目的 了解广西地区新生儿先天性心脏病(CHD)的临床特征及与母体孕期因素的关联,为制定CHD的预防策略提供依据。方法 采用1∶2配比的病例对照研究,选择2021年广西机构内出生并确诊为CHD的2 277例患儿作为病例组,匹配4 554例健康新生儿为对照组。收集和比较两组孕母的产检和分娩信息,采用单因素及多因素logistic回归分析CHD的危险因素。结果 病例组中最常见CHD类型为动脉导管未闭(34.34%),其次是房间隔缺损(14.27%)、室间隔缺损(11.73%)。病例组儿童出生体重(t=23.383)和出生身长(t=27.121)均低于对照组(P<0.001)。多因素logistics回归分析显示,母亲分娩年龄≥35岁(OR=1.21, 95%CI: 1.10~1.34)、分娩孕周＜37周(OR=3.09, 95%CI: 2.43~3.92)、新生儿出生体重＜2 500g(OR=2.73, 95%CI: 2.12~3.51)、孕产妇BMI≥28kg/m2(OR=2.69, 95%CI: 1.92~3.34)、孕期未服用叶酸(OR=2.23, 95%CI:1.96~2.55)、有不良孕产史(OR=2.95, 95%CI: 2.47~3.52)、多胎(OR=6.85, 95%CI: 4.49~10.47)和孕期贫血(OR=3.63, 95%CI: 2.99~4.41)是新生儿发生CHD的危险因素(P<0.01)。结论 广西地区新生儿CHD与多种母体孕期因素密切相关。应重点关注早产儿、低出生体重儿的心脏功能,并针对高龄、未服用叶酸、有不良孕产史、多胎、贫血的孕产妇做好孕期监测和干预,以降低CHD的发生风险。
Abstract
Objective To investigate the clinical characteristics of neonatal congenital heart disease (CHD) and its association with maternal factors during pregnancy in the Guangxi region, so as to provide evidence for developing CHD prevention strategies. Methods A 1∶2 matched case-control study was conducted. A total of 2 277 neonates diagnosed with CHD born in Guangxi maternity institutions in 2021 were selected as the case group, and 4 554 healthy neonates matched by gender and region served as the control group. Maternal antenatal and delivery information was collected for both groups. Univariate and multivariate logistic regression analysis were used to identify risk factors for CHD. Results The most common type of CHD in the case group was patent ductus arteriosus (34.34%), followed by atrial septal defect (14.27%) and ventricular septal defect (11.73%). Birth weight (t=23.383) and length (t=27.121) in the case group were significantly lower than those in the control group (P<0.001). Multivariate analysis revealed that maternal age at delivery ≥35 years (OR=1.21, 95%CI: 1.10 - 1.34), gestational age <37 weeks (OR=3.09, 95%CI: 2.43 - 3.92), neonatal birth weight <2 500g (OR=2.73, 95%CI: 2.12 - 3.51), pre-pregnancy BMI ≥ 28kg/m2 (OR=2.69, 95%CI: 1.92 - 3.34), no folic acid supplementation during pregnancy (OR=2.23, 95%CI: 1.96 - 2.55), history of adverse pregnancy (OR=2.95, 95%CI: 2.47 - 3.52), multiple pregnancy (OR=6.85, 95%CI: 4.49 - 10.47), and anemia during pregnancy (OR=3.63, 95%CI: 2.99 - 4.41) were independent risk factors for neonatal CHD(P<0.01). Conclusions Neonatal CHD in the Guangxi region is closely associated with various maternal factors during pregnancy. Enhanced perinatal monitoring and intervention for pregnant women of advanced age, those with multiple pregnancies, anemia, no folic acid supplementation, or a history of adverse pregnancy are crucial to reduce the risk of CHD.
关键词
先天性心脏病 /
孕期 /
新生儿 /
出生缺陷
Key words
congenital heart disease /
pregnancy /
newborns /
birth defect
{{custom_sec.title}}
{{custom_sec.title}}
{{custom_sec.content}}
参考文献
[1] 中国妇幼卫生事业发展报告(2011)[J].中国妇幼卫生杂志, 2012,3(2):49-58.
