<strong>2008—2020</strong>年江苏省淮安市围产儿出生缺陷变化趋势及影响因素分析

doi:10.3724/zdxbyxb-2021-0120

浙江大学学报（医学版）

2022, Vol. 51

Issue (1): 10-18 DOI: 10.3724/zdxbyxb-2021-0120

专题报道

2008—2020年江苏省淮安市围产儿出生缺陷变化趋势及影响因素分析

王慧¹,张悦²,丁伟洁¹,朱怡^2,³,卢红梅¹,岳虹霓¹,戴晓晨⁴,李端辉²,朱晓琴^1,*(

),徐小林^2,^5,*(

)

1.淮安市妇幼保健院群体保健科，江苏淮安 223001
2.浙江大学医学院公共卫生学院，浙江杭州 310058
3.华中科技大学同济医学院公共卫生学院，湖北武汉 430030
4.美国华盛顿大学公共卫生学院，美国西雅图 98195
5.浙江大学医学院附属第二医院临床大数据与统计中心，浙江杭州 310009

Trends and influencing factors of perinatal birth defects in Huai’an from 2008 to 2020

WANG Hui¹,ZHANG Yue²,DING Weijie¹,ZHU Yi^2,³,LU Hongmei¹,YUE Hongni¹,DAI Xiaochen⁴,LI Duanhui²,ZHU Xiaoqin^1,*(

),XU Xiaolin^2,^5,*(

)

1. Department of Preventive Health Care, Huai’an Maternity and Child Health Care Hospital, Huai’an 223001, Jiangsu Province, China;
2. School of Public Health, Zhejiang University School of Medicine, Hangzhou 310058, China;
3. School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China;
4. School of Public Health, University of Washington, Seattle 98195, USA;
5. Center for Clinical Big Data and Statistics, the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310009, China

全文: PDF(3974 KB)

HTML( 5 )

摘要：

目的：分析2008—2020年淮安市围产儿出生缺陷的发生情况、变化趋势及其影响因素。方法：数据来源于江苏省淮安市妇幼卫生信息系统中2008—2020年的监测数据以及淮安市统计年鉴。以年度变化百分比和平均年度变化百分比（AAPC）为主要指标，采用JoinPoint回归描述十三年间淮安市出生缺陷发生的变化趋势。采用Spearman相关性分析探讨出生缺陷发生率与人口出生率、结婚登记率及高龄产妇分娩占比的相关性。结果：2008—2020年，淮安市共发生围产儿出生缺陷3414例，出生缺陷发生率为4.6‰（3414/736 608），且表现为明显的上升趋势（AAPC=8.8%，t=3.2，P<0.01），2016年为变化转折点。在24类出生缺陷中，先天性心脏病发病率急剧上升，已成为顺位第一疾病，而无脑畸形、脑膨出、脊柱裂等神经管缺陷发病率下降明显。出生缺陷率与人口出生率呈负相关（r=–0.751，P<0.01），与结婚登记率无明显相关性（r=–0.516，P>0.05），与高龄产妇分娩占比呈正相关（r=0.726，P<0.01）。结论：2008—2020年，淮安市出生缺陷发生率整体呈上升趋势，先天性心脏病已成为第一顺位的出生缺陷，高龄产妇分娩占比与出生缺陷之间关系密切。

关键词： 围产儿; 出生缺陷; 发生率; 流行趋势; 影响因素

Abstract:

