出生缺陷与出生体重、胎龄的相关性

Correlations of Birth Defects With Birth Weight and Gestational Age

目的分析不同出生体重及胎龄围产儿的出生缺陷发生率,为进一步完善出生缺陷监测系统和降低出生缺陷发生率提供新的科学依据。方法对2003年10月1日至2015年9月30日西安市各级开设产科的医疗保健机构出生的孕28周~生后7 d所有围产儿进行出生缺陷监测并收集相关资料。结果2003至2015年共监测围产儿1236937例,其中出生缺陷儿10619例,出生缺陷发生率为8.59‰。2003至2015年西安市出生缺陷医院监测系统共收集出生体重<2500 g出生缺陷患儿3306例,出生孕周≥28周且<37周的出生缺陷患儿3473例,出生孕周≥42周的出生缺陷患儿共224例。2003至2015年低出生体重儿出生缺陷率显著高于正常体重儿(χ^(2)=37097.79,P<0.001)。2003至2015年早产儿(<37周)出生缺陷率显著高于正常产期儿(χ^(2)=24998.24,P<0.001),过期产儿出生缺陷率(≥42周)显著高于正常产期儿(χ^(2)=196.40,P<0.001)。低体重儿出生缺陷常见缺陷类型前5位依次是先天性脑积水、脊柱裂、先天性心脏病、无脑畸形、唇裂合并腭裂。正常体重儿出生缺陷出生结局以活产为主(占68.60%),而低体重儿出生缺陷出生结局以死胎为主(占54.72%),低体重儿出生缺陷与正常体重儿出生缺陷出生结局比较,差异有统计学意义(χ^(2)=647.59,P<0.001)。正常产期儿出生缺陷出生结局以活产为主(占77.38%),过期产儿出生缺陷出生结局以活产为主(占83.93%),而早产儿出生缺陷出生结局以死胎为主(占57.79%)。早产儿与正常产期儿出生缺陷出生结局比较,差异有统计学意义(χ^(2)=2025.08,P<0.001),早产儿与过期产儿出生缺陷出生结局比较,差异有统计学意义(χ^(2)=245.39,P<0.001),正常产期儿与过期产儿出生缺陷出生结局比较差异有统计学意义(χ^(2)=16.28,P=0.001)。结论早产儿、低出生体重儿及过期产儿出生缺陷发生率显著高于正常产期儿,低体重儿与正常体重儿、早产儿与正常产期儿、早产儿与过期产儿、正常产期儿与过期产儿出生缺陷出生结局比较,差异均有统计学意义。

Objective To analyze the incidence rate of birth defects in infants born at different gestational ages and birth weights,so as to provide a basis for improving the surveillance system and reducing the incidence of birth defects.Methods Data of all perinatal infants born at and after 28 weeks of gestation and within 7 days after delivery in all the hospitals with the obstetrical department from October 1,2003 to September 30,2015 were collected.Results From 2003 to 2015,1236937 perinatal infants were monitored,including 10619 with birth defects(incidence rate of 8.59‰).Among the infants with birth defects identified by the hospital surveillance system of birth defects in Xi’an during the study period,3306,3473,and 224 infants showed the birth weights less than 2500 g,the gestational age within the range of[28,37]weeks,and the gestation age≥42 weeks,respectively.The low birth weight infants showed higher incidence rate of birth defects than the normal birth weight infants(χ^(2)=37097.79,P<0.001).The premature infants(gestational age<37 weeks)and postterm infants(gestational age≥42 weeks)showed higher incidence rates of birth defects than infants born at normal gestational age(χ^(2)=24998.24,P<0.001;χ^(2)=196.40,P<0.001).The top five birth defects of low birth weight infants were congenital hydrocephalus,spina bifida,congenital heart disease,anencephaly,and cleft lip and cleft palate.The outcomes of birth defects in normal weight infants and low weight infants were mainly live births(68.60%)and stillbirths(54.72%),respectively,which showed a significant difference(χ^(2)=647.59,P<0.001).The main outcomes of birth defects in the infants born at normal gestation age,postterm infants,and premature infants were mainly live births(77.38%),live births(83.93%),and stillbirths(57.79%),respectively,which showed significant differences(premature infants vs.infants born at normal gestation age:χ^(2)=2025.08,P<0.001;premature infants vs.postterm infants:χ^(2)=245.39,P<0.001;infants born at normal gestation age vs.postterm infants:χ^(2)=16.28,P=0.001).Conclusions Premature infants,low birth weight infants,and postterm infants showed significantly higher incidence rate of birth defects than the infants born at normal gestation age.The outcomes of birth defects had significant differences between low birth weight infants and normal birth weight infants,between premature infants and infants born at normal gestation age,between premature infants and postterm infants,and between infants born at normal gestation age and postterm infants.