Zhang Xiaohui, Sun Yu, Zhu Jiajun, Zhu Yuning, Qiu Liqian
Department of Women's Health, Women's Hospital School of Medicine Zhejiang University, Hangzhou, 310006, Zhejiang Province, China.
Department of Neonatology, Women's Hospital School of Medicine Zhejiang University, Hangzhou, China.
BMC Pediatr. 2020 Sep 2;20(1):416. doi: 10.1186/s12887-020-02313-4.
BACKGROUND: Congenital heart defect is the leading malformation in China. There may have been changes in congenital heart defect incidence because of birth policy shift in China over past years. This study aimed to investigate the epidemiology, prenatal diagnosis, and outcomes of congenital heart disease to improve medical and policy decisions. METHODS: Data on cases of congenital heart disease identified during 2014-2018 were taken from the Zhejiang provincial birth defects surveillance system. Chi-square test, odds ratio (OR) and 95% confidence interval (CI) were used to explore epidemiology, prenatal diagnosis, and birth outcomes of congenital heart disease. RESULTS: The average incidence of congenital heart disease was 16.0 per 1000 births, which increased by 62.2% during 2014-2018(χ = 181.41, P < 0.001). However, the average critical congenital heart incidence was 1.6 per 1000 births, which remained stable over time. Women aged ≤20 years (OR2.1, 95% CI 1.9-2.3) or ≥ 35 years (OR 1.2, 95% CI 1.2-1.3) were at higher risk of having babies with congenital heart disease than women aged 21-34 years. Women who gave birth in urban areas (OR 1.2, 95% CI 1.2-1.3), had a son (OR 1.3, 95% CI 1.3-1.4), or had multiple births (OR 4.0, 95% CI 3.7-4.4) were also at higher risk than those giving birth in rural areas, to girls, or single births, respectively. The three major subtypes of congenital heart disease were atrial septal defect (67.9%), patent ductus arteriosus (34.7%), and ventricular septal defect (6.4%). The prenatal detection rate of critical congenital heart disease was 90.0%, which was far higher than total congenital heart disease, at 22.2% (χ = 1687.67, P < 0.001). There were 1457 (17.1%) stillbirths, 106 (1.2%) early neonatal deaths, and 6983 (81.7%) live births associated with congenital heart disease. CONCLUSIONS: The high incidence of congenital heart disease in Zhejiang might be attributable to the large proportion of mild congenital heart disease. The incidence of critical congenital heart disease, the prenatal detection rate, and perinatal deaths from congenital heart disease are comparable to those in other studies.
背景：先天性心脏病是中国最主要的出生缺陷。过去几年，由于中国生育政策的转变，先天性心脏病的发病率可能有所变化。本研究旨在调查先天性心脏病的流行病学、产前诊断及结局，以改善医疗和政策决策。 方法：2014 - 2018年期间确诊的先天性心脏病病例数据来自浙江省出生缺陷监测系统。采用卡方检验、优势比（OR）和95%置信区间（CI）来探讨先天性心脏病的流行病学、产前诊断及出生结局。 结果：先天性心脏病的平均发病率为每1000例出生16.0例，在2014 - 2018年期间增加了62.2%（χ² = 181.41，P < 0.001）。然而，严重先天性心脏病的平均发病率为每1000例出生1.6例，随时间保持稳定。年龄≤20岁（OR 2.1，95% CI 1.9 - 2.3）或≥35岁（OR 1.2，95% CI 1.2 - 1.3）的女性生育先天性心脏病患儿的风险高于21 - 34岁的女性。在城市地区分娩的女性（OR 1.2，95% CI 1.2 - 1.3）、生育男孩的女性（OR 1.3，95% CI 1.3 - 1.4）或多胎分娩的女性（OR 4.0，95% CI 3.7 - 4.4）分别比在农村地区分娩的女性、生育女孩的女性或单胎分娩的女性风险更高。先天性心脏病的三大主要亚型为房间隔缺损（67.9%）、动脉导管未闭（34.7%）和室间隔缺损（6.4%）。严重先天性心脏病的产前检出率为90.0%，远高于先天性心脏病总体检出率22.2%（χ² = 1687.67，P < 0.001）。与先天性心脏病相关的有1457例（17.1%）死产、106例（1.2%）早期新生儿死亡和6983例（81.7%）活产。 结论：浙江先天性心脏病的高发病率可能归因于轻度先天性心脏病占比较大。严重先天性心脏病的发病率、产前检出率以及先天性心脏病导致的围产期死亡与其他研究相当。
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