蚌埠地区0～5岁儿童出生缺陷的流行病学研究
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摘要
目的:了解蚌埠地区0～5儿童出生缺陷患病率及出生缺陷的构成、分布情况(包括人群、时间、地区分布),探索蚌埠地区出生缺陷的危险因素,为当地政府、计生部门提供0～5岁儿童出生缺陷情况,为其提供决策依据。为出生缺陷的三级预防提供强有力的支持,特别是为病因预防提供干预措施,降低出生缺陷发生率,提高人口素质,做到优生优育提供依据。
方法:应用分层按比例整群抽样的方法,对蚌埠三县五区进行抽样,对样本点0～5岁儿童进行筛查。筛查登记对象为2001年7月1日零时～2006年6月30日24时出生的婴儿(其母亲怀孕及生产均在调查小区的常住人口),共16698例。筛查出的出生缺陷具有明确诊断或者经医师体检诊断出生缺陷儿作为调查对象,共883例。采用自行设计的调查表,由调查员一对一对883例缺陷儿的父母或者家人进行问卷调查,用频率指标描述出生缺陷的分布情况,用χ~2检验比较性别、年龄、城乡之间的差别,对可能的危险因素如胎数、家庭居住环境、家庭附近有无污染、、母亲患病、用药、接触毒物、父亲吸烟等情况做χ~2检验,提出可能的危险因素。接着对其中565例出生缺陷儿做1:1配对病例对照研究,对照选择原则:同一村(社母区居委会)、出生时间前后不到1个月、同性别的经过相同诊断标准的正常儿。采用1:1配对病例对照研究,对565对病例与对照进行问卷调查,采用SPSS软件对所有调查因素进行单因素分析和多因素的条件Logistic回归分析。
结果样本点内0～5岁儿童16698人,共检出BD病例883例,BD发生率为883/16698=5.29%。男性为553人,占62.6%,女性为330人,占37.4%,性别比男:女=1.7:1。男女性别间出生缺陷发生率差异有统计学意义(χ~2=70.1 P<0.05);蚌埠市0～5岁出生缺陷前五位主要包括:血管瘤、先天性心脏病、素痣、疝气,先天性脑积水,占全部BD的46.32%;对比不同年龄孕产妇比较发现,出生缺陷发生率差异存在统计学意义(χ~2=161.9,P<0.05);双胎及多胎中的发生率高于单胎的出生缺陷发生率(χ~2=34.0,P<0.05);农村出生缺陷发生率显著高于城市(χ~2=34.0,P<0.05);春夏秋冬季出生缺陷发生率不同(χ~2=10.73,P<0.05);缺陷儿家庭居住环境中有无河流,显示二者差异没有统计学意义(χ~2=0.68,P﹥0.05);有污染源的家庭出生缺陷发生率明显高于无污染源家庭(χ~2=16.2,P<0.05)。对1:1配对病例对照研究资料分析:有统计学意义的危险因素是:家庭附近有污染(OR=5.18)父母近亲结婚(OR= 12.37)有生育畸形儿史(OR=2.52)、孕育期接触有害物质(OR=10.81)、孕育期用药(OR= 3.27)、孕育期接触宠物(OR= 4.26)、父亲吸烟(OR= 1.95)与出生缺陷的发生有关。
结论:蚌埠市的出生缺陷发生率为5.29%,与国内外的发生率相一致。家庭附近有污染、父母近亲结婚、有生育畸形儿史、孕育期接触有害物质、孕育期用药、孕育期接触宠物、父亲吸烟是出生缺陷的危险因素。我们可以针对这些危险因素采取措施,降低出生缺陷的发生率。
Objective: To investigate the prevalence of birth defects of 0～5 years old children in Bengbu City, seek and identify some potential influential factors, explore the intervention measures, cut down the incidence, promote the health of people, and provide the scientific evidences for reaching aristogenesis.
Methods: Stratified random clustered sampling in proportion. There are 3 counties and 5 districts (except high-tech district) have 16,698 babies(their mothers are residents of investigated area when they were pregnant and delivered) born from midnight on July 1 in 2001 to 24 on June 30 in 2006. This investigation adopted 833 cases diagnosed as birth defects by final diagnosis or medical examination 833 controls matched by sex, age and inhabitance in urban and countryside. All the parents or folks from 833 couples of case-controls were investigated according to self-designed questionnaire, and the distribution of birth defects was described with frequency index.χ~2 test was used to compare discrepancy between sex, age, and town and country in order to detect possible risk factors such as fetus, inhabited environment, pollution around home, mother disease, exposures to medicine and poisons, and fathers’smoking etc. The questionnaire investigations on 565 couples of birth defects and controls were performed according to 1:1 matched case-control study. The single-variate and multivariate logistic regression models were adopted with help of SPSS software.
