基于前瞻性队列研究先天畸形的危险因素及其对其他不良妊娠结局的影响

Risk factors of congenital malformations and its impacts on adverse pregnancy outcomes: A prospective cohort study

目的探讨影响先天畸形(congenital malformations,CMs)发生的危险因素,并评估其对其他不良妊娠结局(adverse pregnancy outcomes,APOs)的影响。方法应用前瞻性队列研究方法,对湖南省妇幼保健院生殖中心、产科、不孕症门诊和超声科2013年3月～2016年2月接受首次产前保健的孕妇及其配偶进行问卷调查。采用单因素和多因素Logistic回归法对CMs可能的危险因素进行筛选并评价其对其他APOs的影响。结果研究发现湖南省孕妇孕前非标准体重、有吸烟史、妊娠并发症史、妊娠糖尿病史、肝炎史、不孕症及采用辅助生殖技术受孕、孕期未服用叶酸、主被动吸烟、饮酒、饮食不均衡、高强度体力活动均增加子代CMs的风险。此外,配偶吸烟和进食槟榔史也增加子代CMs发病风险。CMs可能增加早产、极早产、低出生体重、极低出生体重和围产期死亡的发生风险。结论 CMs的危险因素有很多,掌握这些危险因素并给予有效的控制是预防CMs发生的重要环节,也是降低其他APOs发生率的重要环节。应该针对性的给予防范措施,从而降低CMs的发生,提高全人类的整体人口素质。

Objective To explore risk factors of congenital malformations(CMs)and to evaluate its impacts on adverse pregnancy outcomes(APOs).Methods A prospective cohort study was conducted among pregnant women who received the first antenatal care from March 2013 to February 2016 in the reproductive center,obstetrics clinics,infertility clinics and ultrasound department of Hunan Provincial Maternal and Child Health Hospital.Corresponding information from pregnant women and their spouses were collected.Univariate and multivariate Logistic regression were used to screen possible risk factors of CMs and evaluate the impacts of CMs on other APOs.Results The study showed that women had history of non-standard BMI,smoking,hepatitis,pregnancy-related complications,gestational diabetes mellitus,infertility and using assisted reproductive technology before pregnancy;had no folic acid taking,active and passive smoking,drinking,uneven diet,high intensity physical activity during pregnancy increased the risk of CMs in offspring.Furthermore,the history of spouse smoking and eating betel nut also increased the risk of CMs in offspring.CMs might increase the risk of preterm birth,very preterm birth,low birth weight,very low birth weight,and perinatal mortality.Conclusions There are many risk factors of CMs.Knowing these risk factors,and giving them optimal prevention strategies and effective intervention measures are important measures in preventing the occurrence of CMs and other APOs.