安康市2017-2021年围产儿出生缺陷监测及先天性心脏病影响因素分析

Monitoring of birth defects and analysis of influencing factors of congenital heart disease in perinatal infants in Ankang from 2017 to 2021

摘要

目的 了解陕西省安康市近五年(2017-2021年)围产儿出生缺陷发生情况及变化趋势,分析围产儿发生先天性心脏病(CHD)的影响因素,为制定有效的出生缺陷防治策略提供科学依据。方法 依据陕西省妇幼健康信息系统中的有关数据,回顾性分析2017-2021年安康市各助产医疗机构围产儿出生缺陷资料.采用病例对照研究设计,选择孕满28周至出生后7天明确诊断为CHD的围产儿为病例组(200例),选择同期诊断为非CHD的出生缺陷儿为对照组(400例),以单因素分析和多因素Logistic回归分析CHD的影响因素。结果 2017-2021年共监测安康市围产儿126077例,其中发生出生缺陷1116例,出生缺陷总体发病率为88.52/万;围产儿出生缺陷发生的前5顺位为CHD(29.90/万)、多指(趾)(13.72/万)、唇腭裂(7.54/万)、外耳其他畸形(6.11/万)、马蹄内翻足(5.79/万).2017-2021年安康市出生缺陷发病率由63.89/万持续上升至131.96/万,2021年比2017年增长了约2.07倍,有显著的上升趋势(χ²_趋势=106.074,P<0.001);其中CHD发病率上升明显(χ²_趋势=81.109,P<0.001).2017-2021年监测的377例CHD出生缺陷围产儿中,动脉导管未闭、房间隔缺损、室间隔缺损、法洛四联症为4种最常见的CHD,依次占32.10%、24.14%、13.79%、9.02%;其中复合多种亚型的CHD(房间隔缺损+动脉导管未闭、房间隔缺损+室间隔缺损、房间隔缺损+肺动脉瓣狭窄)围产儿有12人,占3.18%.单因素分析显示,病例组与对照组围产儿胎龄及产妇围孕期的自然流产史和烟草暴露史的分布比较差异均有统计学意义(χ²值分别为13.187、5.280、12.927,P<0.05).多因素Logistic回归分析显示,非足月儿(胎龄<37周)(OR=1.834,95%CI:1.196~2.812)和产妇围孕期有烟草暴露史(OR=1.914,95%CI:1.081~3.387)均是围产儿发生CHD的危险因素(P<0.05)。结论 加强健康宣教,做好孕期保健,保障足月胎龄分娩,远离烟草等不良暴露,积极参与出生缺陷防控相关的惠民项目,其均是预防出生缺陷发生的有效策略.

Abstract

Objective To understand the incidence and change trends of birth defects among perinatal infants in Ankang city, Shaanxi Province, from 2017 to 2021, and analyze the influencing factors of congenital heart disease (CHD). This aims to provide a scientific basis for developing effective prevention and control strategies for birth defects. Methods Based on data from the Maternal and Child Health Information System of Shaanxi Province, a retrospective analysis was conducted on the data of perinatal infants with birth defects in Ankang City from 2017 to 2021 across various midwifery medical institutions. A case-control study design was adopted, and the perinatal infants diagnosed with CHD from 28 weeks of gestation to 7 days after birth were selected as the case group (200 cases), while infants diagnosed with non-CHD birth defects during the same period were selected as the control group (400 cases). Univariate analysis and multivariate Logistic regression analysis were used to analyze the influencing factors of CHD. Results From 2017 to 2021, a total of 126077 perinatal infants were monitored in Ankang City. Among them, there were 1,116 cases of birth defects, with an overall incidence rate of 88.52 per 10000. The top five birth defects among perinatal infants were CHD (29.90 per 10000), polydactyly (13.72 per 10000), cleft lip and palate (7.54 per 10000), other external ear anomalies (6.11 per 10000), and clubfoot (5.79 per 10000). From 2017 to 2021, the incidence rate of birth defects in Ankang City increased from 63.89 per 10000 to 131.96 per 10000. In 2021, it was approximately 2.07 times higher than that in 2017, showing a significant upward trend (χ ² _trend=106.074, P<0.001). Specifically, the incidence rate of CHD showed a significant increase (χ² _trend=81.109, P<0.001). Among the 377 cases of CHD birth defects monitored from 2017 to 2021, the most common types of CHD were patent ductus arteriosus, atrial septal defect, ventricular septal defect, and tetralogy of Fallot, accounting for 32.10%, 24.14%, 13.79%, and 9.02%, respectively. Additionally, there were 12 infants with complex CHD subtypes (atrial septal defect+patent ductus arteriosus, atrial septal defect+ventricular septal defect, atrial septal defect+pulmonary valve stenosis), accounting for 3.18%. Univariate analysis showed statistically significant differences in the distribution of gestational age and maternal history of spontaneous abortion and tobacco exposure between the case group and the control group (χ² values were 13.187, 5.280 and 12.927, respectively, all with P<0.05). Multivariate logistic regression analysis revealed that preterm birth (gestational age<37 weeks) (OR=1.834, 95%CI: 1.196, 2.812) and maternal history of tobacco exposure (OR=1.914, 95%CI: 1.081, 3.387) were both risk factors for CHD in perinatal infants (P<0.05). Conclusion Strengthening health education, improving pregnancy healthcare, staying away from tobacco and other adverse exposures, and actively participating in beneficial programs are all effective strategies for preventing the occurrence of birth defects.

关键词

围产儿 / 出生缺陷 / 先天性心脏病 / 病例对照研究 / 影响因素

Key words

perinatal infant / birth defect / congenital heart disease / case-control study / influencing factor

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基金资助

国家自然科学基金资助项目(72174167)