Result: Among 16,698 children of zero t five, 833 of BD cases are testified and BD rate is 883/16698=5.29%. There are 553 males, takes up 62.6% and 330 females, 37.4%, sex rate male: female=1.7:1. The difference between male and female has statistical meaning(χ~2=70.1 P<0.05); the first five birth deficiencies of 0~5 are angioma,innate heart disease, nevus,hernia, Congenital hydrocephalus , and occupy 43.49%of BD; comparing pregnant women of different age, the paper discovers that the differences in the birth defects rate have statistical meaning(χ~2=161.9,P<0.05):the age of 25~30 has lowest rate and age of no less than 35 has highest rate; double fetuses and multi-fetuses occur more often than single-fetus; birth defects rate in village is higher than that in town(χ~2=34.0,P<0.05); rates in spring, summer, autumn and winter respectively are 46.62%、49.51%、53.15、61.8% ; whether there is a river in living environment does not have statistical meaning(χ~2=0.68,P﹥0.05);birth defects in contaminated family is higher than that in non-contaminated one (χ~2=16.2 ,P<0.05);mother’s disease in early pregnancy takes up 30.4%of birth defects, especially upper respiration tract infection; medicines mother had in early pregnancy occupies13.3%, antibiotics in particular; among possible dangerous factors, pets is19.6%,pesticides7.5%;among the doubtful dangerous factors, cigars is 47.8%,alcohol 24.7%, pesticides 15.3%. A 1∶1 matched case-control study was conducted to investigate 565 pairs of cases and the control. The results of multiple regression model showed that the risk factors of BD were : domestic contamination(OR=5.18)consanguineous marriage(OR=12.37)bearing malformation child history(OR=2.52), exposure on harmful substance during pregnancy(OR=10.81), drug usage during pregnancy(OR= 3.27), pet contacting during pregnancy(OR= 4.26)father smoking(OR= 1.95)
Conclusion: The prevalence of birth defects in Bengbu City is 5.29%, which is consistent with that of home and abroad. The risk factors of birth defects chiefly contain pollution near home, consanguineous marriage, history breeding oaf, exposures to hazardous agent and medicine during pregnant period, and fathers’smoking. The interventions on these risk factors will be able to effectively decrease the incidence of birth defects.
方法:应用分层按比例整群抽样的方法,对蚌埠三县五区进行抽样,对样本点0～5岁儿童进行筛查。筛查登记对象为2001年7月1日零时～2006年6月30日24时出生的婴儿(其母亲怀孕及生产均在调查小区的常住人口),共16698例。筛查出的出生缺陷具有明确诊断或者经医师体检诊断出生缺陷儿作为调查对象,共883例。采用自行设计的调查表,由调查员一对一对883例缺陷儿的父母或者家人进行问卷调查,用频率指标描述出生缺陷的分布情况,用χ~2检验比较性别、年龄、城乡之间的差别,对可能的危险因素如胎数、家庭居住环境、家庭附近有无污染、、母亲患病、用药、接触毒物、父亲吸烟等情况做χ~2检验,提出可能的危险因素。接着对其中565例出生缺陷儿做1:1配对病例对照研究,对照选择原则:同一村(社母区居委会)、出生时间前后不到1个月、同性别的经过相同诊断标准的正常儿。采用1:1配对病例对照研究,对565对病例与对照进行问卷调查,采用SPSS软件对所有调查因素进行单因素分析和多因素的条件Logistic回归分析。
结果样本点内0～5岁儿童16698人,共检出BD病例883例,BD发生率为883/16698=5.29%。男性为553人,占62.6%,女性为330人,占37.4%,性别比男:女=1.7:1。男女性别间出生缺陷发生率差异有统计学意义(χ~2=70.1 P<0.05);蚌埠市0～5岁出生缺陷前五位主要包括:血管瘤、先天性心脏病、素痣、疝气,先天性脑积水,占全部BD的46.32%;对比不同年龄孕产妇比较发现,出生缺陷发生率差异存在统计学意义(χ~2=161.9,P<0.05);双胎及多胎中的发生率高于单胎的出生缺陷发生率(χ~2=34.0,P<0.05);农村出生缺陷发生率显著高于城市(χ~2=34.0,P<0.05);春夏秋冬季出生缺陷发生率不同(χ~2=10.73,P<0.05);缺陷儿家庭居住环境中有无河流,显示二者差异没有统计学意义(χ~2=0.68,P﹥0.05);有污染源的家庭出生缺陷发生率明显高于无污染源家庭(χ~2=16.2,P<0.05)。对1:1配对病例对照研究资料分析:有统计学意义的危险因素是:家庭附近有污染(OR=5.18)父母近亲结婚(OR= 12.37)有生育畸形儿史(OR=2.52)、孕育期接触有害物质(OR=10.81)、孕育期用药(OR= 3.27)、孕育期接触宠物(OR= 4.26)、父亲吸烟(OR= 1.95)与出生缺陷的发生有关。
结论:蚌埠市的出生缺陷发生率为5.29%,与国内外的发生率相一致。家庭附近有污染、父母近亲结婚、有生育畸形儿史、孕育期接触有害物质、孕育期用药、孕育期接触宠物、父亲吸烟是出生缺陷的危险因素。我们可以针对这些危险因素采取措施,降低出生缺陷的发生率。
Objective: To investigate the prevalence of birth defects of 0～5 years old children in Bengbu City, seek and identify some potential influential factors, explore the intervention measures, cut down the incidence, promote the health of people, and provide the scientific evidences for reaching aristogenesis.
Methods: Stratified random clustered sampling in proportion. There are 3 counties and 5 districts (except high-tech district) have 16,698 babies(their mothers are residents of investigated area when they were pregnant and delivered) born from midnight on July 1 in 2001 to 24 on June 30 in 2006. This investigation adopted 833 cases diagnosed as birth defects by final diagnosis or medical examination 833 controls matched by sex, age and inhabitance in urban and countryside. All the parents or folks from 833 couples of case-controls were investigated according to self-designed questionnaire, and the distribution of birth defects was described with frequency index.χ~2 test was used to compare discrepancy between sex, age, and town and country in order to detect possible risk factors such as fetus, inhabited environment, pollution around home, mother disease, exposures to medicine and poisons, and fathers’smoking etc. The questionnaire investigations on 565 couples of birth defects and controls were performed according to 1:1 matched case-control study. The single-variate and multivariate logistic regression models were adopted with help of SPSS software.
