围孕期环境危险因素的暴露与常见结构性出生缺陷发生风险的关系

目的 探讨出生缺陷环境危险因素与结构性出生缺陷发生风险之间的关系.方法 采用成组病例对照研究方法.病例组为2002-2004年在无锡市各医院住院分娩的、出生缺陷监测在孕28周到出生后7天内发现的结构性出生缺陷胎(婴)儿,共388例;对照组为同期在无锡市各医院住院分娩的正常活产儿,共1607例.采用多因素logistic回归模型控制生育年龄、受教育程度等人口学因素的影响后,估计各类围孕期环境危险因素与结构性出生缺陷发生的关联强度.结果 在所研究的环境危险因素中,导致出生缺陷发生风险最高的是从事接触有毒有害物质工作,OR值(95%CI)为5.37(3.60～7.99);围孕期生殖道感染,孕早期发生持续24 h、38.5℃以上高热及服用安眠镇静药和抗惊厥剂等可疑致畸形药物均可显著增加结构性出生缺陷的发生风险,OR值(95%CI)分别为3.38(1.33～8.56)、3.57(1.73～7.37)和2.75(1.57～4.83),但怀孕前半年内口服避孕药与出生缺陷发生的关系无统计学意义;居住内环境污染、熬夜和养宠物导致出生缺陷的风险相对较低,OR值(95%CI)分别为2.28(1.75～2.98)、1.96(1.21～3.18)和2.50(1.66～3.76),但人群中的暴露比例相对较高;随着围孕期环境危险因素暴露数目的增加,出生缺陷的发生风险呈上升趋势,具有1、2及3种危险因素发生出生缺陷的相对危险度分别为1.60、4.32和10.23.结论 常见结构性出生缺陷的发生受到众多环境危险因素的影响,而且环境危险因素数目与结构性出生缺陷发生之间存在剂量-反应关系.

The relationships between exposure of periconceptional environmental risk factors and risks of common structural birth defects

OBJECTIVE: This paper is to explore the relationships between the occurrence of structural birth defects and environmental risk factors on birth defects. METHODS: A survey was conducted by using a population-based case control study. A total number of 388 structural birth defects, which were detected after 28 weeks' gestational age to 7th day after birth in various hospitals were recruited in Wuxi from 2002 to 2004. The control group consisted of 1607 normal live births born in the same period. Multiple logistic regression model was used to analyze relationships between environmental risk factors and occurrence of structural birth defects after controlling women's education level and childbearing age. RESULTS: Among those factors which affected birth defects, the exposure to toxic substances in working environment was the highest risk factor, with OR value as 5.37 (95 % CI : 3.60-7.99). Suffering from reproductive tract infections, high fever during first trimester gestation, and taking potential teratogenic drugs such as hypnotics and anti-convulsion drug agents, might significantly increase the risk of structural birth defects, with OR values (95% CI) as 3.38 (1.33-8.56), 3.57 (1.73-7.37) and 2.75 (1.57-4.83) respectively. However, the correlation between oral contraceptives intake within six months before pregnancy and risk of birth defects had no statistical significance. In addition, pollution of the residential environment, staying up all night and raising pets at home, had relatively lower association with birth defects, with OR values (95% CI) as 2.28 (1.75-2.98), 1.96 (1.21-3.18) and 2.50 (1.66-3.76) respectively, yet with a higher proportion of exposure to those factors in pregnant women. There was a significant increase in occurrence risks of birth defects with increase in the number of exposuse to environmental risk factors. OR values for having one, two, three kinds of environmental risk factors were 1.60, 4.32 and 10.23 respectively. CONCLUSION: The common structural birth defects were affected by a number of environmental risk factors. There was also a dose-response relationship between the number of environmental risk factors and occurrence risks of structural birth defects noticed in our study.