Objective: To analyze the incidence, trends and related factors of birth defects in Huai’an from 2008 to 2020. Methods: The surveillance data from maternal and child health system of Huai’an from 2008 to 2020 and Huai’an Statistical Yearbook were used for analysis. Taking the annual change percentage and average annual change percentage (AAPC) as the main outcome indicators, the JoinPoint regression analysis was performed to estimate the changing trend of birth defects from 2008 to 2020. Spearman correlation analysis was used to examine the association between birth defects and birth rate, marriage rate, proportion of women with advanced maternal age. Results: During 2008 to 2020, a total of 3414 cases of neonatal birth defects occurred in Huai’an, with an incidence of 4.6‰ (3414/736 608). The rate of perinatal birth defects in Huai’an showed an increasing trend (AAPC=8.8%, t=3.2, P<0.01), and the year of 2016 was a significant changing point. Among 24 types of birth defects, the incidence of congenital heart disease rose and became the most prevalent defect, while the incidence of neural tube malformations such as anencephaly, encephalocele and spina bifida was declined. The incidence of birth defect was negatively correlated with the birth rate (r=–0.751, P<0.01), not correlated with marriage rate (r=–0.516, P>0.05), and positively correlated with the proportion of women with advanced maternal age (r=0.726, P<0.01).Conclusion: The incidence of birth defects in Huai’an shows an increasing trend from 2008 to 2020 with congenital heart disease as the most common type of birth defect, and the increase of birth defects incidence is closely related with the increase of the proportion of women with advanced maternal age.

Key words: Perinatal infants Birth defects Incidence Changing trends Influencing factors

收稿日期: 2021-10-11 出版日期: 2022-05-17

CLC:

R722

基金资助: 江苏省妇幼健康科研项目（F201402，F201932）；淮安市科技项目（HAB202043）；江苏省医院管理创新研究课题（JSYGY-3-2020-442）；淮安市卫生健康科研项目（HAWJ202020，HAWJ202118）；美国中华医学基金会公开竞争项目（21-416）；浙江大学百人计划启动经费

通讯作者: 朱晓琴,徐小林 E-mail: xiaolin.xu@zju.edu.cn

	服务
	把本文推荐给朋友
	加入引用管理器
	E-mail Alert
	RSS
	作者相关文章
	王慧
	张悦
	丁伟洁
	朱怡
	卢红梅
	岳虹霓
	戴晓晨
	李端辉
	朱晓琴
	徐小林

引用本文:

王慧,张悦,丁伟洁,朱怡,卢红梅,岳虹霓,戴晓晨,李端辉,朱晓琴,徐小林. 2008—2020年江苏省淮安市围产儿出生缺陷变化趋势及影响因素分析[J]. 浙江大学学报（医学版）, 2022, 51(1): 10-18.

WANG Hui,ZHANG Yue,DING Weijie,ZHU Yi,LU Hongmei,YUE Hongni,DAI Xiaochen,LI Duanhui,ZHU Xiaoqin,XU Xiaolin. Trends and influencing factors of perinatal birth defects in Huai’an from 2008 to 2020. J Zhejiang Univ (Med Sci), 2022, 51(1): 10-18.

链接本文:

https://www.zjujournals.com/med/CN/10.3724/zdxbyxb-2021-0120 或 https://www.zjujournals.com/med/CN/Y2022/V51/I1/10

表 1 2008—2020年江苏省淮安市前五位出生缺陷类型及发生率

图 1 2008年与2020年江苏省淮安市围产儿出生缺陷顺位变化颜色代表出生缺陷分类：蓝色（眼、耳、面和颈部先天性畸形），橙色（神经系统畸形），紫色（肌肉、骨骼系统先天性畸形），绿色（消化系统先天性畸形），红色（先天性心脏病），灰色（其他先天性畸形），墨绿色（染色体畸形），亮绿色（泌尿系统畸形）. 实线表示发生率上升，虚线表示发生率下降. 在2008年和2020年，膀胱外翻和联体双胎发生率均为0，未纳入比较.

图 2 2008—2020年江苏省淮安市围产儿出生缺陷发生率变化趋势图出生缺陷发生率=某年某地出生缺陷数/当年该地围产儿数.图中虚线代表节点年份.

