevalence rate of fetal malformation between different residences （urban and rural）, early pregnancy diseases （fever and non fever）, exposure of harmful substances （radiation, exposure to noise and non radiation, normal environmental exposure）, premarital and prenatal examination （or not） were significant （P＜0.05）. Conclusion The prevalence rate of fetal malformation in women who are too young or too old is high. However, the effects of parity on the prevalence rate are relatively complex. Affecting by age effects, since most pregnant women are 25 to 30 years old, the two-child policy has little effect on the quality of population. In addition, the prevalence of fetal malformation is also related to prenatal examination, pregnancy diseases, environmental factors and so on.