摘要
目的系统评价出生缺陷的危险因素，为制定最佳预防控制决策，实行有效的干预措施、提供科学依据。方法搜集国内外近10—20年间关于出生危险因素的研究文献，根据文献纳入和排除标准先对其初步筛选，再通过文献质量评估对符合要求的数据进行定性和定量分析。对不同纳入结果进行敏感性分析；应用漏斗图、线性回归分析和失安全数综合评估研究文献的发表性偏倚。结果Meta分析结果表明：孕3个月内孕妇感冒或发热OR=7．64，95％CI：5．61—10．40；妊娠前后接触化学制剂OR=4．14，95％CI：2．88～5．95；孕期服药史OR：3．94，95％CI：2．25～6．88；辅助生殖技术OR=1．38，95％CI：1．28—1．48。累积Meta分析结果表明：所有时间点的Meta分析结果均具有显著性差异；敏感性分析结果与原结论相近；线性回归法表明在口=0．05检验水准上漏斗图对称有统计学意义，失安全数大于5k＋10，发表行偏倚得到了较好地控制。定性分析结果表明纳入文献的现有研究中关于中国人群与出生缺陷相关联的遗传、环境危险因素为：①先天疾患家族史；②既往出生缺陷史；③近亲结婚；④母亲及父亲方面的多种因素。结论按照Wynder标准：在中国人群中孕3个月内孕妇感冒或发热、妊娠前后接触化学制剂、孕期服药史与出生缺陷均呈中度相关，研究结果较真实地反映了我国近20年来出生缺陷环境危险因素的流行病学主要研究结果。在所有人群中辅助生殖技术与出生缺陷存在弱相关。纳入的关于遗传、环境因素的现有研究中未见或少见微波辐射、高温、孕母营养和体重、受孕季节、环境激素、家庭经济情况、孕期情绪以及父亲年龄等因素与出生缺陷发生风险的文献。
Objective To systematically evaluate risk factors of birth defects, so as to provide scientific basis for working out effective intervention measures and strategies of prevention and control for prevalence of birth defects. Methods The studies on risk factors of birth defects in recent 10 - 20 years in domestic and abroad were collected. The literatures were screened preliminarily according to inclusion and exclusion creteria and then quality evaluation was conducted to distill the data and qualitative and quantitative analyses were undertaken for the data which met criteria, and sensitivity analysis for different results was conducted. The funnel plot, linear regression and fail-safe number were used to evaluate the publishing bias of literatures studied. Results Meta-analysis showed that ORs and 95% Cls of cold or fever during the first trimester of pregnancy, contact with （ exposure to）chemicals before and after gestation, medication history of women during pregnancy and assisted reproductive technologies （ART） were 7.64, 5.61 - 10.40 ; 4.14, 2.88 -5.95 ; 3.94, 2.25 - 6.88 and 1.38, 1.28 - 1.48 respectively. The accumulated meta-analysis showed that there were significant differences in results of mata-analysis at all time points and sensitivity analysis results were close to the original conclusions. Linear regression showed that in funnel plot symmetry at significance level of a = 0.05 there was significant difference and the publishing bias was better controlled when fail-safe number was larger than 5k ＋ 10. The qualitative analysis showed that the risk factors in genetics and environment which correlated with birth defects among Chinese people in all studies in the literatures included ： （1）family histories of congenital diseases ; （2）previous history of birth defects ; （3）consanguineous marriage; （4）maternal and paternal factors. Conclusion According to Wynder criterion： among Chinese people in the present study of adopted literatures, suffering from cold or fever during the first trimester of pregnancy, contact with chemicals before and after gestation, medication history of women during pregnancy were all moderatedly related with birth defects, and the study results of meta- analysis more really reflected main epidemiological study achievements on environmental risk factors of birth defects in recent two decades in China. There was weak relationship between ART and birth defects among all populations. Microwave radiation, high temperature, environmental hormones, nutritional status and body weight of pregnant woman, season of gestation and situation of domestic economy, emotion of pregnant women and parternal age etc in the genetic and environmental risk factors of birth defects among Chinese people in included studies were absent or fewly seen.
出处
《中国妇幼健康研究》
2009年第3期329-333,共5页
Chinese Journal of Woman and Child Health Research
关键词
出生缺陷
危险因素
META分析
系统评价
辅助生殖技术
birth defect
risk factor
meta-analysis
systematic evaluation
assisted reproductive technology （ART）
