西藏林芝地区胎儿先天性心脏病的危险因素分析

Study on Risk Factors of Congenital Heart Defects in Nyingchi of Tibet

目的:探究西藏林芝地区先天性心脏病(CHD)的发生情况及其相关危险因素的关系。方法:选择于2016年6月至2018年6月在林芝市人民医院产前检查和(或)分娩且为当地常住人口的2126例孕妇,孕中期常规进行胎儿CHD筛查及孕期危险因素的调查。经胎儿超声心动图诊断出胎儿心脏畸形病例纳入CHD组,将胎儿超声心动图检查结果正常的孕妇纳入对照组,所有胎儿出生后进一步检查以明确诊断。结果:CHD组纳入26例,产后均确诊为CHD;对照组纳入2100例,产后进行一般体检未见异常,心脏听诊未闻及杂音;CHD产前检出率1.22%。单因素分析结果显示,两组孕妇年龄、孕前体质量指数(BMI)、孕产史、孕前6个月至此次产前检查期间主动及被动吸烟史、孕早期补充叶酸及微量元素、孕期发热史及感染性疾病史、妊娠期合并糖尿病史比较,差异有统计学意义(P<0.05)。多因素分析结果显示,孕前超重(OR=13.60,95%CI5.04~36.66)及孕前肥胖(OR=67.33,95%CI16.03~282.78)、孕前6个月至此次产前检查期间主动与被动吸烟史(OR=4.02,95%CI1.59~10.17)、孕期发热史(OR=10.31,95%CI1.56~68.29)、妊娠合并糖尿病史(OR=15.88,95%CI3.90~64.63)是胎儿发生CHD的危险因素。结论:为降低先心病的发病及改善预后,应加强林芝地区孕妇的孕期保健知识宣教及孕期管理,及时进行有效产前检查。

Objective:To explore the incidence of congenital heart disease in Nyingchi of Tibet as well as its relationship with proposed risk factors.Methods:An epidemiological study was performed in Nyingchi People's Hospital between June 2016 to June 2018 including 2126 local pregnant women who went through antenatalcare and(or) delivery in this hospital.Regular screening for congenital heart defect was performed in second trimester as well as investigations of risk factors in pregnancy. Pregnant women were enrolled in CHD group if the fetus was diagnosed with congenital heart defect using fetal echocardiography. Other women were collected in control group with normal fetal echocardiographic results.Final diagnosis was confirmed after births.Results:There were 26 cases in the CHD group,which were all confirmed as CHD after births.2100 cases were enrolled in control group without abnormalitiesin postnatal screening or cardiac soufflé inheart auscultation.The prenatal detection rate of congenital heart defects was 1.22%.Univariate analysis showed that there were statistically significant differences in the maternal related factors including maternal age,maternal pre-pregnancy BMI,maternal passive or active smoking up to six months before pregnancy,previous obstetric history,maternal folate and micronutrient intake in the first trimester,the history of fever and infection disease as well as diabetes mellitus between the congenital heart defects group and the control group (P<0.05).Multivariate Logistic regression analysis found that maternal overweight(OR= 13.60,95%CI 5.04-36.66) and obesity( OR= 67.33,95%CI 16.03-282.78),maternal passive or active smoking up to six months before pregnancy(OR = 4.02,95%CI 1.59-10.17),the history of fever(OR= 10.31,95%CI 1.56-68.29) and diabetes mellitus complicating pregnancy( OR= 15.88,95%CI 3.90-64.63) were correlated with the occurrence of congenital heart defects.Conclusions:To reduce the incidence of congenital heart disease and improve prognosis,the healthy education about pregnancy care and maternal management should be strengthened,and prenatal screening should be conducted appropriately.