贵州黔南地区农村少数民族0～5岁儿童出生缺陷发生情况及其危险因素分析

Prevalence and influence factors of birth defects among minority children under five in southern Guizhou province, 2017–2018

目的了解贵州黔南地区农村少数民族0~5岁儿童出生缺陷发生情况及其危险因素,为采取相应干预措施提供参考依据。方法于2017年1月—2018年10月采用多阶段分层、随机、整群抽样方法在贵州黔南地区农村少数民族中抽取49 887名0~5岁儿童进行问卷调查、体格检查和实验室检查。结果贵州黔南地区农村少数民族49 887名0~5岁儿童中,出生缺陷发生941例,发生率为188.63/万,标化发生率为188.17/万。多因素非条件logistic回归分析结果显示,男性(OR=3.225,95%CI=1.271~4.776)、苗族(OR=3.653,95%CI=1.238~3.895)和毛南族(OR=4.856,95%CI=1.467~5.126)、分娩孕周<37周(OR=3.207,95%CI=1.108~3.783)、出生体重<2 500 g(OR=3.803,95%CI=1.356~4.935)、家庭人均年收入<5 000元(OR=2.935,95%CI=1.216~4.028)、依山而居(OR=2.864,95%CI=1.012~3.846)、母亲年龄<20岁(OR=3.274,95%CI=1.216~4.125)和≥35岁(OR=4.761,95%CI=1.334~5.628)、母亲文化程度小学及以下(OR=3.368,95%CI=1.264~4.265)、孕期接触有害物质(OR=3.225,95%CI=1.138~4.009)、孕期有不良情绪(OR=2.868,95%CI=1.217~3.139)、有出生缺陷家族史(OR=2.546,95%CI=1.207~3.118)、有吸毒史(OR=3.003,95%CI=1.141~3.971)、有药物服用史(OR=2.881,95%CI=1.214~3.597)、有妊娠合并症史(OR=2.932,95%CI=1.133~3.084)和有精神神经异常史(OR=3.071,95%CI=1.225~3.762)是贵州黔南地区农村少数民族0~5岁儿童出生缺陷发生的危险因素;婚前检查(OR=0.412,95%CI=0.245~0.821)、孕前检查(OR=0.642,95%CI=0.452~0.879)、孕期接受保健服务(OR=0.453,95%CI=0.302~0.732)和孕期服用叶酸(OR=0.487,95%CI=0.276~0.865)是贵州黔南地区农村少数民族0~5岁儿童出生缺陷发生的保护因素。结论贵州黔南地区农村少数民族0~5岁儿童出生缺陷患病率较高,应针对该地区0~5岁儿童出生缺陷患病的危险因素进行干预。

Objective To examine the prevalence and risk factors of birth defects among 0-5 years old children living in southern area of Guizhou province and to provide references for taking corresponding interventions.Methods A total of 49 887 minority rural children aged 0-5 years were randomly selected using stratified multistage cluster sampling from Qiannan prefecture in southern Guizhou province and surveyed with a face-to-face interview,physical examination,and laboratory test between January 2017 and October 2018.Results Totally 941 birth defects cases were diagnosed and the crude and standardized prevalence rate of birth defects were 188.63/10 000 and 188.17/10 000 among children surveyed.Unconditional multivariate logistic regression analysis revealed following risk factors for birth defects in the children:male gender(odds ratio[OR]=3.225,95%confidence interval[95%CI]:1.271-4.776),Miao nationality(OR=3.653,95%CI:1.238-3.895),Maonan nationality(OR=4.856,95%CI:1.467-5.126),with a gestational age<37 weeks at the delivery(OR=3.207,95%CI:1.108-3.783),birth weight<2 500 grams(OR=3.803,95%CI:1.356-4.935),per capita annual household income<5 000 RMB yuan(OR=2.935,95%CI:1.216-4.028),mountainous residential environment(OR=2.864,95%CI:1.012-3.846),maternal age<20 years(OR=3.274,95%CI:1.216-4.125),maternal age≥35 years(OR=4.761,95%CI:1.334-5.628),maternal education of primary school and below(OR=3.368,95%CI:1.264-4.265),exposure to harmful substances during pregnancy(OR=3.225,95%CI:1.138-4.009),maternal negative emotion during pregnancy(OR=2.868,95%CI:1.217-3.139),family history of birth defect(OR=2.546,95%CI:1.207-3.118),maternal history of drug abuse(OR=3.003,95%CI:1.141-3.971),maternal medication history(OR=2.881,95%CI:1.214-3.597),maternal pregnancy complication history(OR=2.932,95%CI:1.133-3.084),and maternal mental disorder history(OR=3.071,95%CI:1.225-3.762);the protective factors against birth defects resulted from the analysis were having premarital checkup(OR=0.412,95%CI:0.245-0.821),taking pre-pregnancy physical examination(OR=0.642,95%CI:0.452-0.879),receiving health care during pregnancy(OR=0.453,95%CI:0.302-0.732),and with folic acid supplementation during pregnancy(OR=0.487,95%CI:0.276-0.865),respectively.Conclusion The prevalence of birth defects is high among 0-5 years old minority rural children in southern Guizhou province and risk factor-specific interventions on birth defects should be carried out in the region.