福建省出生缺陷特征与变化趋势研究
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摘要
目的:
分析1986年至2006年福建省围产儿出生缺陷的特征与变化趋势,探讨影响福建省主要出生缺陷的危险因素、评估其危险度以及分布特征,为出生缺陷的预防和干预提供科学指导。
方法:
收集福建省出生缺陷监测医院1986年至2006年出生或引产的孕28周至产后7天的围产儿资料。分析出生缺陷总发生率、特征别发生率、顺位和长期趋势。用卡方检验、t检验、多元回归分析和时间序列分析等统计学方法分析出生缺陷的发生特征、变化趋势和主要影响因素。用OR值及其95%的可信区间(CI)估计相对危险度。采用1∶1配对的病例对照研究,对1986年10月1日至1992年8月3日病例组和对照组的一般情况进行描述性分析,对危险因素进行单因素和多因素非条件logistic回归模型分析,计算各危险因素与出生缺陷发生的相对危险度(OR)及其95%的可信区间(CI)。采用交叉分析方法分析重要危险因素的交互联合作用。
结果:
1986年至2006年福建省总出生缺陷发生率呈现逐年升高的趋势(趋势χ2=5.708,P<0.05)。出生缺陷分布有明显的季节聚集性。城市农村出生缺陷的缺陷顺位不同,农村无脑儿、脊柱裂、外耳其他畸形、肢体短缩、先天性膈疝、脑积水、唇并腭裂、内翻足的危险性高于城市(P值均小于0.05,OR均大于1),而食道闭锁、膀胱外翻、先天性心脏病的危险性低于城市(P值小于0.05,OR小于1)。孕妇高龄是唐氏综合征的危险因素。多因素非条件logistic回归分析的结果显示,出生缺陷的主要危险因素按OR值排列依次为:孕期接触射线OR为22.9,(95% CI=2.798～186.676);孕期患病OR为16.5,(95% CI=8.051～34.004);孕期接触化学制剂危险度为15.0,(95% CI=4.661～48.512);孕期接触农药OR为12.7,(95% CI=3.330～48.086);孕期接触抗生素的OR为11.4,(95% CI=2.187～2.905);孕期吸烟OR为8.2,(95% CI=5.783～11.665);孕期接触中草药危险度为4.8,(95% CI=3.196～7.299);孕期发热OR为4.0,(95% CI=2.877～5.610);孕妇高龄OR为3.4,(95% CI=1.149～10.001);孕期接触噪音OR为3.7,(95% CI=2.777～4.995);孕期饮酒OR为2.6,(95% CI=1.779～3.822);孕妇低文化程度OR为2.2,(95% CI=1.086～4.331);受孕季节OR为1.7,(95% CI=1.147～2.432);既吸烟又饮酒的孕妇,其胎儿出生缺陷OR为34.6,(95% CI=25.528～46.789),吸烟和饮酒存在交互与联合作用,二者共同作用加大了出生缺陷的危险。
结论:
福建省出生缺陷发生率呈上升趋势。影响福建省主要出生缺陷的危险因素为:孕期接触射线、孕期患病、孕期接触化学制剂、孕期接触农药、孕期接触抗生素、孕期吸烟、孕期接触中草药、孕期发热,孕妇年龄、孕期接触噪音、孕期饮酒,孕妇文化程度,受孕季度等。减少出生缺陷儿发生的可行措施主要有:避免孕期患病、戒烟戒酒、孕期远离化学品及有害职业暴露、避免射线和噪音接触。提高孕妇文化程度。加大宣传力度,普及预防出生缺陷的知识,做好出生缺陷的三级预防。
Objective
To analyze the variational tendency of birth defect from 1986 to 2006 in Fujian,China. Furthermore to explore the possible risks, which were evaluated in company with its distribution characteristic subsequently.And provide some scientific guidelines for the prevention and intervention of birth defect.
Methods
Data from 1986 to 2006 were collected via Fujian Birth Defect (BD) Monitoring Network―a hospital that based on planning congenital anomalies registry system as a whole. During that period all lives or stillbirth with 28 weeks or more of gestation were assessed within 7 days after delivery. The overall rates of general incidence and typical incidence, ranking and long-term trend were evaluated. By using Chi-square test,t-test, biological regression and time series analysis, ,odds ratio and 95% confidence interval, A 1:1 matched case control study was designed to be described and evaluated from October 1,1986 to August 3,1992. By means of simple and multivariable conditional logistic regression, the odds ratio and 95% confidence interval were computed. Moreover, the interaction for the important risk factors was analyzed.
