【作者】 张绍强；

【导师】 杜玉开；

【作者基本信息】 华中科技大学 ， 儿少卫生与妇幼保健学， 2010， 博士

【摘要】 研究目的调查深圳市龙岗区出生缺陷的流行状况,了解孕妇对预防出生缺陷的知识、态度、行为情况,采用病例对照研究方法探索重大出生缺陷的危险因素,提出预防出生缺陷的适宜措施,为进一步完善婚前保健、孕前保健及围产期保健服务提供合理化建议,不断提高出生人口素质。研究方法1、深圳市龙岗区围生儿出生缺陷监测数据分析收集2004-2008年深圳市龙岗区围生儿出生缺陷监测资料,获得历年围生儿出生缺陷相关数据,内容包括每年的围生儿数、出生缺陷类型以及缺陷儿性别、转归等情况。2、孕期妇女出生缺陷相关知识情况调查研究采用分层抽样和随机抽样的方法,抽取深圳市龙岗区三个街道内的90名孕期妇女作为调查对象,利用自行设计的调查表,进行面对面问卷调查,了解孕期妇女出生缺陷的知信行(KAP)情况。3、先天性心脏病危险因素研究采取以医院为基础的1：1病例对照研究方法,探讨深圳市龙岗区先天性心脏病危险因素。所有资料使用Excel2003及Epidata3.1录入电脑建立数据库；采用SAS9.0统计软件进行描述性分析、t检验、x2检验、非参数检验、多因素条件logistic回归等统计分析。研究结果1、深圳市龙岗区围生儿出生缺陷监测数据分析深圳市龙岗区围生儿出生缺陷占围生儿死亡原因构成的19.30%,是导致围生儿死亡的首位原因；2004～2007年出生缺陷发生率呈逐年上升趋势；流动人口平均出生缺陷发生率为13.76‰,常住人口为11.07‰,流动人口平均出生缺陷发生率高于常住人口；龙岗区2004-2008年男性围生儿出生缺陷发生率为14.23‰,女性发生率为11.80‰,发生例数比例为1.51：1,男性出生缺陷发生率比女性发生率高；出生缺陷类型中先天性心脏病的发生率较高。2、孕期妇女出生缺陷相关知识情况调查研究(1)孕期妇女出生缺陷知信行(KAP)情况龙岗区孕期妇女对出生缺陷及叶酸的知识有一定的了解,有91.86%的孕期妇女在怀孕前听说过出生缺陷,有94.87%的人知道育龄妇女服用叶酸可以预防出生缺陷,且有89.74%的人补充过叶酸；为了预防出生缺陷有72.09%的人注意个人保护。有80.77%的孕期妇女对政府免费发放叶酸制剂政策表示支持。(2)出生缺陷知识的来源途径孕前需要进行预防出生缺陷相关准备的知识来源途径以医生和宣传材料最高,分别为30.23%和29.07%,其次是电视和广播(17.44%)、别人介绍(17.44%)、报纸(8.14%)等。而调查对象叶酸知识的来源则是亲戚朋友最高,为34.62%,其次是报纸／杂志／网络(30.77%)、卫生部门(12.82%)等。(3)孕期妇女出生缺陷相关知识影响因素1)文化程度：文化层次高的孕妇,夫妇双方参与婚前医学检查率明显高于文化水平低的,差异有统计学意义(x2=6.7717,P<0.05)；而且,文化程度越高的孕妇对孕期保健、预防出生缺陷知识掌握及叶酸的认知也会越高,文化程度高的孕妇对政府发放叶酸制剂的政策支持率也高于其他人。2)家庭人均月收入：对孕期“保持良好心情”的知晓率以月收入2000～4000元组最高(32.43%),月收入7000元以上组的知晓率最低(10.81%)；在孕期“注意少接触农药／油漆”及“注意少接触猫狗等”行为方面也有不同,家庭人均月收入越高的孕妇对上述行为的重视程度越高。3、先天性心脏病危险因素研究(1)对照组母亲在孕早期每天喝250ml及以上的奶、每天吃肉制品不少于250g和口服维生素的比例高于病例组；而病例组孕母经常饮茶、孕早期病毒感染的比例高于对照组。(2)多因素条件logistic回归分析发现,先天性心脏病的危险因素分别为孕前3个月父亲大量饮酒(OR=2.929)、母亲孕早期偏食(OR=2.876)、母亲孕前体质指数高(OR=2.557)和母亲孕早期病毒感染(OR=2.557)。研究结论深圳市龙岗区围生儿出生缺陷发生率总体呈上升趋势；孕期妇女对出生缺陷及叶酸的基本知识有一定的了解。母亲孕早期病毒感染、孕前身高体重指数及父母在孕早期的生活行为方式是先天性心脏病的影响因素。要普遍开展生殖健康教育,改变不良生活方式,做好围孕期保健工作,预防和减少出生缺陷的发生,提高我国出生人口素质。更多还原