1	秦怀金, 朱军. 中国出生缺陷防治报告[M]. 北京: 人民卫生出版社, 2013: 1 QIN Huaijin, ZHU Jun. National stocktaking report on birth defect prevention[M]. Beijing: People’s Medical Publishing House, 2013: 1. (in Chinese)
2	中华人民共和国国家卫生健康委员会. 中国妇幼健康事业发展报告(2019)[EB/OL]. (2019-05-27) [2021-12-21].http://www.nhc.gov.cn/fys/s7901/201905/bbd8e2134a7e47958c5c9ef032e1dfa2.shtml
3	HARRISB S, BISHOPK C, KEMENYH R, et al.Risk factors for birth defects[J]Obstetrical Gynecol Survey, 2017, 72( 2): 123-135. doi: 10.1097/OGX.0000000000000405
4	HOWLEYM M, PAPADOPOULOSE A, VAN BENNEKOMC M, et al.Asthma medication use and risk of birth defects: national birth defects prevention study, 1997—2011[J]J Allergy Clin Immunol-Pract, 2020, 8( 10): 3490-3499.e9. doi: 10.1016/j.jaip.2020.07.033
5	GILDESTADT, BJØRGET, HAALANDØ A, et al.Maternal use of folic acid and multivitamin supplements and infant risk of birth defects in Norway, 1999—2013[J]Br J Nutr, 2020, 124( 3): 316-329. doi: 10.1017/S0007114520001178
6	ZHAOJ, YANY, HUANGX, et al.Do the children born after assisted reproductive technology have an increased risk of birth defects? A systematic review and meta-analysis[J]J Matern-Fetal Neonatal Med, 2020, 33( 2): 322-333. doi: 10.1080/14767058.2018.1488168
7	LIJ, DUY, QUF, et al.Propensity score analysis of the association between maternal exposure to second-hand tobacco smoke and birth defects in Northwestern China[J]J Dev Orig Health Dis, 2022, 1-8. doi: 10.1017/S2040174421000714
8	ZHOUY, MAOX, ZHOUH, et al.Birth defects data from population-based birth defects surveillance system in a district of southern Jiangsu, China, 2014—2018[J]Front Public Health, 2020, 378. doi: 10.3389/fpubh.2020.00378
9	ZHOUY, MAOX, ZHOUH, et al.Epidemiology of birth defects based on a birth defect surveillance system in Southern Jiangsu, China, 2014—2018[J]J Matern Fetal Neonatal Med, 2022, 35( 4): 745-751. doi: 10.1080/14767058.2020.1763951
10	杨婷, 王芳, 衡驰, 等. 婚前保健服务对出生缺陷的影响研究——以广西为例[J]. 中国卫生政策研究, 2016, 9(5): 8-12 YANG Ting, WANG Fang, HENG Chi, et al. Effects of premarital healthcare services on birth defects: a case study of Guangxi province[J]. Chinese Journal of Health Policy, 2016, 9(5): 8-12. (in Chinese)
11	张丽, 相晓妹, 宋辉, 等. 西安市空气污染物与出生缺陷的时序变化及相关性的生态学研究[J]. 西安交通大学学报(医学版), 2017, 38(3): 353-358, 401 ZHANG Li, XIANG Xiaomei, SONG Hui, et al. Ecological research on time series changes in air pollutants and birth defects in Xi’an and their correlation[J]. Journal of Xi’an Jiaotong University (Medical Sciences), 2017, 38(3): 353-358, 401. (in Chinese)
12	RENZ, ZHUJ, GAOY, et al.Maternal exposure to ambient PM10 during pregnancy increases the risk of congenital heart defects: evidence from machine learning models[J]Sci Total Environ, 2018, 1-10. doi: 10.1016/j.scitotenv.2018.02.181
13	BALDACCI S, GORINI F, MINICHILLI F, et al. Review of epidemiological studies on individual and environmental risk factors in the aetiology of congenital heart defect[J]. Epidemiol Prev, 2016, 40(3-4): 185-196
14	迟文学, 王劲峰, 李新虎, 等. 山西和顺县出生缺陷地域的相关性分析[J]. 卫生研究, 2007, 36(3): 328-330 CHI Wenxue, WANG Jinfeng, LI Xinhu, et al. Regional correlation analysis of birth defects in Heshun County, Shanxi Province[J]. Journal of Hygiene Research, 2007, 36(3): 328-330. (in Chinese)
15	余章斌, 韩树萍, 陈小慧, 等. 系统评价国内外围产儿先天性心脏病的发生率[J]. 中国循证儿科杂志, 2014, 9(4): 252-259 YU Zhangbin, HAN Shuping, CHEN Xiaohui, et al. Systematic review of the prevalence of perinatal congenital heart disease[J]. Chinese Journal of Evidence-based Pediatrics, 2014, 9(4): 252-259. (in Chinese)
