妇女围孕期特殊危险因素暴露对新生儿出生缺陷的影响
Association between birth defects and special risk exposures during peri-conception period

摘要：目的 探讨妇女围孕期特殊危险因素暴露对于新生儿出生缺陷的影响。方法 于2013 年7-12月采用分层多阶段随机抽样方法，以陕西省抽取2010-2013年期间曾经妊娠的15～49岁育龄妇女及其子女为调查对象，调查围孕期特殊危险因素暴露情况，采用Logistic回归模型分析这些危险因素与新生儿出生缺陷的关系。结果 本研究共纳入调查育龄妇女30010名，新生儿29550例，出生缺陷发生率为193.57/万。对妇女围孕期特殊危险因素分析发现，校正社会人口学等因素后，围孕期饮酒[OR=2.29，95% CI(1.22，4.29)]和被动吸烟[OR=1.25，95% CI(1.02，1.53)]是出生缺陷发生的危险因素，而在孕前3个月和孕后3个月服用药物[OR=1.64，95% CI(1.04，2.61)]，接触农药[OR=2.41，95% CI(1.09，5.35)]、生物危险因素[OR=1.64，95% CI(1.05，2.56)]、物理危险因素[OR=1.15，95% CI(1.13，2.34)]和化学危险因素[OR=2.36，95% CI(1.36，4.11)]显著增加新生儿出生缺陷的风险。进一步就不同类型药物对出生缺陷的影响分析发现，校正社会人口学因素及生活行为因素后，水杨酸类药物和镇咳药是新生儿出生缺陷的危险因素(P<0.05)。结论 妇女围孕期有被动吸烟和饮酒、孕前3个月至孕3个月暴露药物、生物和理化危险因素可增加其分娩新生儿出生缺陷的发生风险。
ABSTRACT: Objective?? To analyze the effect of special risk exposures during periconception period on birth defects of newborns. Methods?? From Jul. to Dec. 2013, the multi-stage stratified random sampling method was adopted. Women of childbearing age between 15 and 49 who were pregnant during 2010 to 2013 in Shaanxi Province were selected as study subjects for investigation on special risk factors exposed during periconception period. The Logistic regression model was adopted to analyze the association between newborns’ birth defects and special risk exposures. Results?? The study included 30010 women of childbearing age and 29550 newborns with 572 (193.57/10000) cases of birth defects. After adjusting for demographic factors, the risk factors for birth defects were drinking [OR=2.29, 95% CI (1.22, 4.29)] and passive smoking [OR=1.25, 95% CI (1.02, 1.53)] during periconception. There was a higher risk of birth defects when exposure to medicine [OR=1.64, 95% CI (1.04, 2.61)], pesticides [OR=2.41, 95% CI (1.09, 5.35)], biological risk factors [OR=1.64, 95% CI (1.05, 2.56)], physical risk factors [OR=1.15, 95% CI (1.13, 2.34)] and chemical risk factors [OR=2.36, 95% CI (1.36, 4.11)] 3 months both before and after pregnancy. Similarly, after adjusting for demographic factors and behaviors, we found that birth defects were related to antibiotics, salicylates, and antitussive, which could increase the risk of birth defects (P<0.05). Conclusion?? Exposure to passive smoking and drinking during periconception and exposure to medicines and pesticides, as well as biological, physical and chemical risk factors 3 months before and after pregnancy could increase the risk of birth defects in newborns