Report on the development of maternal and child health in China (2011)[J]. Chin J Eug Gene, 2012,3(2):49-58.(in Chinese)
[2] 姚莉琴,邹团标,张山山,等.1986—2014年中国出生缺陷发生率的变化趋势及地理分布[J].中国优生与遗传杂志,2020,28(3): 351-356.
Yao LQ, Zou TB, Zhang SS, et al. Trends and geographical distribution of birth defects in China from 1986 to 2014[J]. Chin J Eug Gene, 2020,28(3):351-356.(in Chinese)
[3] Deng L, Li Q, Cheng Z. Evaluating the global, regional, and national burden of congenital heart disease in infants younger than 1 year: A 1990—2021 systematic analysis for the GBD study 2021[J]. Front Pediatr, 2025, 13:1467914.
[4] Zhao L, Chen L, Yang T, et al. Birth prevalence of congenital heart disease in China, 1980—2019: A systematic review and Meta-analysis of 617 studies[J]. Eur J Epidemiol, 2020, 35(7):631-642.
[5] Lemieux A, Khalilipalandi S, Lauzon-Schnittka J, et al. Meta-analysis of risk factors for congenital heart disease: Part 2, maternal medication, reproductive technologies, and familial and fetal factors[J]. Can J Cardiol, 2024, 40(12):2496-2511.
[6] 强毅,齐学宏,邢旺,等.父母相关因素对甘肃省高海拔地区先天性心脏病患儿发病的影响[J].中国妇幼保健,2024,39(9): 1665-1669.
Qiang Y, Qi XH, Xing W, et al. Influence of parents-related factors on the incidence of congenital heart disease in children at high altitude in Gansu Province[J]. Maternal and Child Health Care of China, 2024,39(9): 1665-1669.(in Chinese)
[7] 赵华俊,裴磊磊,高显舜,等.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[J].中国妇幼健康研究,2024,35(5): 36-41.
Zhao HJ, Pei LL, Gao XS, et al. Monitoring of perinatal birth defects and analysis of influencing factors of congenital heart disease in Ankang City from 2017 to 2021[J]. Chinese Journal Woman and Child Health Research, 2024,35(5):36-41.(in Chinese)
[8] 张念,李红娜,王小丽.新疆部分地区新生儿先天性心脏病影响因素[J].中国儿童保健杂志,2024,32(12): 1369-1373.
Zhang N, Li HN, Wang XL. Influencing factors of congenital heart disease in newborns in some areas of Xinjiang[J]. Chin J Child Health, 2024,32(12): 1369-1373.(in Chinese)
[9] 许文婧,魏莉莉,王莹,等.我国围生儿先天性心脏病发病率的Meta分析[J].国际生殖健康/计划生育杂志,2020,39(4): 269-275.
Xu WJ, Wei LL, Wang Y, et al. A Meta-analysis of the incidence of congenital heart disease in perinatal infants in China[J]. Inter J Reproductive Health/Family Planning, 2020,39(4): 269-275.(in Chinese)
[10] Yuan Z, Zhang LZ, Li B, et al. Investigation of echocardiographic characteristics and predictors for persistent defects of patent foramen ovale or patent ductus arteriosus in Chinese newborns[J]. Biomed J, 2021,44(2):209-216.
[11] 刘金晶,章琴.荆州地区先天性心脏病新生儿出生情况及母体孕期影响因素分析[J].中国优生与遗传杂志,2020,28(10): 1244-1247.
Liu JJ, Zhang Q. Analysis of birth status of newborns with congenital heart disease and influencing factors of maternal pregnancy in Jingzhou[J]. Chin J Eug Gene, 2020,28(10): 1244-1247.(in Chinese)
[12] 朱颖杰,万立新,张雯艳,等.吉林地区儿童先天性心脏病影响因素的病例对照研究[J].中国儿童保健杂志, 2022,30(11): 1250-1253.
