孕早期环境因素与儿童先天性心脏病关系的病例-对照研究

目的 了解孕早期环境因素对儿童先天性心脏病(简称先心病)的影响,为防治先心病的发生提供科学依据.方法 选择2005年1-6月在中南大学湘雅一医院和湘雅二医院治疗的无先心病家族史的0～7岁湖南籍的汉族先心病患儿为病例,采用以医院为基础的1:1配对病例-对照研究方法,对先心病病例和对照的母亲进行问卷调查,对资料进行单因素分析和多因素条件Logistic回归分析.结果 多因素分析结果显示,摄入叶酸(OR=0.340,95%CI:0.178～0.649)、饮牛奶(OR=0.660,95%CI:0.460～0.947)、食用肉类(OR=0.771,95%CI:0.583～0.867)、妊娠反应(OR=0.457,95%CI:0.271～0.770)可预防先心病的发生;感染(OR=2.736,95%CI:1.462～5.121)、用药(OR=2.735,95%CI:1.483～5.044)、化学毒物接触(OR=2.764,95%CI:1.065～7.177)、重大精神刺激(OR=2.211,95%CI:1.022～4.782)是引起先心病发生的危险因素.结论 孕妇加强孕早期营养,保持良好的心态,避免感染、用药,防止化学毒物的接触,可预防儿童先心病的发生.

A Case-Control Study on the Relationship Between Environmental Risk Factors Exposed in Early Pregnancy and Congenital Heart Disease

Objective To understand the effect of environmental risk factors exposed in the first trimester of pregnancy on congenital heart disease, then provide scientific evidence for congenital heart disease prevention. Methods A hospital-based 1:1 matched case-control study was conducted. The risk factors were obtained by field investigation with standardized questionnaires. The data was dealt with single factor analysis and conditional Logistic regression using SPSS version 11.5. Results Folic acid(OR=0.340, 95%CI: 0.178-0.649), milk(OR=0.660, 95%CI: 0.460-0.947), meat(OR=0.771, 95%CI: 0.583-0.867) and nausea and vomiting of pregnancy(OR=0.457, 95%CI: 0.271-0.770)were significantly associated with congenital heart disease. Maternal infection(OR=2.736, 95%CI: 1.462-5.121), taking medicine(OR=2.735, 95%CI: 1.483-5.044), poisonous chemicals(OR=2.764, 95%CI: 1.065-7.177) and mental stress(OR=2.211, 95%CI: 1.022-4.782) were risk factors of congenital heart disease. Conclusion To prevent congenital heart diseases, pregnant women should take more nutriment, keep healthy state and avoid infecting, taking medicine and exposing chemical toxicants in the first trimester of pregnancy.