Results
The overall prevalence rates of birth defect were rising yearly( Linear-by-Linear Associationχ2=5.708,P<0.05) The incidence of birth defect is varied in different seasons and especially higher in summer.There were different BD orders in rural and urban. The BD risk of anencephalus, cleft spine, deformity of external-ear, limbs decurtation, congenital diaphragmatic, hernia, hydrocephaly ,cleft and varus were higher in rural than that in urban (P<0.05,OR>1), which holds the higher risk of gullet-clausura, bladder exstrophy, congenital cardiopathy .
The results of multivariable non-conditional logistic regression showed that birth defect was mostly caused by the exposure to ray,exposure to chemicals,exposure to pesticide,exposure to antibiotic,exposure to smoking,exposure to Chinese herbal medicine,by being abnormal in the duration of pregnancy, which including having a fever or any diseases, drinking, smoking, in touch with chemicals, antibiotic, by women’s age that beyond 35, and also by their low education background. the season of androlepsis,Respectively OR and 95% confidential interzone (CI) were:22.9,(95% CI=2.798～186.676);16.5,(95% CI=8.051～34.004); 15.0,(95% CI=4.661～48.5120);12.7,(95% CI=3.330～48.086);11.4, (95% CI=2.187～2.905);8.220,(95% CI=5.783～11.665); 4.830,(95% CI=3.196～7.299);4.017,(95% CI=2.877～5.610); 3.390,(95% CI=1.149～10.001);3.724,(95% CI=2.777～4.995); 2.607,(95% CI=1.779～3.822); 1.670,(95% CI=1.147～2.432).
As a result, interactions were found between smoking and drinking. (OR=34.560,95% CI=25.528～46.789),
Conclusion
From 1986 to 2006, the prevalence rate of congenital anomalies is increasing gradually in Fujian ,China. The main risk factors of birth defect are the season of androlepsis, abnormal in the duration of pregnancy, high women’s age aged 35 or over, and women with low education level.In order to decrease the rate of birth defect, serveral efficient and feasible ways can be fetched out as follows: raising resistance of illness, abstinence, away from poisonous chemicals, noise and ray , adjusting the occupation before pregnancy, accepting education, enlarging health education, making the knowledge of birth defect wild-spread and executing the three-stage protection against birth defect.
分析1986年至2006年福建省围产儿出生缺陷的特征与变化趋势,探讨影响福建省主要出生缺陷的危险因素、评估其危险度以及分布特征,为出生缺陷的预防和干预提供科学指导。
方法:
收集福建省出生缺陷监测医院1986年至2006年出生或引产的孕28周至产后7天的围产儿资料。分析出生缺陷总发生率、特征别发生率、顺位和长期趋势。用卡方检验、t检验、多元回归分析和时间序列分析等统计学方法分析出生缺陷的发生特征、变化趋势和主要影响因素。用OR值及其95%的可信区间(CI)估计相对危险度。采用1∶1配对的病例对照研究,对1986年10月1日至1992年8月3日病例组和对照组的一般情况进行描述性分析,对危险因素进行单因素和多因素非条件logistic回归模型分析,计算各危险因素与出生缺陷发生的相对危险度(OR)及其95%的可信区间(CI)。采用交叉分析方法分析重要危险因素的交互联合作用。
结果:
1986年至2006年福建省总出生缺陷发生率呈现逐年升高的趋势(趋势χ2=5.708,P<0.05)。出生缺陷分布有明显的季节聚集性。城市农村出生缺陷的缺陷顺位不同,农村无脑儿、脊柱裂、外耳其他畸形、肢体短缩、先天性膈疝、脑积水、唇并腭裂、内翻足的危险性高于城市(P值均小于0.05,OR均大于1),而食道闭锁、膀胱外翻、先天性心脏病的危险性低于城市(P值小于0.05,OR小于1)。孕妇高龄是唐氏综合征的危险因素。多因素非条件logistic回归分析的结果显示,出生缺陷的主要危险因素按OR值排列依次为:孕期接触射线OR为22.9,(95% CI=2.798～186.676);孕期患病OR为16.5,(95% CI=8.051～34.004);孕期接触化学制剂危险度为15.0,(95% CI=4.661～48.512);孕期接触农药OR为12.7,(95% CI=3.330～48.086);孕期接触抗生素的OR为11.4,(95% CI=2.187～2.905);孕期吸烟OR为8.2,(95% CI=5.783～11.665);孕期接触中草药危险度为4.8,(95% CI=3.196～7.299);孕期发热OR为4.0,(95% CI=2.877～5.610);孕妇高龄OR为3.4,(95% CI=1.149～10.001);孕期接触噪音OR为3.7,(95% CI=2.777～4.995);孕期饮酒OR为2.6,(95% CI=1.779～3.822);孕妇低文化程度OR为2.2,(95% CI=1.086～4.331);受孕季节OR为1.7,(95% CI=1.147～2.432);既吸烟又饮酒的孕妇,其胎儿出生缺陷OR为34.6,(95% CI=25.528～46.789),吸烟和饮酒存在交互与联合作用,二者共同作用加大了出生缺陷的危险。
结论:
福建省出生缺陷发生率呈上升趋势。影响福建省主要出生缺陷的危险因素为:孕期接触射线、孕期患病、孕期接触化学制剂、孕期接触农药、孕期接触抗生素、孕期吸烟、孕期接触中草药、孕期发热,孕妇年龄、孕期接触噪音、孕期饮酒,孕妇文化程度,受孕季度等。减少出生缺陷儿发生的可行措施主要有:避免孕期患病、戒烟戒酒、孕期远离化学品及有害职业暴露、避免射线和噪音接触。提高孕妇文化程度。加大宣传力度,普及预防出生缺陷的知识,做好出生缺陷的三级预防。
Objective