16	罗灿, 徐昊立, 陈婷婷, 等. 广东2006—2015年围产儿出生缺陷监测分析[J]. 中国公共卫生, 2017, 33(11): 1669-1672 LUO Can, XU Haoli, CHEN Tingting, et al. Birth defects among perinatal infants in Guangdong province, 2006—2015[J]. Chinese Journal of Public Health, 2017, 33(11): 1669-1672. (in Chinese)
17	李春荣, 赵顺霞, 段链, 等. 成都市出生缺陷发生水平及流行病学分析[J]. 现代预防医学, 2015, 42(10): 1776-1778, 1790 LI Chunrong, ZHAO Shunxia, DUAN Lian, et al. Analysis of the incidence and epidemiology of birth defects in Chengdu[J]. Modern Preventive Medicine, 2015, 42(10):1776-1778, 1790. (in Chinese)
18	张志力, 胡先明, 范惠霞, 等. 2012—2017年山西省围生儿出生缺陷监测结果和流行病学分析[J]. 中国全科医学, 2020, 23(10): 1298-1304 ZHANG Zhili , HU Xianming, FAN Huixai, et al. Epidemiological analysis of the surveillance data of birth defects among perinatal infants in Shanxi province, 2012—2017[J]. Chinese General Practice, 2020, 23(10): 1298-1304. (in Chinese)
19	章琦, 相晓妹, 宋辉, 等. 2010—2015年西安市围产儿出生缺陷的流行特征[J]. 西安交通大学学报(医学版), 2017, 38(3): 375-379 ZHANG Qi, XIANG Xiaomei, SONG Hui, et al. The epidemiological characteristics of perinatal birth defects in Xi’an from 2010 to 2015[J]. Journal of Xi’an Jiaotong University (Medical Sciences), 2017, 38(3): 375-379. (in Chinese)
20	张艳. 2010—2014年深圳市坪山新区围产儿出生缺陷监测分析及干预探讨[J]. 中国健康教育, 2016, 32(4): 367-368 ZHANG Yan. Analysis of the monitoring data of birth defects in Pingshan from 2010—2014 and a preliminary discussion of intervention mode[J]. Chinese Journal of Health Education, 2016, 32(4): 367-368. (in Chinese)
21	国家卫生计生委妇幼健康服务司. 中国妇幼卫生监测工作手册(2013版)[EB/OL]. (2013-08-30)[2021-12-21]. http://www.mchscn.cn/National-22/450.html
22	全国妇幼卫生监测办公室. 主要先天畸形诊断手册[A]. 1998
23	KIMH J, FAYM P, FEUERE J, et al.Permutation tests for joinpoint regression with applications to cancer rates[J]Statist Med, 2000, 19( 3): 335-351. doi: 10.1002/(SICI)1097-0258(20000215)19:3<335::AID-SIM336>3.0.CO;2-Z
24	李辉章, 杜灵彬. Joinpoint回归模型在肿瘤流行病学时间趋势分析中的应用[J]. 中华预防医学杂志, 2020, 54(8): 908-912 LI Huizhang, DU Lingbin. Application of Joinpoint regression model in cancer epidemiology time trend analysis[J]. Chinese Journal of Preventive Medicine, 2020, 54(8): 908-912. (in Chinese)
25	Division of Cancer Control and Population Sciences National Cancer Institute. Joinpoint help manual 4.8.0.1[EB/OL]. (2020-04-21)[2021-12-21]. https://surveillance.cancer.gov/joinpoint/Joinpoint_Help_4.8.0.1.pdf
26	姜红, 杨士敏, 潘佳雪, 等. 2014—2018济南市522 437例围产儿出生缺陷发生情况分析[J]. 现代预防医学, 2021, 48(1): 74-77 JIANG Hong, YANG Shimin, PAN Jiaxue, et al. Analysis of birth defects in 522 437 perinatal infants in Jinan, 2014—2018[J]. Modern Preventive Medicine, 2021, 48(1): 74-77. (in Chinese)
27	ZHANG X H, CHEN L J, WANG X M, et al. Changes in maternal age and prevalence of congenital anomalies during the enactment of China’s universal two-child policy (2013—2017) in Zhejiang Province, China: an observational study[J/OL]. PLoS Med, 2020, 17(2): e1003047
28	姚莉琴, 邹团标, 张山山, 等. 1986~2014年中国出生缺陷发生率的变化趋势及地理分布[J]. 中国优生与遗传杂志, 2020, 28(3): 351-356, 359 YAO Liqin, ZOU Tuanbiao, ZHANG Shanshan, et al. Trends and geographical distribution of birth defects in China from 1986 to 2014[J]. Chinese Journal of Birth Health & Heredity, 2020, 28(3): 351-356, 359.(in Chinese)
29	SUNR R, LIUM, LUL, et al.Congenital heart disease: causes, diagnosis, symptoms, and treatments[J]Cell Biochem Biophys, 2015, 72( 3): 857-860. doi: 10.1007/s12013-015-0551-6
30	BAIRDP A, SADOVNICKA D, YEEI M L, et al.Maternal age and birth defects: a population study[J]Lancet, 1991, 337( 8740): 527-530. doi: 10.1016/0140-6736(91)91306-F
31	TRIEDMANJ K, NEWBURGERJ W. Trends in congenital heart disease[J]Circulation, 2016, 133( 25): 2716-2733. doi: 10.1161/CIRCULATIONAHA.116.023544
