| Objective To investigate preliminarily current prenatal monitoring situation for birth defects,and evaluate the significance of current prenatal monitoring protocol in preventing and diagnosing birth defects by retrospective analysis of 150 birth defects,in order to decrease incidence rate of babies with birth defects by establishing a clinical guidance for ante partum monitoring.Methods Prenatal-surveillance information of 450 babies were analyzed retrospectively,among which 150 babies with birth defects were enrolled as case group and the normal ones served as control group.Case control study was used for analyzing.Descriptive statistics were used to describe the epidemic characters of the cases;quantitative data was analyzed by McNemar' s chisqtest and binomial distribution.Single factor and multi-factor logistic regression were employed to explore the main risk factors of birth defect.Results:1,general information:Gravidae in case group were older than that in control group(28.5±4.47 VS 26.1±3.68,P=0.000 ),yet their husbands were younger than that in controls(30.7±4.54 VS 32.1 4.19,p=0.001).The ratio of reguhr antepartum clinical visiting,passive smoking,pregnancy complications between the case group and control group were respectively 41.3%VS64.3%, 60.7%VS35.3%and 28.7%VS 15.7%(p＜0.01).The lower the educational degrees of gravidae were,the higher the incidence rate of birth defects would occur(p=0.000, OR=0.447).2.Among these 450 cases,there are 276 had done this screening, Screening rate was 61.3%(276/450),Down's high-risk positive rate was 9.1% (25/276),the false positive rate was 8.7%[(25-1) /(276-1)],and the specificity was 91.2%(250/274).Among 13 babies with neural tube defects and three with Down's syndrome,only two had done this antepartum check-up,one with open neural tube defects was detected,the other with hidden spina bifida was missed,the difference of Down's high-risk positive rate between two groups was not statistically significant.3,TORCH:screening rate of 54%(243/450),positive rate of TORCH infection in case group was 14.8%(9 / 61),it was 2.2%(4 / 182) in controls,the difference was statistically significant(p = 0.000).4,anemia:the difference of degree on anemia was significant(p = 0.001) between two groups,the more severe anemia was,the higher the incidence rate of birth defects would occur by the Logistic regression analysis.5,B-mode ultrasound:132 had done this prenatal examination,the rate of check-up was 88%(132/150),tbere was 93 detected,the masculine rate of ultrasonic diagnosis was 70.2%(93/132),the rate of missed diagnosis ultrasonic diagnosis was 29.8%(39/132).Missed diagnosis of disease was of hypospadias,hyperdactylia and other small defects.6,glucose tolerance test: the screening rate Glucose tolerance test was 66.4%(299/450),those were 48.0%and 75.7%respectively in case groups and the control group,The masculine rate of carbohydrate tolerance test were 19.4%and 7.0%respectively, those had conspicuous statistical significance between the two groups(p=0.002).7, thalassemia:The screening rate of thalassemia was 62%(279/450),and the masculine rate of it was 2.2%(6/279).Conclusions 1.Many factors are associated with babies' birth defects, including elder pregnant age,lower educational,degrees,the more severe the degree of anemia,no regular antepartum visiting,having pregnancy complications and passive smoking,but in a specific age range,the older the husband were,the higher the incidence rate of birth defects would occur(p=0.000,OR=0.447).and foetus sex;occupation,blood type,masculine in HbsAg,gravidity,URI in pregnant nonage,season of LMP had no significant correlation.2,the screening of down's syndrome had low rate with the babies who had down's syndrome or neural tube defects,and it did not show significant screening to other types of birth defects.4,B-mode ultrasound had shared an important role on the detection of birth defects,but it missing rate was still as high as 30 percent,especially in those minor type. |
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