To analyze the variational tendency of birth defect from 1986 to 2006 in Fujian,China. Furthermore to explore the possible risks, which were evaluated in company with its distribution characteristic subsequently.And provide some scientific guidelines for the prevention and intervention of birth defect.
Methods
Data from 1986 to 2006 were collected via Fujian Birth Defect (BD) Monitoring Network―a hospital that based on planning congenital anomalies registry system as a whole. During that period all lives or stillbirth with 28 weeks or more of gestation were assessed within 7 days after delivery. The overall rates of general incidence and typical incidence, ranking and long-term trend were evaluated. By using Chi-square test,t-test, biological regression and time series analysis, ,odds ratio and 95% confidence interval, A 1:1 matched case control study was designed to be described and evaluated from October 1,1986 to August 3,1992. By means of simple and multivariable conditional logistic regression, the odds ratio and 95% confidence interval were computed. Moreover, the interaction for the important risk factors was analyzed.
Results
The overall prevalence rates of birth defect were rising yearly( Linear-by-Linear Associationχ2=5.708,P<0.05) The incidence of birth defect is varied in different seasons and especially higher in summer.There were different BD orders in rural and urban. The BD risk of anencephalus, cleft spine, deformity of external-ear, limbs decurtation, congenital diaphragmatic, hernia, hydrocephaly ,cleft and varus were higher in rural than that in urban (P<0.05,OR>1), which holds the higher risk of gullet-clausura, bladder exstrophy, congenital cardiopathy .
The results of multivariable non-conditional logistic regression showed that birth defect was mostly caused by the exposure to ray,exposure to chemicals,exposure to pesticide,exposure to antibiotic,exposure to smoking,exposure to Chinese herbal medicine,by being abnormal in the duration of pregnancy, which including having a fever or any diseases, drinking, smoking, in touch with chemicals, antibiotic, by women’s age that beyond 35, and also by their low education background. the season of androlepsis,Respectively OR and 95% confidential interzone (CI) were:22.9,(95% CI=2.798～186.676);16.5,(95% CI=8.051～34.004); 15.0,(95% CI=4.661～48.5120);12.7,(95% CI=3.330～48.086);11.4, (95% CI=2.187～2.905);8.220,(95% CI=5.783～11.665); 4.830,(95% CI=3.196～7.299);4.017,(95% CI=2.877～5.610); 3.390,(95% CI=1.149～10.001);3.724,(95% CI=2.777～4.995); 2.607,(95% CI=1.779～3.822); 1.670,(95% CI=1.147～2.432).
As a result, interactions were found between smoking and drinking. (OR=34.560,95% CI=25.528～46.789),
Conclusion
From 1986 to 2006, the prevalence rate of congenital anomalies is increasing gradually in Fujian ,China. The main risk factors of birth defect are the season of androlepsis, abnormal in the duration of pregnancy, high women’s age aged 35 or over, and women with low education level.In order to decrease the rate of birth defect, serveral efficient and feasible ways can be fetched out as follows: raising resistance of illness, abstinence, away from poisonous chemicals, noise and ray , adjusting the occupation before pregnancy, accepting education, enlarging health education, making the knowledge of birth defect wild-spread and executing the three-stage protection against birth defect.
引文
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[1]Song X M,Zheng X Y,Zhu W L,et al.Relationship between polymorphism of crystathionine beta synthase gene and congenital heart diseases in Chinese nuclear families[J].Biomedical and Environmental Sciences,2006,19(6):452-456.
