Spatial Distribution And Analysis Of Influencing Factors On Adverse Pregnancy Outcomes

Objective:To understand the spatial distribution of Birth Defects(BDs)and Spontaneous Abortion(SA)in Xiping and Wenshang counties,and explore the influencing factors of BDs and SA.Methods:Create Thiessen polygon simulated village boundaries and visualize the occurrence of BDs and SA using ArcGIS software.Use GeoDa software to realize spatial Empirical Bayes smooth adjustment of the original incidence of BDs and SA,and perform global spatial autocorrelation and local spatial autocorrelation analysis mainly at the village level.Dimensionality reduction of the original indicators of influencing factors was realized through principal component analysis.Global spatial regression analysis and geographically weighted regression analysis were performed on the incidence of BDs and SA at the township level.The data of births,BDs and SA used were all from the Birth and Birth Defects Monitoring project of the Maternal and Child Health Center of China CDC.The environmental data used was mainly collected from Health Commission of Xiping County and Wenshang County coordinating the local CDC,township government and township health centers.Results:1.From 2014 to 2018,a total of 45,1 88 perinatal babies were collected in Xiping County,and 58,201 perinatal babies were collected in Wenshang County.The total BDs incidence rate in Xiping County was 259.36/10,000 and in Wenshang County was 242.95/10,000 from 2014 to 2018.From August 2017 to December 2018,the total SA incidence rate was 3.88%in Xiping County and 4.09%in Wenshang County.There were more boys than girls in children with BDs,and the incidence of premature birth for them was high.SA occurred mostly in early pregnancy,and the educational level of pregnant women was generally low.The mothers of children who suffered BDs and pregnant women who had miscarriages had a higher proportion of advanced age.2.The top five BDs from 2014 to 2018 in Xiping County were:congenital heart disease,other malformations of the external ear(except for small ears,no ears),umbilical hernia,multi-finger(toe),hydrocele;in Wenshang County were:congenital heart disease,other malformations of the external ear(except for small ears and no ears),undescended testicles(cryptotestis),multiple fingers(toes),and other deformities(specify the disease name or Detailed Description).3.The occurrence of BDs in Xiping County showed a clear increasing trend from northeast to southwest.There was a significant low aggregation in the northeast,and a significant high aggregation in the southwest.The occurrence of BDs in Wenshang County was significantly higher in the north than in the south.SA occurred mostly in the county seat and surrounding areas.4.From 2014 to 2018,the global spatial autocorrelation index(Moran’s I autocorrelation coefficient)of BDs and SA incidences in Xiping and Wenshang counties were all greater than 0,and both were statistically significant,indicating that the occurrence of BDs and SA had a space positive correlation,which meant spatial clustering.The results of local spatial autocorrelation analysis showed that the low-accumulation areas where BDs and SA occurred in Xiping County overlapped,mainly located in Renhe Township,Wugouying Town,and Jiaozhuang Township;both high and low accumulation areas where BDs and SA occurred in Wenshang County overlapped,high-accumulation overlapping areas mainly located in Ciqiu Town,Guolou Town,and Guocang Township,low-accumulation overlapping areas mainly located in Kangyi Town,Yiqiao Township,and Baishi Township.5.The results of global regression model analysis showed that the occurrence of BDs in Xiping County was related to economic conditions(In this study,it mainly referred to the local population and fiscal revenue).The better the economic conditions,the lower the incidence of BDs.The occurrence of BDs in Wenshang County was related to drinking water,environmental pollution,economic conditions,etc.The better the situation of economic and drinking water,the lower the incidence of BDs,and the more serious the environmental pollution,the higher the incidence of BDs.The statistically significance of effects of various factors on SA were not found.Geographically weighted regression results showed that the effect of economic on occurrence of BDs in Xiping County increased gradually from south to north;the spatial heterogeneity of the effects of factors on the occurrence of BDs in Wenshang County was not obvious.Conclusion:The distribution of gender,gestational age,mother’s age,and mother’s education level in the BDs and SA in the monitoring area had obvious regularity;the occurrence of BDs and SA had significant spatial clustering,and the clustering areas overlapped;the occurrence of BDs may be related to drinking water,environmental pollution,and economy,and there was spatial heterogeneity for the effects.No statistical significance was found in the impact of the above factors on SA.