32	VAN DER LINDED, KONINGSE E M, SLAGERM A, et al.Birth prevalence of congenital heart disease worldwide[J]J Am College Cardiol, 2011, 58( 21): 2241-2247. doi: 10.1016/j.jacc.2011.08.025
33	景慧, 李晶, 杜玉娇, 等. 母亲围孕期焦虑与子代先天性心脏病关系的病例对照研究[J]. 中华流行病学杂志, 2021, 42(9): 1635-1640 JING Hui, LI Jing, DU Yujiao, et al. Association of maternal anxiety with congenital heart disease in offspring based on case-control study[J]. Chinese Journal of Epidemiology, 2021, 42(9): 1635-1640. (in Chinese)
34	PAIGES L, YANGW, PRIESTJ R, et al.Risk factors associated with the development of double‐inlet ventricle congenital heart disease[J]Birth Defects Res, 2019, 111( 11): 640-648. doi: 10.1002/bdr2.1501
35	RUTKOWSKIR E, TANNERJ P, ANJOHRINS B, et al.Proportion of critical congenital heart defects attributable to unhealthy prepregnancy body mass index among women with live births in Florida, 2005—2016[J]Birth Defects Res, 2021, 113( 18): 1285-1298. doi: 10.1002/bdr2.1946
36	JOINAU-ZOULOVITSF, BERTILLEN, COHENJ F, et al.Association between advanced paternal age and congenital heart defects: a systematic review and meta-analysis[J]Hum Reprod, 2020, 35( 9): 2113. doi: 10.1093/humrep/deaa105
37	WANG T, LI Q, CHEN L, et al. Effect of maternal alcohol consumption during the pre-pregnancy/early-pregnancy period on congenital heart disease: a prospective cohort study in Central China[J]. Prev Med, 2022, 155: 106963
38	VAN DER BOMT, ZOMERA C, ZWINDERMANA H, et al.The changing epidemiology of congenital heart disease[J]Nat Rev Cardiol, 2011, 8( 1): 50-60. doi: 10.1038/nrcardio.2010.166
39	WILLIAMS J, MAI C T, MULINARE J, et al. Updated estimates of neural tube defects prevented by mandatory folic acid fortification——United States, 1995—2011[J]. MMWR Morb Mortal Wkly Rep, 2015, 64(1): 1-5
40	SANTOSL M P, LECCAR C R, CORTEZ-ESCALANTEJ J, et al.Prevention of neural tube defects by the fortification of flour with folic acid: a population-based retrospective study in Brazil[J]Bull World Health Organ, 2016, 94( 1): 22-29. doi: 10.2471/BLT.14.151365
41	CAWLEY S, MCCARTNEY D, WOODSIDE J V, et al. Optimization of folic acid supplementation in the prevention of neural tube defects [J]. J Public Health (Oxf), 2018, 40(4): 827-834
42	陈金慧. 浙江省影响出生缺陷发生的社会环境因素研究[D]. 杭州: 浙江大学, 2009 CHEN Jinhui. Research on social environmental factors which influence birth defects in Zhejiang province[D]. Hangzhou: Zhejiang University, 2009.(in Chinese)
43	LIH, ZHOUT, JIAC. The influence of the universal two-child policy on China’s future population and ageing[J]J Pop Res, 2019, 36( 3): 183-203. doi: 10.1007/s12546-019-09228-7
44	HARRIS B S, BISHOP K C, KEMENY H R, et al. Risk factors for birth defects[J]. Obstetrical & Gynecological Survey, 2017, 72(2): 123-135
45	CSERMELY G, CZEIZEL A E, VESZPREMI B. Distribution of maternal age and birth order groups in cases with unclassified multiple congenital abnormalities according to the number of component abnormalities: a national population-based case-control study[J]. Birth Defects Res A Clin Mol Teratol, 2015, 103(2): 67-75
46	FREDERIKSENL E, ERNSTA, BRIXN, et al.Risk of adverse pregnancy outcomes at advanced maternal age[J]Obstet GynEcol, 2018, 131( 3): 457-463. doi: 10.1097/AOG.0000000000002504
47	HANSENM, KURINCZUKJ J, MILNEE, et al.Assisted reproductive technology and birth defects: a systematic review and meta-analysis[J]Hum Reprod Update, 2013, 19( 4): 330-353. doi: 10.1093/humupd/dmt006
48	杨晓鹤. 中国人口出生率的地域差异及影响因素分析[D]. 重庆: 重庆理工大学, 2018 YANG Xiaohe. Analysis on the regional differences and influencing factors of the birth rate in China[D]. Chongqing: Chongqing University of Technology, 2018. (in Chinese)

