北京市2007—2016年度出生缺陷儿母亲唐氏综合征产前血清学筛查服务利用情况及其影响因素

Utilization and its influencing factors of serological screening for Down′s syndrome among mothers having a fetus or newborn with congenital defect in Beijing: 2007 – 2016

目的了解北京市2007—2016年度出生缺陷儿母亲唐氏综合征产前血清学筛查服务利用情况及影响因素,为进一步提高唐氏综合征产前血清学筛查服务覆盖率,有效降低严重出生缺陷提供参考依据。方法收集北京市西城区、海淀区和怀柔区所有助产机构和儿科2006年10月1日—2016年9月30日通过医院出生缺陷监测系统上报的孕13周~出生后7 d 13800名出生缺陷儿母亲的监测资料,回顾性分析出生缺陷儿母亲唐氏综合征产前血清学筛查服务利用情况,并应用多因素非条件logistic回归模型分析相关影响因素。结果北京市2007—2016年度出生缺陷儿母亲唐氏综合征产前血清学筛查服务利用比例为74.42%,服务利用比例由2007—2008年度的65.94%上升至2013—2014年度的79.30%,此后回落至2015—2016年度的76.12%,总体呈上升趋势(Z=10.58,P<0.001);各年度本地户籍服务利用比例均高于外埠户籍服务利用比例,但差距不断缩小(Z=–12.10,P<0.001)。多因素非条件logistic回归分析结果显示,2011—2016年度、年龄≥25岁、文化程度初中及以上和月平均收入≥2000元的北京市出生缺陷儿母亲唐氏综合征产前血清学筛查服务利用比例较高,外埠户籍、产次≥1次、双胎和三胎的北京市出生缺陷儿母亲唐氏综合征产前血清学筛查服务利用比例较低。结论北京市2007—2016年度出生缺陷儿母亲唐氏综合征产前血清学筛查服务利用比例较高,本地户籍与外埠户籍服务利用差异不断缩小;年度、年龄、文化程度、月平均收入、户籍类型、产次和胎数是该地区出生缺陷儿母亲唐氏综合征产前血清学筛查服务利用情况的主要影响因素。

Objective To examine the utilization and influencing factors of serological screening for Down′s syndrome in mothers whose fetus or newborn diagnosed with congenital defect in Beijing from 2007 to 2016 for improving the coverage of serological screening and providing evidences to reduce serious birth defects effectively.Methods The data of the study were reported by midwifery institutions and pediatrics in two urban and one suburban district of Beijing city from October 1,2006 to September 30,2016 and extracted from hospital birth defect monitoring system.With the data collected,we conducted a retrospective analysis on utilization and its influencing factors of serological screening for Down′s syndrome among 13800 mothers having a fetus or newborns with congenital defect diagnosed from 13 genital weeks to 7 days after the birth.Multivariate unconditional logistic regression model was applied in data analyses.Results In the three regions of Beijing during the 10-year period,the overall proportion of the mothers utilizing serological screening for Down′s syndrome was 74.42%and the annual proportion increased from 65.94%in the surveillance year of 2007–2008 to 79.30%in 2013–2014 but then declined to 76.12%in 2015–2016,with a significant upward trend generally(Z=10.58,P<0.001).The mothers with local household registration had a higher proportion for utilizing the screening compared to those with household registration of other regions;while,the gap in the proportion between the two groups of the mother had been narrowed continuously(Z=–12.10,P<0.001).Multivariate unconditional logistic regression analysis demonstrated that the mothers having a delivery in surveillance year of 2011–2016,aged≥25 years,with an education of junior high school and above,and having an average monthly income of≥2000 RMB yuan were more likely to utilize the screening;whereas,the mothers without local household registration,with multiple parities,and having a pregnancy of twins or triplets were less likely to utilize the screening.Conclusion The utilization of serological screening service for Down′s syndrome in mothers having a fetus or newborn with congenital defect was high during 2007–2016 in Beijing city,and the deficit in the utilization for the mothers without local household registration was decreased during the period;the utilization is mainly influenced by the year of delivery,age,education,monthly income,type of household registration,parity,and multiple gestation among the mothers.