Result: Among 16,698 children of zero t five, 833 of BD cases are testified and BD rate is 883/16698=5.29%. There are 553 males, takes up 62.6% and 330 females, 37.4%, sex rate male: female=1.7:1. The difference between male and female has statistical meaning(χ~2=70.1 P<0.05); the first five birth deficiencies of 0~5 are angioma,innate heart disease, nevus,hernia, Congenital hydrocephalus , and occupy 43.49%of BD; comparing pregnant women of different age, the paper discovers that the differences in the birth defects rate have statistical meaning(χ~2=161.9,P<0.05):the age of 25~30 has lowest rate and age of no less than 35 has highest rate; double fetuses and multi-fetuses occur more often than single-fetus; birth defects rate in village is higher than that in town(χ~2=34.0,P<0.05); rates in spring, summer, autumn and winter respectively are 46.62%、49.51%、53.15、61.8% ; whether there is a river in living environment does not have statistical meaning(χ~2=0.68,P﹥0.05);birth defects in contaminated family is higher than that in non-contaminated one (χ~2=16.2 ,P<0.05);mother’s disease in early pregnancy takes up 30.4%of birth defects, especially upper respiration tract infection; medicines mother had in early pregnancy occupies13.3%, antibiotics in particular; among possible dangerous factors, pets is19.6%,pesticides7.5%;among the doubtful dangerous factors, cigars is 47.8%,alcohol 24.7%, pesticides 15.3%. A 1∶1 matched case-control study was conducted to investigate 565 pairs of cases and the control. The results of multiple regression model showed that the risk factors of BD were : domestic contamination(OR=5.18)consanguineous marriage(OR=12.37)bearing malformation child history(OR=2.52), exposure on harmful substance during pregnancy(OR=10.81), drug usage during pregnancy(OR= 3.27), pet contacting during pregnancy(OR= 4.26)father smoking(OR= 1.95)
Conclusion: The prevalence of birth defects in Bengbu City is 5.29%, which is consistent with that of home and abroad. The risk factors of birth defects chiefly contain pollution near home, consanguineous marriage, history breeding oaf, exposures to hazardous agent and medicine during pregnant period, and fathers’smoking. The interventions on these risk factors will be able to effectively decrease the incidence of birth defects.
引文
1.钟南.浅谈我国出生缺陷研究的现况与展望.中国优生优育2007,13(1)10—11.
2.黄越华.中国出生缺陷监测的现状.广西医学.2006,28(11):1745-1746
3.周凤荣,陈志欣,张蓬等.山东省围产儿出生缺陷危险因素的病例对照研究.中国儿童保健杂志,2005,13(5):398-400.
4. Kenneth D ,Kocharlek MA,Sh erry L,et al. Deaths: Leading Causes for 2002[J].National Vital Statistics Reports.2004,53(5):10-1.
5.中华人民共和国卫生部,中国残疾人联合会.中国提高出生人口素质、减少出生缺陷和残疾行动计划(2002-2010年).中国生育健康杂志,2002,13:98-101.
6. Kenneth D ,Kocharlek MA,Sh erry L,et al. Deaths: Leading Causes for 2002[J].National Vital Statistics Reports.2004,53(5):10-1.
7.罗家有.我国出生缺陷干预的现状与发展趋势.实用预防医学2005,12(2):458-459
1.董丽媛,王华,张月莲.太原地区12375例围产儿出生缺陷分析.中国优生与遗传杂志,2007;15(3):80-81.
2. Rosano A, Botto L D,Botting B,et al.Infant morality and congenital anomalies from 1950 to 1994: an international perspective.J Epidemiol Community Health, 2000; 54: 660 - 666 .
3.中华人民共和国卫生部,中国残疾人联合会.中国提高出生人口素质、减少出生缺陷和残疾行动计划(2002-2010年).中国生育健康杂志,2002;13:98-101.
4.钟南.浅谈我国出生缺陷的研究与展望.中国优生优育,2007;13(1):10-11.
5.黄越华.中国出生缺陷监测的现状,广西医学,2006;28(11):1745-1747
6.朱文丽,刀京晶,成君,等.血清同型半胱氨酸及叶酸水平与先天性心脏病的关系.卫生研究.34(6):740-743
7.唐贵忠.我国人口出生缺陷状况及干预措施的分析.中国妇幼保健,2001,16,(7):408.
8.张小平,梁艳,刘淑芳,等.围产儿42272名出生缺陷分析.中国儿童保健杂志,2004,12(3):259-261.
9. Kao H F, Liang H M, Ou C Y, et al.Twin pregnancy with gastroschisis in both twins. Taiwan J Obstet Gynecol. 2007 ; 46(4): 414-6.
10. Lee Y M, Wylie B J, Simpson L L, et al. Twin chorionicity and the risk of stillbirth. Obstet Gynecol. 2008 ; 111(2 Pt 1):301-308.
11.王梦芳,李冬凤,王善英.芜湖县2002-2005年3 033例围生儿出生缺陷监测结果与分析.皖南医学院学报,2007,26(1):74-76.
12. Wang L, Pinkerton K E. Air pollutant effects on fetal and early postnatal development. Birth Defects Res C Embryo Today. 2007;81(3):144-154.
13. Bérard A, Ramos E, Rey E, et al. First trimester exposure to paroxetine and riskof cardiac malformations in infants: the importance of dosage. Birth Defects Res B Dev Reprod Toxicol. 2007;80(1):18-27.)
