母亲围孕期用药与新生儿先天性心脏病关系的流行病学研究

Association between congenital heart disease and medication taken during pregnancy among women of childbearing age

目的探讨母亲围孕期用药与新生儿先天性心脏病的关系。方法采用横断面调查设计，于2013年8－11月运用多阶段分层随机抽样方法，以问卷调查方式收集2010－2013年陕西省怀孕结局明确的母亲及其子女的相关信息。采用多因素Poisson回归模型分析母亲围孕期用药和新生儿先天性心脏病的关系。结果共纳入研究对象28 680名，其中围孕期用药者占16.0%，先天性心脏病患病率为67.9/万。多因素Poisson回归分析结果显示，在控制了母亲的基本情况、药物过敏史、家族心脏病史和围孕期患病等因素后，母亲围孕期用药（RR=1.95，95%CI：1.42-2.68）、服用感冒药（RR=1.68，95%CI：1.07-2.64）、抗生素（RR=1.90，95%CI：1.25-2.90）、水杨酸类药物（RR=5.01，95%CI：1.84-13.64）及抗真菌药（RR=10.22，95%CI：3.25-32.19）与先天性先脏病的发生有关。孕早、中、晚期用药分析显示，孕早期使用感冒药（RR=1.90，95%CI：1.01-3.61）、抗生素（RR=2.18，95%CI：1.17-4.06）、水杨酸类药物（RR=6.07，95%CI：1.45-25.41）、抗真菌药（RR=21.01，95%CI：4.17-105.87）和其他药（RR=2.31，95%CI：1.19-4.47）是生育先天性心脏病患儿的危险因素。结论母亲孕早期使用感冒药、抗生素、水杨酸类药物、抗真菌药和其他药物会增加新生儿先天性心脏病的风险。

Objective To analyze the relationship between medication taken during pregnancy and congenital heart disease of the newborns.Methods A large cross-sectional survey was conducted between August and November 2013. A questionnaire survey was conducted among the childbearing aged women, selected through multistage stratified random sampling in Shaanxi from 2010 to 2013. All of the childbearing aged women under study were in pregnancy and with definite pregnancy outcomes. Multivariable Poisson regression was conducted for data analyses.Results A total of 28 680 cases were included in this study. The proportion of medication taken at any time during pregnancy was 16.0%, and the prevalence of congenital heart disease among the newborns was 67.9/10 000. After adjustment for factors as general demographic characteristic, history of heart disease and drug allergy and the situation of disease during pregnancy of these women, results from the multivariable Poisson regression showed that, factors as taking drugs （RR=1.95, 95%CI： 1.42- 2.68）, cold medicine （RR=1.68, 95%CI： 1.07-2.64）, antibiotics （RR=1.90, 95%CI： 1.25-2.90）, salicylates （RR=5.01, 95%CI： 1.84-13.64） and antifungal drugs （RR=10.22, 95%CI： 3.25-32.19） during pregnancy were all related to congenital heart disease, and with the history of taking cold medicine （RR=1.90, 95%CI： 1.01-3.61）, antibiotics （RR=2.18, 95%CI： 1.17-4.06）, salicylates （RR=6.07, 95%CI： 1.45-25.41）, antifungal drugs （RR=21.01, 95%CI： 4.17-105.87） and other drugs （RR=2.31, 95%CI： 1.19-4.47） during early pregnancy. These factors were with higher risks for congenital heart disease.Conclusion Women of childbearing age who took cold medicine, antibiotics, salicylic acid drugs, antifungal drugs and other drugs during early pregnancy would increase the risks related to congenital heart diseases.