摘要
目的:探讨胎儿患不同类型先天性心脏病(CHD)孕妇孕前及孕早期的危险因素,旨为CHD出生缺陷干预提供科学依据。方法:病例组为2020年1月-2022年6月产前诊断为胎儿CHD的孕妇319例,对照组1:1配比检查结果正常的孕妇。采用调查表收集孕妇家庭基本信息及孕前及孕早期相关暴露因素的信息,分析不同类型CHD的影响因素。结果:211例简单CHD中最常见的类型是室间隔缺损,占50.7%,妊娠次数≥3(OR=1.567,95%CI 1.288~3.927)、孕期营养不良(OR=2.378,95%CI 1.182~5.721)是胎儿患简单CHD的危险因素。108例复杂CHD中主要的类型是法洛氏四联症(38.9%),孕妇高龄(OR=1.938,95%CI 1.077~3.627)、职业暴露(OR=5.199,95%CI 2.730~11.024)、围孕期吸烟饮酒(OR=3.539,95%CI 1.736~6.892)、TORCH等病原体感染(OR=2.178,95%CI 1.109~4.685)、动物接触史(OR=2.611,95%CI 1.278~5.821)是胎儿复杂CHD发病的危险因素,围孕期增补叶酸(OR=0.483,95%CI 0.307~0.935)是胎儿复杂CHD发病的保护因素。不良孕产史(OR=4.436,95%CI 1.192~12.027;OR=6.478,95%CI 1.782~15.789)、孕早期感冒(OR=4.878,95%CI 1.153~14.792;OR=4.101,95%CI 1.063~12.381)、孕早期服用药物(抗生素/解热镇痛药/精神神经病类药)(OR=2.281,95%CI 1.007~5.022;OR=1.732,95%CI 1.006~2.832)、负性生活事件(OR=2.578,95%CI 1.483~4.872;OR=3.087,95%CI 1.735~6.342)、孕妇生活环境不良(OR=1.729,95%CI 1.049~2.998;OR=2.421,95%CI 1.157~5.233)是胎儿简单CHD和复杂CHD发病危险因素。结论:针对孕妇CHD危险因素进行健康指导和教育,做好出生缺陷一级预防,对降低胎儿CHD、尤其是复杂CHD发生有重要意义。
Objective:To analyze the risk factors of women with different types of fetal congenital heart disease(CHD)before pregnancy or during the first trimester of pregnancy,so as to provide scientific basis for the intervention of birth defects of the fetal CHD.Methods:319pregnant women with prenatal diagnosis of fetal CHD were selected in case group,and the women with normal pregnancy after examination were selected in control group based on 1:1ratio from January 2019to June 2019.A questionnaire was used to collect the basic family information and the information on maternal exposure factors of the women in the two groups before pregnancy or during the first trimester of pregnancy.The influencing factors of different types of fetal CHD were analyzed.Results:The most common type of simple fetal CHD was ventricular septal defect(VSD),accounting for 50.7%.The pregnant number≥3times(OR=1.567,95%CI 1.288-3.927)and the malnutrition during pregnancy(OR=2.378,95%CI 1.182-5.721)of the women were the risk factors of their offspring with simple CHD.Among 108women with complex fetal CHD,the tetralogy of Fallot was the main type,accounting for 38.9%.The maternal age(OR=1.938,95%CI 1.077-3.627),the occupational exposure(OR=5.199,95%CI 2.730-11.024),the perinatal smoking and drinking(OR=3.539,95%CI1.736-6.892),the TORCH pathogens infections(OR=2.178,95%CI 1.109-4.685),and the exposure to animals(OR=2.611,95%CI 1.278-5.821)of the women were the risk factors for the development of the complex CHD of their offspring.The perinatal folic acid supplementation(OR=0.483,95%CI 0.307-0.935)of the women was a protective factor for their fetal complex CHD.The adverse pregnancy history(OR=4.436,95%CI 1.192-12.027,and OR=6.478,95%CI 1.782-15.789),the colds during the first trimester of pregnancy(OR=4.878,95%CI 1.153-14.792,and OR=4.101,95%CI 1.063-12.381),the drugs used during the first trimester of pregnancy(OR=2.281,95%CI 1.007-5.022,and OR=1.732,95%CI 1.006-2.832),the negative life events(OR=2.578,95%CI 1.483-4.872,and OR=3.087,95%CI 1.735?6.
作者
王蕾
杨娟
杨坡
王艳丽
张金玲
李豆豆
WANG Lei;YANG Juan;YANG Po;WANG Yanli;ZHANG Jinling;LI Doudou(Henan Institute of Reproduction Health Science and Technology,National Health Commission Key Laboratory of Birth Defects Prevention,Henan Key Laboratory of Population Defects Prevention,Zhengzhou,450052;The First Affiliated Hospital of Zhengzhou University;Maternal and Child Health Care Hospital of Henan Province)
出处
《中国计划生育学杂志》
2023年第9期2120-2126,共7页
Chinese Journal of Family Planning
基金
2020年河南省医学科技攻关联合共建项目(LHGJ20200258)
河南省生殖健康科学技术研究院基本科研费项目(JBKY2020004、JBKY2023012)。
关键词
胎儿先天性心脏病
危险因素
孕前
孕早期
Fetal congenital heart disease
Risk factors
Before pregnancy
First trimester of pregnancy