14. Carter TC, Druschel CM, Romitti PA, Antifungal drugs and the risk of selected birth defects. Am J Obstet Gynecol. 2008 Feb;198(2):191.e1-7.
15.周凤荣,陈志欣,张蓬,等.山东省围产儿出生缺陷危险因素的病例对照研究.中国儿童保健杂志,2005,13(5):398-400.
16. Halac M, Ergul N, Sager S, Demir A, Buyukpinarbasli N, Sonmezoglu K. PET/ CT findings in a multicentric form of Castleman's disease. Hell J Nucl Med. 2007; 10 (3) : 172– 4.
17. Dwyer J B, Broide R S, Leslie F M. Nicotine and brain development. Birth Defects Res C Embryo Today. 2008;84(1):30-44.
18.于向民,潘晓亮,闫凤霞.被动吸烟对胚胎致畸作用的研究和致畸动物模型的建立.中国优生与遗传杂志,2006,14(6):89-90.
19.袁雪,王惠珊,闰淑娟,等.10665名儿童先天性心脏病发病状况监测结果和环境危险因素分析.中国妇幼保健,2006,21(6):781-783.
1.钟南.浅谈我国出生缺陷研究的现况与展望[R].中国优生优育2007,13(1)10—11.
2.周凤荣,陈志欣,张蓬等.山东省围产儿出生缺陷危险因素的病例对照研究[J].中国儿童保健杂志,2005,13(5):398-400.
3.覃丹丹,仇小强,曾小云等.围产儿出生缺陷危险因素的Logistic配对研究[J].中国计划生育学杂志2007,5(139):1061—2..
4.郑晓瑛,景枫,李成福等.无锡市出生缺陷发生的主要环境危险因素[R].中国计划生育学杂志.2007,5:273—5.
5.仇小强,覃丹丹,曾小云等.广西少数民族出生缺陷危险因素的危险度评价和干预研究[J].中国优生与遗传杂志.2003,11(6):119-21.
6.修晓燕,张荣莲,陈起燕.出生缺陷的研究进展[R].中国妇幼健康研究,2007,18(5):400-2.
7. Finckenstein FG, Davicionj E, Osborn KG, et al. Transgenic mice expressing PAX3一FKHR have multiple defects in muscle development, including ectopic skeletal myogenesis in the developing neural tube. Transgenic Research, 2006,15(5): 595-614
8. Mosayebi Z, Movahedian AH. Pattern of congenital malformations in consanguineous versus nonconsanguineous marriages in Kashan, Islamic Republic of Iran[J]. East Mediterr Health J. 2007 Jul-Aug;13(4):868-75.
9. Seliem MA, Bou-Holaigah IH, Al-Sannaa N. Influence of consanguinity on the pattern of familial aggregation of congenital cardiovascular anomalies in an outpatient population: studies from the eastern province of Saudi Arabia[J]. Community Genet. 2007;10(1):27-31.
10. Hemminki E,Gissler M,Toukomaa H .Exposure to female hormone drugsduring pregnancy:effect on malformations and cance r[J].Br J Cancer,1 999,80:1092-7.
11. Honein MA, Rasmussen SA, Reefhuis J, et al. Maternal smoking and environmental tobacco smoke exposure and the risk of orofacial clefts. Epidemiology. 2007,18(2):226-233
12.冯玉荣,关世平,张秀英等.出生缺陷与生育年龄关系调查分析[J],中国优生与遗传杂志,2001 ,9(4):92-93
13.王太晗,张明伦,康华等.571例出生病残儿童的多因素调查分析[J],中华综合临床医学杂志,2005,7(6):7-9
1.Lenz W, et al. Arch Environ Health, 1962, 5:100
2.陈佳鹏,宋新明,陈功,等.欧洲关于产前检查并终止妊娠对出生缺陷监测发生率影响的资料分析.中国计划生育学杂志. 2006,6:345-347.
3.March of Dimes. Global report on birth defects: the hidden toll of dying and disabled children, 2006: 3-4
4.黄越华.中国出生缺陷监测现状.广西医学.2006,28(11):
5.郑晓瑛.中国出生人口质量的现状与干预途径.中国人口科学,2000,6
6.Song XM, Zheng XY, Zhu WL, et aI. Relationship between polymorphism of crystathjonine beta synthase gene and congenital heart diseases in Chinese nuclear families. Biomedical and Environmental Sciences. 2006,19(6):452-456.
7. Finckenstein FG, Davicionj E, Osborn KG, et al. Transgenic mice expressing PAX3一FKHR have multiple defects in muscle development, including ectopic skeletal myogenesis in the developing neural tube. Transgenic Research, 2006,15(5):595-614
8. Toso L, Roberson R, Abebe D. Neuroprotective peptides prevent some alcohol-induced alteration in gamma-aminobutyric acid A-beta3, which plays a role in cleft lip and palate and learning in fetal alcohol syndrome. American Journal of Obstetrics and Gynecology. 2007, 196(3):259-265.
9.王志新等.同济医科大学学报.1996,25(5):382-385
10. Abe T, et al. Nippon Rinsho, 1997,55(4):865-869
11.郝晶,高英茂,马金龙,等.神经生长因子及其受体与高温致神经管畸形关系的研究.山东医科大学学报. 2000,38(2):
12.于丽,管英俊,高英茂,等.热休克蛋白在高温致神经管畸形中的表达.中国组织化学与细胞化学杂志. 2003,12(2):171-174
13.马金龙,高英茂,刘凯,等.Bcl-2、Bax在高温致神经管畸形发生中的表达.山东大学学报(医学版).2005,43(9):
14. Edwards MJ. Review :Hyperthermia and fever during pregency. Birth defects research. Part A Clinical and Molecular Teratology, 2006,76(7):507-516.