[1]	于玥,凌诗颖,帅瑞雪,邱文娟,张惠文,梁黎黎,季文君,刘宇超,顾学范,韩连书. 720例甲基丙二酸血症MMACHC基因c.609G>A突变患者临床特征及随访分析[J]. 浙江大学学报（医学版）, 2021, 50(4): 436-443.
[2]	王锦涛,黄蕾,魏丽丽,陈炜. 重复经颅磁刺激治疗阿尔茨海默病患者的疗效影响因素[J]. 浙江大学学报（医学版）, 2021, 50(3): 383-389.
[3]	李荣，熊丰，胡玉娟，侯玲，程昕然，罗雁红，马勤香，王力，罗顺清，朱岷. 1型糖尿病儿童青少年生存质量调查及分析[J]. 浙江大学学报（医学版）, 2013, 42(4): 388-395.
[4]	胡音;郭谊;王奕琪;杜强;丁美萍. 成人癫痫患者生活质量问卷-31-P的信度和效度分析[J]. 浙江大学学报（医学版）, 2009, 38(6): 605-610.
[5]	黄丽丽, 潘永观. 32例妊娠期肝内胆汁郁积症孕妇围产儿死亡分析[J]. 浙江大学学报（医学版）, 1995, 24(3): 126-127.

Viewed

Full text

Abstract

Cited

Shared

Discussed