A 1:1 Matched Case-control Study On Neonatal Malformation In A Certain Area Of Hubei Province

Objective: To describe the epidemiological characteristics of congenital malformations of newborns in a certain area of Hubei Province,and to explore the risk factors of congenital malformations of newborns in this area,so as to provide scientific reference for effectively controlling and reducing the incidence of congenital malformations of newborns in this area.Methods: The subjects were 4462 live births with heart and other malformations delivered in four leading specialist or general hospitals in the region from January 1,2013 to December 30,2017.They were defined as case group.A 1:1 matched design was used to collect neonatal information and B data from live births without defects within 7 days of gestational age difference in the same hospital as control group.Ultrasound diagnosis reports and other basic information,and pregnant women and their spouses before pregnancy and early pregnancy environmental exposure,life behavior and other questionnaires.After eliminating the incomplete information or refusing to accept the questionnaire,3886 pairs of subjects were included in this study.A paired case-control study was used to conduct conditional logistic regression analysis of single and multiple factors.Results:(1)The population of the study area is about 360,000.From January 1,2013 to December 30,2017,a total of 65,149 pregnant women were collected in four county hospitals,including 4462 cases of malformation and 6.85% of the cases.217 cases of induced labor due to medical needs(including 98 cases of fetal intrauterine growth arrest).Among 4462 live births,3513(78.75%)had cardiac malformations,and the incidence of cardiac malformations accounted for about 5.39% of the total number of newborns.The incidence of cardiac malformations in this area was much higher than that reported in other areas in China.(2)Of the 3886 newborns with congenital malformations included in this study,3235(83.25%)had cardiac malformations.Atrial septal defect + ventricular septal defect(30.31%),ventricular septal defect + patent foramen ovale(19.68%)and atrial septal defect(10.73%).There were 600 other malformations including urinary system malformations,spinal and limb malformations,cleft lip,palate and foot varus.The main malformations were urinary system malformations(5.51%),followed by spine,limb malformations(5.32%)and cleft lip and jaw(1.32%).There were 23 cases(1.31%)of newborns with malformations,mainly heart malformations with other malformations.The total number of female newborns was higher than that of male.(3)Univariate analysis showed that the residence of the case group was located in groundwater contaminated area,folic acid and vitamin B12 supplementation in early pregnancy,pets in the first three months of pregnancy and early pregnancy,smoking or alcohol abuse in the first three months of pregnancy and early pregnancy by spouses,high fever exposure in the first three months of pregnancy and early pregnancy,noise exposure in the early pregnancy,pregnant women and spouses.There were significant differences in exposure to radiation environment in the first three months of pregnancy and early pregnancy,heavy metals(lead,arsenic,cadmium,mercury,chromium,etc.)in pregnant women and spouses,harmful gases in the first three months of pregnancy and early pregnancy(P < 0.05).(4)Multivariate conditional logistic stepwise regression analysis showed that living in contaminated areas(OR = 9.404,95% CI: 2.732~32.363),pregnant women in the first three months of pregnancy and early pregnancy were exposed to noise(OR = 3.179,95% CI: 2.049~5.461),pregnant women in the first three months of pregnancy and early pregnancy were exposed to radiation(OR = 2.557,95% CI: 1.087~19.923),the first three months of pregnancy and the first three months of pregnancy.Pregnant women in early pregnancy were exposed to high-fever working environment(OR = 1.198,95% CI: 1.158 ~ 4.681),heavy metals(lead,arsenic,cadmium,mercury,chromium,etc.)in the environment(OR = 19.098,95% CI: 3.096~21.655),smoking and alcoholism(OR = 1.577,95% CI: 1.171~7.005)in the first three months of pregnancy and in the first trimester of pregnancy(OR = 1.577,95% CI: 1.171~7.005),and exposure to heavy metals(OR = 19.098,95% CI: 3~21.655)in the first trimester Hazardous gases(OR = 2.436,95% CI: 1.568~ 6.447)were the risk factors of neural tube malformation in this area,while folic acid and vitamin B12 supplementation in early pregnancy were protective factors(OR = 0.018,95% CI: 0.003 ~ 0.122).Conclusions: Environmental pollution is an important risk factor for the occurrence of congenital malformation of newborns.While developing regional economy,congenital malformation of newborns caused by environmental pollution is a serious problem to be faced.Reducing and eliminating environmental pollution is of great public health significance to effectively control and reduce the incidence of congenital malformation of newborns.