15. Nelson BK, Moorman WJ, Schrader SM, et al. Paternal exposure of rabbits to lead: behavioral deficits in offspring. Neurotoxicol Teratol. 1997, May-Jun;19(3): 191-8.
16. Irgens A, Kruger K, Skorve AH, Irgens LM. Reproductive outcome in offspring of parents occupationally exposed to lead in Norway. Am J Ind Med. 1998, Nov; 34(5): 431-7.
17.Lorente C,et al.Am J Public Health,2000,90(3):415-419
18. Cordier S,et al.Epidemiology, 1997,8(4):355-363
19. Brender JD, Zhan FB, Langlois PH,et al. Residential proximity to waste sites and industrial facilities and chromosomal anomalies in offspring. Int J Hyg Environ Health, 2007,4(28):778-784.
20.Singh ND, Sharma AK, Dwivedi P, et al. Citrini and endosulfan induced eratogenic effects in Wistar rats. Journal of Applied Toxicology. 2007,27(2):143-151.
21.张英骅等.微量元素与健康研究,1999,16(1):37-39
22.Carmichael SL, Shaw GM, Laurent C, et al. Maternal progestin intake and risk of hypospadias. Archives of Pediatrics & Adolescent Medicine,2005,195(10); 957-962
23. Watts DH, Li D, Handelsman E, et al. Assessment of birth defects according to maternal therapy among infants in the women and infants transmission study. Journal of Acquired Immune Defects Syndrome,2007,44(3):299-305
24. Berard A, Ramos E, Rey E, et al. First trimester exposure to paroxetine and risk of cardiac malformations in infants:The importance of dosage. Birth Defects Res B Dev Reprod Toxicol,2007,80(11):8-27
25.张学君,李守祥,刘东霞.辐射诸因素致畸胎儿的回顾性分析.中国辐射卫生.2005,14(2):99
26.任霞,李勇.维生素A与出生缺陷的研究进展.中国生育健康杂志,2004, 15 (6):372-375
27.朱文丽,刀京晶,成君,等.血清同型半胱氨酸及叶酸水平与先天性心脏病的关系.卫生研究.34(6):740-743
28.李智文.叶酸与人类先天畸形.中国生育健康杂志.2003,14(6):374-378
29.李竹,Robert Berry,等.中国妇女妊娠前后单纯服用叶酸对神经管畸形的预防效果.中华医学杂志.2000,80(7):493-498
30.Itikala PR, Watkins ML, Mulinare J,et al. Maternal multivitamin use and orofacial clefts in offspring. Teratology, 2001, 63(2):79-86
31. Shaw GM, Carmichael SL, Laurent C, et al. Maternal nutrient intakes and risk of orofacial clefts. Epidemiology 2006, 17(3):285-291
32. Bauer CR, Langer JC, Shankaren S, et al. Acute neonatal effects of cocaine expos- ure during pregnancy. Arch Pediatr Adolesc Med, 2005,159(9):824-834
33. Behnke M, Eyler FD, Garvan CW, et al. The search for congenital malformations in newborns with fetal cocaine exposure. Pediatrics. 2001,107(5):E74
34.曹泽毅主编.中华妇产科学.北京:人民卫生出版社,1999.729
35.Banhidy F, Acs N, Horvath PE, et al. Maternal severe migraine and risk of congen-ital limb deficiencies. Birth Defects Research: Part A Clinical and Molecular Teratology, 2006,76(8):592-601
36. Honein MA, Rasmussen SA, Reefhuis J, et al. Maternal smoking and environmental tobacco smoke exposure and the risk of orofacial clefts. Epidemiology.2007,18(2):226-233
37. Jensen MS, Toft G, Thulstrup AM, et al. Cryptorchildism according to maternal gestational smoking. Epidemiology.2007,218(3):238-348
38. Costa CM, Da Gama SG, Leal MC. Congenital malformations in Rio de Janeiro, Brazil: Prevalence and associated factors. Cademos Desaude Publica, 2006, 22(11): 2423-2431
39. Weinstock M. Alterations induced by gestational stress in brain morphology and behaviour of the offspring. Prog Neurobiol. 2001,65(5):427-451
40.沈玉华.10766例围生儿出生缺陷监测分析.现代临床医学.2005,31(3):173
41. Gareskog M, Eriksson UJ, Wentzel P. Combined supplementation of folic acid and vitamin E diminishes diabetes-induced embryotoxicity in rats. Birth defects resear- ch. Part A Clinical and Molecular Teratology. 2006,76(6):483-490
42. Neggers YH, Singh J. Zinc supplementation to protein-deficient diet in CO-exposed mice decreased fetal mortality and malfor-mation. Biological Trace Element Research. 2006,114(1-3):269-279
43.章斐然,诸华,陆渊源,等.产前检查与围产儿死亡的关系.中国生育健康杂志,2004,15(3):150-153
44.孙晓光,金利娜,甄景然,等.标准产前检查模式的依从性和效果.2005,27(6): 725-728
45.刘岚译.产前保健有效预防孕产妇死亡和严重疾病的证据概述.生殖与避孕, 2005,25(4):242-247
46.全国妇幼卫生监测及年报资料汇编(2004-2005).2005.29
47. Kooper AJ, De Bruijn, Van Ravenwaaij ACM, et al. Fetal anomaly scan potentially will replace routine AFAFP assays for the detection of neural tube defects. Prenatal dia-gnosis,2007,27(1):86-87
48. Christiansen M, Sorensen TL, Norgaard PB. Human placental lactogen is a firsttri- mester maternal serum marker of down syndrome. Prenatal Diagnosis, 2007, 27(1): 1-5
49.世界其他国家的婚检制度.新华网.2005年9月17日.