【Abstract】 ObjectiveTo investigate the epidemic status of birth defects of Longgang District, Shenzhen City, determine knowledge, attitudes and practices about birth defects among pregnant women. A case control study was used to explore possible risk factors for birth defects, and proposed appropriate measures to prevent birth defects; to provide reasonable suggestions to further improve Pre-marital health, Pre-pregnancy health and Perinatal health services,so as to continuously improve the quality of the population.Methods1. Analysis on birth defects surveillance data of Longgang district, Shenzhen City To collect and analysis the birth defects surveillance data of Longgang District, Shenzhen City from 2004 to 2008, the content of data include annual numbers of perinatal, types of birth defects,gender of defective child and the outcome of birth defects,et al.2. Survey on knowledge, attitudes and practices about birth defects among pregnant womenStratified random sampling method was used to select 90 pregnant women from three streets of Longgang district, Shenzhen City as participants in this study.Then to learn knowledge, attitudes and practices about birth defects among them by face-to-face questionnaire.3. Investigate the risk factors for congenital heart disease To explore the risk factors for congenital heart disease by using 1:1 matched case-control studies based on hospital. All data was entered in Excel2003 and Epidata 3.1. All analyses were performed by using the SAS9.0 statistical software package, including descriptive analysis,t test, x2-test and multi-factor non-conditional logistic regression.Results1. Analysis on birth defects surveillance data of Longgang district, Shenzhen City Birth defects were the primary causes of perinatal deaths in Longgang District, Shenzhen City, it accounted for 19.30% of the causes of perinatal deaths.The incidence of birth defects showed an increasing trend from 2004 to 2007. The average incidence of birth defects among floating population (13.76%) was higher than resident population (11.07%). The average incidence of birth defects of male between 2004 and 2008 was 14.23%, higher than female (11.80%), and the male-to-female ratio was 1.51:1. The incidence of congenital heart disease was higher than many other types of birth defect.2. Survey on knowledge, attitudes and practices about birth defects among pregnant women(1) Knowledge, attitudes and practices about birth defects among pregnant women The findings showed that the level of general knowledge about birth defect and folic acid among pregnant women in Longgang district was relatively high. There were 91.86% pregnant women had heard of birth defect before pregnancy,94.87% of them knew folic acid could prevent birth defects,and 89.74% of them had ever eaten folic acid in the perinatal period.72.09% participants had ever taken self-protection measures to prevent birth defect.80.77% pregnant women said they supported the policy of distributed folic acid free by government. (2) The sources of knowledge on birth defectsThe sources of knowledge that you should do some preparation to prevent birth defects before pregnancy were mainly from doctors and promotional materials, with the proportion of 30.23% and 29.07%, respectively; followed by television and radio (17.44%), others’ introduction (17.44%), newspapers (8.14%), etc.. The sources of folic acid knowledge were mainly from friends and relatives, accounting for 34.62%; followed by newspaper/ magazine/network (30.77%), the health sector (12.82%) and so on.(3) Influential factors of knowledge of birth defects among pregnant women1)Literacy:In terms of the pregnant women with high literacy, the participation rate in premarital medical examination of couples was significantly higher than that with low literacy, the difference of which was statistically significant (χ2= 6.7717, P<0.05); Moreover, pregnant women with higher literacy would pay more attention to prenatal care, prevention of birth defects and folic acid knowledge, and have higher support to government policy of distributing folic acid than others.2) Per capita monthly income of family:The awareness rate that you should keep good mood during pregnancy was highest in the group of monthly income at 2000～4000 yuan (32.43%) and lowest in the 7,000 yuan group (10.81%). The awareness rates were also different in the behaviors that you should get rid of contacting with pesticides/paint and reduce the opportunities of touching cats and dogs, etc. The pregnant women with higher per capita monthly income of family would have higher degree of attention to above mentioned behaviors.3、Study on risk factors of congenital heart disease1) In terms of drinking milk (more than 250ml/d), eating meat (no less than 250g/d) and taking vitamin frequently in early pregnancy, the proportion of control group mothers was higher than that of case group mothers; in contrast, the case group mothers had higher proportion in regular tea drinking, and virus’s infection at early pregnancy than the control group mothers. 2) Conditional logistic regression analysis showed that the risk factors of congenital heart disease were fathers with large alcohol intake at three months before pregnancy (OR = 2.929), mothers with partial eclipse during early pregnancy (OR= 2.876), mothers with higher body mass index (OR= 2.557) and mothers with viruses infection during early pregnancy (OR= 2.557).ConclusionsThere is an upward trend of the incidence of perinatal birth defects per year in Longgang district of Shenzhen city. Pregnant women have some understanding on the basic knowledge of birth defects and folic acid. Viruses’ infection during early pregnancy and pre-pregnant body mass index of mothers, and the life and behavior styles of parents in early pregnancy are influential factors of congenital heart disease. We should carry out reproductive health education widely in the crowd to change their unhealthy lifestyles, and do well in periconceptional health care to prevent and reduce the incidence of birth defects, so as to improve the quality of the population born in China.更多还原