孕早期妇女患病和用药与神经管缺陷的病例对照研究  

Risk factors during early pregnancy for neural tube defects:a case control study

作　　者：刘宇龙 杨爽 党文珊 张雪娟[2] LIU Yulong;YANG Shuang;DANG Wenshan;ZHANG Xuejuan(Department of Maternal,Child and Adolescent Health,Shanxi Medical University,Taiyuan 030001,China)

机构地区：[1]山西医科大学公共卫生学院儿少卫生与妇幼保健学教研室,太原030001 [2]山西医科大学附属儿童医院(山西省妇幼保健院)健康教育科,太原030013

出　　处：《中国生育健康杂志》2020年第1期32-35,共4页Chinese Journal of Reproductive Health

摘　　要：目的探讨孕早期妇女患病和用药与神经管缺陷发生的关系。方法选择2010—2014年山西省“削峰工程”各区县监测医院分娩或妇幼保健机构登记的生育神经管缺陷患儿的产妇411例纳入病例组,同时按照1∶1匹配选择同期分娩正常儿的411例产妇作为对照组进行问卷调查。采用单因素和多因素条件Logistic回归模型分析孕早期患病和用药与神经管缺陷的关系。结果多因素条件Logistic回归分析显示,多胎分娩(OR=8.94,95%CI:1.70~47.04)、意外怀孕(OR=2.89,95%CI:1.72~4.87)、孕次≥3(OR=1.82,95%CI:1.08~3.06)、高热(OR=5.37,95%CI:1.47~19.57)、感冒(OR=2.84,95%CI:1.60~5.06)是神经管缺陷的危险因素,增补叶酸(OR=0.36,95%CI:0.24~0.54)是神经管缺陷的保护因素。结论孕妇多胎分娩、意外怀孕、孕次≥3次、高热和感冒是神经管缺陷的危险因素,增补叶酸是神经管缺陷的保护因素。在今后的神经管缺陷预防工作中需要加强对备孕和孕早期妇女的健康教育和指导,强调避免盲目追求多胎妊娠,倡导计划妊娠,提高孕早期妇女的免疫力,必要时接种流感疫苗,避免感冒发热,及时增补叶酸来降低生育神经管缺陷患儿的风险。Objective To explore risk factors during early pregnancy for neural tube defects.Methods To select the pregnant women from the county or district monitoring hospitals as the object of study,which is included in the"peak clipping project"in Shanxi Province from 2010-2014.We selected the women who had fetus with neural tube defects as the case group.Then we used 1∶1 case-control study and selected a woman who gave birth to a healthy baby matched with delivery date.We used the questionnaire survey to collect the related information.Univariate and multivariate conditional logistic regression models were used to analyze the relationship between risk factors and neural tube defects.Results Multivariate conditional logistic regression analysis showed that multiple births(OR=8.94,95%CI:1.70-47.04),unplanned pregnancy(OR=2.89,95%CI:1.72-4.87),gravidity≥3(OR=1.82,95%CI:1.08-3.06),hyperpyrexia(OR=5.37,95%CI:1.47-19.57),influenza(OR=2.84,95%CI:1.60-5.06)are risk factors for neural tube defects,and folic acid supplementation(OR=0.36,95%CI:0.24-0.54)is a protective factor for neural tube defects.Conclusion We need to strengthen health education and guidance for would-be mothers and early pregnant women in the neural tube malformation intervention program in future.We need to emphasize to avoid the blind pursuit of multiple pregnancies.Then we advocate intended pregnancy and improve the immunity of women in early pregnancy,as well as give the vaccine against influenza and fever.Last we supplement folic acid to reduce the risk of neural tube defects.

关 键 词：神经管缺陷 神经管畸形 孕妇 药物 病例对照研究 

分 类 号：R71[医药卫生—妇产科学]