50.刘丹,马丽明,阳健.佛山市7071例婚前医学检查结果分析.实用预防医学, 2003,10(4);569-570
51.毛康娜,等.1996-2003海淀区婚前医学检查结果分析.中国妇幼保健.2005, 20(18):2321-2322.
52.孙莉.甘肃省1997-2001婚前医学检查结果分析.中国妇幼保健,2005,20(6): 738-739
53.李海龙,等.1999-2002年杭州萧山区婚前医学检查情况报告.2000,5(2):127- 129
54.宋清华. 2832例涉外婚前医学检查资料分析.中国妇幼保健,2003,18(5):274- 276
55.张玉侠,战燕,彭卫焕,等.胶州市婚前医学检查与出生缺陷发生率关系的研究.中国妇幼保健,2005,20(9):1148
56.岑汉群,苏丽.婚前医学检查与围产儿出生缺陷.海南医学.2005,16(7):164- 168
2.黄越华.中国出生缺陷监测的现状.广西医学.2006,28(11):1745-1746
3.周凤荣,陈志欣,张蓬等.山东省围产儿出生缺陷危险因素的病例对照研究.中国儿童保健杂志,2005,13(5):398-400.
4. Kenneth D ,Kocharlek MA,Sh erry L,et al. Deaths: Leading Causes for 2002[J].National Vital Statistics Reports.2004,53(5):10-1.
5.中华人民共和国卫生部,中国残疾人联合会.中国提高出生人口素质、减少出生缺陷和残疾行动计划(2002-2010年).中国生育健康杂志,2002,13:98-101.
6. Kenneth D ,Kocharlek MA,Sh erry L,et al. Deaths: Leading Causes for 2002[J].National Vital Statistics Reports.2004,53(5):10-1.
7.罗家有.我国出生缺陷干预的现状与发展趋势.实用预防医学2005,12(2):458-459
1.董丽媛,王华,张月莲.太原地区12375例围产儿出生缺陷分析.中国优生与遗传杂志,2007;15(3):80-81.
2. Rosano A, Botto L D,Botting B,et al.Infant morality and congenital anomalies from 1950 to 1994: an international perspective.J Epidemiol Community Health, 2000; 54: 660 - 666 .
3.中华人民共和国卫生部,中国残疾人联合会.中国提高出生人口素质、减少出生缺陷和残疾行动计划(2002-2010年).中国生育健康杂志,2002;13:98-101.
4.钟南.浅谈我国出生缺陷的研究与展望.中国优生优育,2007;13(1):10-11.
5.黄越华.中国出生缺陷监测的现状,广西医学,2006;28(11):1745-1747
6.朱文丽,刀京晶,成君,等.血清同型半胱氨酸及叶酸水平与先天性心脏病的关系.卫生研究.34(6):740-743
7.唐贵忠.我国人口出生缺陷状况及干预措施的分析.中国妇幼保健,2001,16,(7):408.
8.张小平,梁艳,刘淑芳,等.围产儿42272名出生缺陷分析.中国儿童保健杂志,2004,12(3):259-261.
9. Kao H F, Liang H M, Ou C Y, et al.Twin pregnancy with gastroschisis in both twins. Taiwan J Obstet Gynecol. 2007 ; 46(4): 414-6.
10. Lee Y M, Wylie B J, Simpson L L, et al. Twin chorionicity and the risk of stillbirth. Obstet Gynecol. 2008 ; 111(2 Pt 1):301-308.
11.王梦芳,李冬凤,王善英.芜湖县2002-2005年3 033例围生儿出生缺陷监测结果与分析.皖南医学院学报,2007,26(1):74-76.
12. Wang L, Pinkerton K E. Air pollutant effects on fetal and early postnatal development. Birth Defects Res C Embryo Today. 2007;81(3):144-154.
13. Bérard A, Ramos E, Rey E, et al. First trimester exposure to paroxetine and riskof cardiac malformations in infants: the importance of dosage. Birth Defects Res B Dev Reprod Toxicol. 2007;80(1):18-27.)
14. Carter TC, Druschel CM, Romitti PA, Antifungal drugs and the risk of selected birth defects. Am J Obstet Gynecol. 2008 Feb;198(2):191.e1-7.
15.周凤荣,陈志欣,张蓬,等.山东省围产儿出生缺陷危险因素的病例对照研究.中国儿童保健杂志,2005,13(5):398-400.
16. Halac M, Ergul N, Sager S, Demir A, Buyukpinarbasli N, Sonmezoglu K. PET/ CT findings in a multicentric form of Castleman's disease. Hell J Nucl Med. 2007; 10 (3) : 172– 4.
17. Dwyer J B, Broide R S, Leslie F M. Nicotine and brain development. Birth Defects Res C Embryo Today. 2008;84(1):30-44.
18.于向民,潘晓亮,闫凤霞.被动吸烟对胚胎致畸作用的研究和致畸动物模型的建立.中国优生与遗传杂志,2006,14(6):89-90.
19.袁雪,王惠珊,闰淑娟,等.10665名儿童先天性心脏病发病状况监测结果和环境危险因素分析.中国妇幼保健,2006,21(6):781-783.
1.钟南.浅谈我国出生缺陷研究的现况与展望[R].中国优生优育2007,13(1)10—11.
