孕前及孕早期母体因素与子代复杂先天性心脏病的相关性研究

目的 探讨孕前及孕早期母体环境暴露因素与子代复杂先心病的关系，为先天性心脏病（congenital heart disease ,CHD）的科学预防和干预提供依据。方法 选取2017年1月-2018年12月产前超声诊断为子代复杂先心病的孕妇62例为病例组，按照1∶2匹配正常孕妇为对照组，问卷调查后通过多因素logstic回归分析复杂先心病可能的危险因素和保护因素。结果 母亲不良生育史（OR:6.981, 95%CI:3.621～11.017）、孕前吸烟饮酒史（OR:2.418，95%CI:1277～6.757）、孕早期呼吸道感染（OR:3.906, 95%CI:1.115～5.242）、噪音环境（OR:2.391, 95%CI:0.898～4.710）、不良精神心理因素（OR:4.791, 95%CI:2.242～8.597）为子代复杂先心独立危险因素。而孕前及孕早期食用蛋、奶类等高蛋白物质（OR:0.517，95%CI:0.311～0.803）和补充叶酸及其它营养素（OR:2.979，95%CI:1.537～5.016）为子代复杂先心保护因素。结论 孕前及早孕期孕妇需避免上述危险因素的接触，增加高蛋白和叶酸摄入量，对降低及预防复杂CHD有重要价值。

Analysis of relationship between maternal factors during preconception or early pregnancy and fetal complex congenital heart disease

The study aimed to analyze the relationship between maternal environmental risk factors during preconception or early pregnancy and fetal complex congenital heart disease(CHD), then to provide scientific guidelines for CHD′ s prevention. Methods 62 pregnant women with fetal complex congenital heart disease diagnosed by prenatal ultrasound from January 2017 to December 2018 were selected as the case group. Normal pregnant women were selected as the control group according to the paired ratio of 1:2. After the questionnaire survey, the possible risk factors and protective factors of complex congenital heart disease were analyzed by single factor and multifactor logistic regression. Results Maternal adverse pregnancy history(OR:6.981, 95%CI:3.621-11.017), smoking and drinking history during preconception(OR:2.418, 95%CI:1277-6.757), respiratory infection in early pregnancy(OR:3.906, 95%CI:1.115-5.242), noisy living environment(OR:2.391, 95%CI:0.898-4.710), adverse life events and mental stimulation(OR:4.791, 95%CI:2.242-8.597) were independent risk factors. High protein intakes such as eggs and milk(OR:0.517, 95%CI:0.311-0.803) and folic acid supplementation and other nutrients(OR:2.979, 95% CI:1.537-5.016) are protective factors. Conclusion Avoiding maternal exposure to the above environmental risk factors, balanced nutrition and timely supplementation with folic acid during preconception or early pregnancy are important for reducing and preventing fetal complex CHD.