亲代社会人口学特征和孕期因素对子代出生缺陷影响巢式病例对照研究

Effects of maternal socio-demographic and perinatal factors on birth defects:a nested case-control study

目的分析亲代社会人口学特征和孕期因素对子代出生缺陷发生的影响,以期为出生缺陷的早期干预提供科学依据。方法采用巢式病例对照研究设计,从2013—2014年在浙江省宁波市江北区早孕建卡的全部孕妇队列中,选取已分娩出生缺陷儿的全部孕妇为病例,采用1:1配对原则,选取建卡前后不超过1周、孕期生活在同街道、在同级医院分娩同性别胎儿的孕妇为对照,随访时间从孕13周至生后2年,共获得病例组和对照组各230例,分析2组孕妇的社会人口学特征、生育史、孕期检查和分娩信息等各项数据的差异。结果单因素分析结果表明,母亲是外地户籍、文化水平低、年龄≥30岁、有不孕史、自然流产史和附件手术史、辅助受孕、孕早期体质指数(BMI)≥24 kg/m^2、有妊娠合并症和产科并发症的病例组比例显著高于对照组。多因素分析发现,母亲年龄≥30岁、先兆流产、妊高症、胎盘异常使子代出生缺陷发病风险增加到2.27、3.00、11.58、2.78倍。本地户籍为发病的保护因素。结论对于年龄≥30岁、妊娠期多种异常的孕母,应加强其子代发育的监测。

Objective To analyze effects of maternal socio-demographic factors and physical health during pregnant and puerperal period on birth defects of children and to provide evidences for early intervention of birth defects.Methods We conducted a nested case-control study from 2013 through 2014 among pregnant women registered for prenantal healthcare and their children in Jiangbei district of Ningbo city,Zhejiang province.All the pregnant women giving births to infants with birth defects at the birth or diagnosed during the 2-year follow-up were recruited as the cases(n=230);one control was matched to each of the cases by gender of the infant,the time of registry for prenantal healthcare(±one week),residing in a same residential district,hospitalized in medical institutions at same administrative level for the delivery.All the participants were followed up from 13-gestational week to 2-year after the delivery to collect relevant information.Paired t and chi-square test and binary logistic regression analysis were adopted in data analysis with SPSS 22.0.Results Univariate analysis demonstrated that the cases had significantly higher ratios of nonlocal census register,low education,aged≥30 years,infertility/spontaneous abortion and adnexal surgery history,assisted reproduction,and body mass index>24 kg/m2 at early pregnancy compared to the controls.Muntlivariate analysis revealed significantly increased risk of infants'birth defects for the pregnant women aged≥30 years(odds ratio[OR]=2.27),having threatened abortion(OR=3.11),with pregnancyinduced hypertension(OR=11.58),and with placental abnormality(OR=2.78);while,with local census register was a protective factor against birth defects among the pregnant women.Conclusion Monitoring on fetus development should be strengthened among the pregnant women aged 30 years and above and with various pregnancy-related abmormalities.