2.周凤荣,陈志欣,张蓬等.山东省围产儿出生缺陷危险因素的病例对照研究[J].中国儿童保健杂志,2005,13(5):398-400.
3.覃丹丹,仇小强,曾小云等.围产儿出生缺陷危险因素的Logistic配对研究[J].中国计划生育学杂志2007,5(139):1061—2..
4.郑晓瑛,景枫,李成福等.无锡市出生缺陷发生的主要环境危险因素[R].中国计划生育学杂志.2007,5:273—5.
5.仇小强,覃丹丹,曾小云等.广西少数民族出生缺陷危险因素的危险度评价和干预研究[J].中国优生与遗传杂志.2003,11(6):119-21.
6.修晓燕,张荣莲,陈起燕.出生缺陷的研究进展[R].中国妇幼健康研究,2007,18(5):400-2.
7. Finckenstein FG, Davicionj E, Osborn KG, et al. Transgenic mice expressing PAX3一FKHR have multiple defects in muscle development, including ectopic skeletal myogenesis in the developing neural tube. Transgenic Research, 2006,15(5): 595-614
8. Mosayebi Z, Movahedian AH. Pattern of congenital malformations in consanguineous versus nonconsanguineous marriages in Kashan, Islamic Republic of Iran[J]. East Mediterr Health J. 2007 Jul-Aug;13(4):868-75.
9. Seliem MA, Bou-Holaigah IH, Al-Sannaa N. Influence of consanguinity on the pattern of familial aggregation of congenital cardiovascular anomalies in an outpatient population: studies from the eastern province of Saudi Arabia[J]. Community Genet. 2007;10(1):27-31.
10. Hemminki E,Gissler M,Toukomaa H .Exposure to female hormone drugsduring pregnancy:effect on malformations and cance r[J].Br J Cancer,1 999,80:1092-7.
11. Honein MA, Rasmussen SA, Reefhuis J, et al. Maternal smoking and environmental tobacco smoke exposure and the risk of orofacial clefts. Epidemiology. 2007,18(2):226-233
12.冯玉荣,关世平,张秀英等.出生缺陷与生育年龄关系调查分析[J],中国优生与遗传杂志,2001 ,9(4):92-93
13.王太晗,张明伦,康华等.571例出生病残儿童的多因素调查分析[J],中华综合临床医学杂志,2005,7(6):7-9
1.Lenz W, et al. Arch Environ Health, 1962, 5:100
2.陈佳鹏,宋新明,陈功,等.欧洲关于产前检查并终止妊娠对出生缺陷监测发生率影响的资料分析.中国计划生育学杂志. 2006,6:345-347.
3.March of Dimes. Global report on birth defects: the hidden toll of dying and disabled children, 2006: 3-4
4.黄越华.中国出生缺陷监测现状.广西医学.2006,28(11):
5.郑晓瑛.中国出生人口质量的现状与干预途径.中国人口科学,2000,6
6.Song XM, Zheng XY, Zhu WL, et aI. Relationship between polymorphism of crystathjonine beta synthase gene and congenital heart diseases in Chinese nuclear families. Biomedical and Environmental Sciences. 2006,19(6):452-456.
7. Finckenstein FG, Davicionj E, Osborn KG, et al. Transgenic mice expressing PAX3一FKHR have multiple defects in muscle development, including ectopic skeletal myogenesis in the developing neural tube. Transgenic Research, 2006,15(5):595-614
8. Toso L, Roberson R, Abebe D. Neuroprotective peptides prevent some alcohol-induced alteration in gamma-aminobutyric acid A-beta3, which plays a role in cleft lip and palate and learning in fetal alcohol syndrome. American Journal of Obstetrics and Gynecology. 2007, 196(3):259-265.
9.王志新等.同济医科大学学报.1996,25(5):382-385
10. Abe T, et al. Nippon Rinsho, 1997,55(4):865-869
11.郝晶,高英茂,马金龙,等.神经生长因子及其受体与高温致神经管畸形关系的研究.山东医科大学学报. 2000,38(2):
12.于丽,管英俊,高英茂,等.热休克蛋白在高温致神经管畸形中的表达.中国组织化学与细胞化学杂志. 2003,12(2):171-174
13.马金龙,高英茂,刘凯,等.Bcl-2、Bax在高温致神经管畸形发生中的表达.山东大学学报(医学版).2005,43(9):
14. Edwards MJ. Review :Hyperthermia and fever during pregency. Birth defects research. Part A Clinical and Molecular Teratology, 2006,76(7):507-516.
15. Nelson BK, Moorman WJ, Schrader SM, et al. Paternal exposure of rabbits to lead: behavioral deficits in offspring. Neurotoxicol Teratol. 1997, May-Jun;19(3): 191-8.
16. Irgens A, Kruger K, Skorve AH, Irgens LM. Reproductive outcome in offspring of parents occupationally exposed to lead in Norway. Am J Ind Med. 1998, Nov; 34(5): 431-7.
17.Lorente C,et al.Am J Public Health,2000,90(3):415-419
18. Cordier S,et al.Epidemiology, 1997,8(4):355-363
19. Brender JD, Zhan FB, Langlois PH,et al. Residential proximity to waste sites and industrial facilities and chromosomal anomalies in offspring. Int J Hyg Environ Health, 2007,4(28):778-784.
20.Singh ND, Sharma AK, Dwivedi P, et al. Citrini and endosulfan induced eratogenic effects in Wistar rats. Journal of Applied Toxicology. 2007,27(2):143-151.
