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目的探讨母体孕期不良因素对胎儿先天性复杂型心脏病(先心病)的影响。方法 2011年10月至2014年10月选取在本院接受产前胎儿心血管畸形筛查、产前或分娩后经超声心动图检查确诊为复杂型先心病的85例孕妇为病例组,随机选取同期在本院行孕中晚期超声筛查且新生儿出生后经超声心动图确诊为无异常的150例孕妇为对照组。分别采用单因素及Logistic多因素分析母体危险因素对胎儿复杂型先心病的影响。结果与对照组相比,病例组孕妇年龄≥35岁、妊早期上呼吸道感染、孕期不良环境接触、先心病家族史、孕期吸烟、孕期中重度饮酒、精神刺激、孕期用药、孕前肥胖、糖尿病史比例较高(P<0.05),而优生检查比例较低(P<0.05)。经Logistic多因素回归分析可知,妊早期上呼吸道感染(OR:4.523;95%:1.269-6.425)、孕期不良环境接触(OR:6.312;95%:1.326-6.986)、孕期吸烟(OR:4.623;95%:1.239-6.963)、孕期中重度饮酒(OR:5.632;95%:1.025-7.023)、孕前肥胖(OR:3.265;95%:1.208-8.006)、糖尿病史(OR:6.398;95%:1.489-9.360)是胎儿发生复杂型先心病的独立危险因素,而优生检查(OR:5.772;95%:1.277-7.236)是子代复杂型先心病发生的保护因素。结论母体孕期疾病、不良生活方式及不良环境接触是诱发新生儿复杂型先心病发生的独立危险因素,优生检查对复杂型先心病发生具有显著保护作用。
Objective To investigate the influence of maternal gestational adverse factors on fetal congenital complex heart disease (CHD). Methods From October 2011 to October 2014, 85 pregnant women undergoing prenatal fetal cardiovascular malformation screening and prenatal or postnatal echocardiographic diagnosis of complex congenital heart disease were selected as case group and randomly selected The same period in our hospital screening for the second trimester of ultrasound screening and neonatal birth by echocardiography confirmed no abnormalities in 150 pregnant women as the control group. Univariate and Logistic multivariate analysis of maternal risk factors on fetal complicated congenital heart disease were performed. Results Compared with the control group, the cases of pregnant women ≥35 years of age, upper respiratory tract infection in early pregnancy, adverse environmental exposure during pregnancy, family history of congenital heart disease, smoking during pregnancy, moderate alcohol consumption during pregnancy, mental stimulation, medication during pregnancy, pre-pregnancy obesity, diabetes history A higher proportion (P <0.05), while a lower proportion of eugenics (P <0.05). Logistic regression analysis showed that upper respiratory tract infection in early pregnancy (OR: 4.523; 95%: 1.269-6.425), adverse environmental conditions during pregnancy (OR: 6.312; 95%: 1.326-6.986) (OR: 5.632; 95%: 1.025-7.023), pre-pregnancy obesity (OR: 3.265; 95%: 1.208-8.006), history of diabetes (OR: 6.398; 95% 1.489-9.360) was an independent risk factor for fetal congenital heart disease. However, the eugenics (OR: 5.772; 95%: 1.277-7.236) were protective factors for the development of complex congenital heart disease in children. Conclusion Maternal disease, unhealthy life style and adverse environmental exposure are independent risk factors for the development of complex congenital heart disease in neonates. Elective health examination has a significant protective effect on the development of complex congenital heart disease.