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[3]Toso L,Roberson R,Abebe D.Neuroprotective peptides prevent some alcohol-induced alteration in gamma-aminobutyric acid A-beta3,which plays a role in cleft lip and palate and learning in fetal alcohol syndrome[J].American Journal of Obstetrics and Gynecology,2007,196(3):259-265.
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[1]Song X M,Zheng X Y,Zhu W L,et al.Relationship between polymorphism of crystathionine beta synthase gene and congenital heart diseases in Chinese nuclear families[J].Biomedical and Environmental Sciences,2006,19(6):452-456.
[2]Finckenstein F G,Davicioni E,Osborn K G,et al.Transgenic mice expressing PAX3-FKHR have multiple defects in muscle development, including ectopic skeletal myogenesis in the developing neural tube[J].Transgenic Research,2006,15(5):595-614.
[3]Toso L,Roberson R,Abebe D.Neuroprotective peptides prevent some alcohol-induced alteration in gamma-aminobutyric acid A-beta3,which plays a role in cleft lip and palate and learning in fetal alcohol syndrome[J].American Journal of Obstetrics and Gynecology,2007,196(3):259-265.
[4] Edwards MJ .Rview:Hyperthermia and fever during pregnancy[J]. Birth defects research. Part A, Clinical and molecular teratology,2006,76,(7)507-16
[5]Watts D H,Li D,Handelsman E,et al.Assessment of birth defects according to maternal therapy among infants in the women and infants transmission study[J].Journal of Acquired Immune Deficiency Syndromes,2007,44(3):299-305.
[6]Berard A,Ramos E,Rey E,et al.First trimester exposure to paroxetine and risk of cardiac malformations in infants:The importance of dosage[J]. Birth defects research. Part B, Developmental and reproductive toxicology ,2007,80(11):8-27.
[7]Carmichael S L,Shaw G M,Laurent C,et al.Maternal progestin intake and risk of hypospadias[J].Archives of Pediatrics & Adolescent Medicine,2005,195(10):957-962.
[8]Brender J D,Zhan F B,Langlois P H,et al.Residential proximity to waste sites and industrial facilities and chromosomal anomalies in offspring[J].Int J Hyg Environ Health,2007,4(28):778-784.
[9]Singh N D,Sharma A K,Dwivedi P,et al.Citrinin and endosulfan induced teratogenic effects in Wistar rats[J].Journal of Applied Toxicology,2007,27(2):143-151.
[10] Banhidy F, Acs N, Horvath P E, et al. Maternal severe migraine and risk of congenital limb deficiencies[J].Birth Defects Research Part A Clinical and Molecular Teratology,2006,76(8):592-601.
[11]Costa C M,Da Gama S G,Leal M C.Congenital malformations in Rio de Janeiro,Brazil:Prevalence and associated factors[J].Cadernos Desaude Publica,2006,22(11):2423-2431.
[12]Honein M A,Rasmussen S A,Reefhuis J,et al.Maternal smoking and environmental tobacco smoke exposure and the risk of orofacial clefts[J]. Epidemiology,2007,18(2):226-233.
[13]Jensen M S,Toft G,Thulstrup A M,et al.Cryptorchidism according to maternal gestational smoking[J].Epidemiology,2007,218(3):238-348.
[14] Gareskog M;Eriksson UJ;Wentzel P ,Combined supplementation of folic acid and vitamin E diminishes diabetes-induced embryotoxicity in rats[J] Birth defects research. Part A, Clinical and molecular teratology,2006,76,(6),483-90.
[15]Neggers Y H,Singh J.Zinc supplementation to protein-deficient diet in CO-exposed mice decreased fetal mortality and malfor-mation[J]. Biological Trace Element Research,2006,114(1-3):269-279.
[16] Kooper AJ,de Bruijn D,van Ravenwaaij-Arts CM,et al.Fetal anomaly scan potentially will replace routine AFAFP assays for the detection of neural tube defects[J]. Prenatal diagnosis,2007,27(1)86-7.
[17]Christiansen M,Sorensen T L,Norgaard P B.Human placental lactogen is a first-trimester maternal serum marker of Down syndrome[J].PrenatalDiagnosis,2007,27(1):1-5.
[18]Kajbafzadeh A M,Moosavi S,Tajik P,et al.Intravesical injection of botulinum toxin type A:Management of neuropathic bladder and bowel dysfunction in children with myelomeningocele[J].Urology,2006,68(5):1091-1096.
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