21.张英骅等.微量元素与健康研究,1999,16(1):37-39
22.Carmichael SL, Shaw GM, Laurent C, et al. Maternal progestin intake and risk of hypospadias. Archives of Pediatrics & Adolescent Medicine,2005,195(10); 957-962
23. Watts DH, Li D, Handelsman E, et al. Assessment of birth defects according to maternal therapy among infants in the women and infants transmission study. Journal of Acquired Immune Defects Syndrome,2007,44(3):299-305
24. Berard A, Ramos E, Rey E, et al. First trimester exposure to paroxetine and risk of cardiac malformations in infants:The importance of dosage. Birth Defects Res B Dev Reprod Toxicol,2007,80(11):8-27
25.张学君,李守祥,刘东霞.辐射诸因素致畸胎儿的回顾性分析.中国辐射卫生.2005,14(2):99
26.任霞,李勇.维生素A与出生缺陷的研究进展.中国生育健康杂志,2004, 15 (6):372-375
27.朱文丽,刀京晶,成君,等.血清同型半胱氨酸及叶酸水平与先天性心脏病的关系.卫生研究.34(6):740-743
28.李智文.叶酸与人类先天畸形.中国生育健康杂志.2003,14(6):374-378
29.李竹,Robert Berry,等.中国妇女妊娠前后单纯服用叶酸对神经管畸形的预防效果.中华医学杂志.2000,80(7):493-498
30.Itikala PR, Watkins ML, Mulinare J,et al. Maternal multivitamin use and orofacial clefts in offspring. Teratology, 2001, 63(2):79-86
31. Shaw GM, Carmichael SL, Laurent C, et al. Maternal nutrient intakes and risk of orofacial clefts. Epidemiology 2006, 17(3):285-291
32. Bauer CR, Langer JC, Shankaren S, et al. Acute neonatal effects of cocaine expos- ure during pregnancy. Arch Pediatr Adolesc Med, 2005,159(9):824-834
33. Behnke M, Eyler FD, Garvan CW, et al. The search for congenital malformations in newborns with fetal cocaine exposure. Pediatrics. 2001,107(5):E74
34.曹泽毅主编.中华妇产科学.北京:人民卫生出版社,1999.729
35.Banhidy F, Acs N, Horvath PE, et al. Maternal severe migraine and risk of congen-ital limb deficiencies. Birth Defects Research: Part A Clinical and Molecular Teratology, 2006,76(8):592-601
36. Honein MA, Rasmussen SA, Reefhuis J, et al. Maternal smoking and environmental tobacco smoke exposure and the risk of orofacial clefts. Epidemiology.2007,18(2):226-233
37. Jensen MS, Toft G, Thulstrup AM, et al. Cryptorchildism according to maternal gestational smoking. Epidemiology.2007,218(3):238-348
38. Costa CM, Da Gama SG, Leal MC. Congenital malformations in Rio de Janeiro, Brazil: Prevalence and associated factors. Cademos Desaude Publica, 2006, 22(11): 2423-2431
39. Weinstock M. Alterations induced by gestational stress in brain morphology and behaviour of the offspring. Prog Neurobiol. 2001,65(5):427-451
40.沈玉华.10766例围生儿出生缺陷监测分析.现代临床医学.2005,31(3):173
41. Gareskog M, Eriksson UJ, Wentzel P. Combined supplementation of folic acid and vitamin E diminishes diabetes-induced embryotoxicity in rats. Birth defects resear- ch. Part A Clinical and Molecular Teratology. 2006,76(6):483-490
42. Neggers YH, Singh J. Zinc supplementation to protein-deficient diet in CO-exposed mice decreased fetal mortality and malfor-mation. Biological Trace Element Research. 2006,114(1-3):269-279
43.章斐然,诸华,陆渊源,等.产前检查与围产儿死亡的关系.中国生育健康杂志,2004,15(3):150-153
44.孙晓光,金利娜,甄景然,等.标准产前检查模式的依从性和效果.2005,27(6): 725-728
45.刘岚译.产前保健有效预防孕产妇死亡和严重疾病的证据概述.生殖与避孕, 2005,25(4):242-247
46.全国妇幼卫生监测及年报资料汇编(2004-2005).2005.29
47. Kooper AJ, De Bruijn, Van Ravenwaaij ACM, et al. Fetal anomaly scan potentially will replace routine AFAFP assays for the detection of neural tube defects. Prenatal dia-gnosis,2007,27(1):86-87
48. Christiansen M, Sorensen TL, Norgaard PB. Human placental lactogen is a firsttri- mester maternal serum marker of down syndrome. Prenatal Diagnosis, 2007, 27(1): 1-5
49.世界其他国家的婚检制度.新华网.2005年9月17日.
50.刘丹,马丽明,阳健.佛山市7071例婚前医学检查结果分析.实用预防医学, 2003,10(4);569-570
51.毛康娜,等.1996-2003海淀区婚前医学检查结果分析.中国妇幼保健.2005, 20(18):2321-2322.
52.孙莉.甘肃省1997-2001婚前医学检查结果分析.中国妇幼保健,2005,20(6): 738-739
53.李海龙,等.1999-2002年杭州萧山区婚前医学检查情况报告.2000,5(2):127- 129
54.宋清华. 2832例涉外婚前医学检查资料分析.中国妇幼保健,2003,18(5):274- 276
55.张玉侠,战燕,彭卫焕,等.胶州市婚前医学检查与出生缺陷发生率关系的研究.中国妇幼保健,2005,20(9):1148
56.岑汉群,苏丽.婚前医学检查与围产儿出生缺陷.海南医学.2005,16(7):164- 168