Zhu YJ, Wan LX, Zhang WY, et al. A case-control study on influencing factors of congenital heart disease in children in Jilin Province[J]. Chin J Child Health Care, 2022,30(11): 1250-1253.(in Chinese)
[13] 张素华,陈冬梅,徐晓燕,等.2019—2021年四川省成都市锦江区围产儿出生缺陷与母亲孕期高危因素的相关性研究[J].中国妇幼卫生杂志,2023,14(3):35-40.
Zhang SH, Chen DM, Xu XY, et al. Correlation between perinatal birth defects and maternal risk factors during pregnancy in Jinjiang District, Chengdu, Sichuan Province from 2019 to 2021[J]. Chinese Journal Maternal and Child Health, 2023,14(3): 35-40.(in Chinese)
[14] 卢凌亚,程薇,吕兰秋.宁波市2017—2021年儿童先心病流行特征和趋势研究[J].中国儿童保健杂志,2024,32(2): 202-207.
Lu LY, Cheng W, Lv LQ. Study on epidemic characteristics and trends of congenital heart disease in children from 2017 to 2021 in Ningbo City[J]. Chin J Child Health Care, 2024,32(2): 202-207.(in Chinese)
[15] 丁书培.新疆石河子地区先天性心脏病影响因素的病例对照研究[D].石河子:石河子大学,2023.
Ding SP. A case-control study on influencing factors of congenital heart disease in Shihezi district, Xinjiang[D].Shihezi: Shihezi University, 2023.(in Chinese)
[16] 姜迪,王丽雯,白晨晓,等.中国人群先天性心脏病发病母体因素的Meta分析[J].护理学杂志,2019,34(3):36-41.
Jiang D, Wang LW, Bai CX, et al. Meta-analysis of maternal factors in congenital heart disease in Chinese population[J]. J Nursing, 2019,34(3):36-41.(in Chinese)
[17] Ou Y, Mai J, Zhuang J, et al. Risk factors of different congenital heart defects in Guangdong, China[J]. Pediatr Res, 2016, 79(4):549-558.
[18] Persson M, Razaz N, Edstedt BA, et al. Maternal Overweight and Obesity and Risk of Congenital Heart Defects[J]. J Am Coll Cardiol, 2019,73(1):44-53.
[19] Nagasawa M, Ikehara S, Aochi Y, et al. Maternal diabetes and risk of offspring congenital heart diseases: The japan environment and children′s study[J]. Environ Health Prev Med, 2024,29:23.
[20] 李昭润,蒋泓,钱序.孕前体质量指数对妊娠期疾病及妊娠结局的影响[J].上海预防医学,2020,32(7): 545-553.
Li ZR, Jiang H, Qian X. Effect of preconception body mass index on pregnancy disease and pregnancy outcome[J]. Shanghai Preventive Medicine, 2020,32(7):545-553.(in Chinese)
[21] 张书勤,杨惠莲,戚继荣.青海省儿童先天性心脏病影响因素的调查研究[J].中华疾病控制杂志,2023,27(9): 1013-1018.
Zhang SQ, Yang HL, Qi JR. Investigation on influencing factors of congenital heart disease in children in Qinghai Province[J]. Chin J Dis Control Prevention, 2023,27(9):1013-1018.(in Chinese)
[22] 王蕾,杨娟,杨坡,等.胎儿患不同类型先天性心脏病孕妇孕前及孕早期的危险因素分析[J].中国计划生育学杂志,2023,31(9): 2120-2126.
Wang L, Yang J, Yang P, et al. Analysis of risk factors in pregnant women with different types of congenital heart disease before and during early pregnancy[J]. Chin J Family Planning, 2023,31(9):2120-2126.(in Chinese)
[23] 苏翠敏,张惠月,林利平,等.先天性心脏病非遗传性危险因素的病例对照研究[J].中国儿童保健杂志,2019,27(12): 1296-1299.
Su CM, Zhang HY, Lin LP, et al. A case-control study of non-hereditary risk factors for congenital heart disease[J]. Chin J Child Health Care, 2019,27(12):1296-1299.(in Chinese)
基金
广西壮族自治区卫生健康委西医类自筹经费科研课题(Z-A20220327)
PDF(572 KB)
