Feldkamp Marcia, Friedrichs Michael, Carey John C
Department of Pediatrics, Division of Medical Genetics, University of Utah Health Sciences Center, 2C412 SOM, 50 North Medical Drive, Salt Lake City, UT 84132, USA.
Teratology. 2002;66 Suppl 1:S23-8. doi: 10.1002/tera.90006.
The Utah Birth Defect Network, a statewide surveillance program based in the Utah Department of Health, monitors the occurrence of all neural tube defects (NTDs). Retrospectively and prospectively population-based data was utilized to assess the trend in prevalence for NTDs in Utah from 1985-2000.
The Utah Birth Defect Network (UBDN) has prospectively identified NTDs in Utah since 1994. NTD cases, including meningomyelocele, meningocele, anencephaly (including exencephaly), encephalocele and craniorachischisis, born to women who are residents of Utah at delivery are reviewed by a pediatric geneticist. All NTDs occurring from 1985-1993 were ascertained retrospectively and documented to be a case. NTDs from all pregnancy outcomes are included (live births, stillbirths and pregnancy terminations) during the entire study period.
NTDs in Utah have decreased significantly between 1985-2000 and remain at the lowest prevalence over the last three of those years. The most significant decrease was seen from 1993-2000. The downward trend was demonstrable for anencephaly and meningomyelocele but not for encephalocele. The proportion of NTDs diagnosed prenatally, as well as those pregnancies terminated after prenatal diagnosis have remained constant, without any evidence of an increasing trend since 1990. However, the proportion of pregnancy terminations occurring prior to twenty weeks gestation has increased significantly since 1990.
The reason for the observed decrease is not known but is likely the result of simultaneous prevention activities locally and nationally, the Utah population's propensity for vitamin and supplement consumption, and recent food fortification. The Centers for Disease Control and Prevention recommended in 1992 that all women in their childbearing years take folic acid daily. The Utah Folic Acid Educational Campaign targeted all women of childbearing years beginning in 1996 with this message. Additionally, fortification of grains was voluntary from 1996, became mandatory in 1998 at which point NTD prevalence declined to its lowest level. These factors may have collectively contributed to the reduction observed in NTD prevalence within Utah, demonstrating the positive impact of an important public health endeavor.
犹他州出生缺陷监测网络是一个设在犹他州卫生部的全州范围监测项目，负责监测所有神经管缺陷（NTD）的发生情况。利用回顾性和前瞻性的人群数据评估1985 - 2000年犹他州NTD的患病率趋势。
自1994年以来，犹他州出生缺陷监测网络（UBDN）对犹他州的NTD进行前瞻性识别。包括脊髓脊膜膨出、脊膜膨出、无脑儿（包括露脑畸形）、脑膨出和颅脊柱裂等NTD病例，由一名儿科遗传学家对分娩时为犹他州居民的妇女所生的病例进行审查。对1985 - 1993年发生的所有NTD进行回顾性确定并记录为病例。在整个研究期间，纳入所有妊娠结局（活产、死产和终止妊娠）中的NTD。
1985 - 2000年期间，犹他州的NTD显著减少，在过去三年中患病率保持在最低水平。1993 - 2000年期间下降最为显著。无脑儿和脊髓脊膜膨出呈下降趋势，但脑膨出没有。自1990年以来，产前诊断出的NTD比例以及产前诊断后终止妊娠的比例保持不变，没有任何上升趋势的迹象。然而，自1990年以来，妊娠20周前终止妊娠的比例显著增加。
观察到的下降原因尚不清楚，但可能是地方和全国同时开展预防活动、犹他州人群食用维生素和补充剂的倾向以及近期食品强化的结果。疾病控制和预防中心在1992年建议所有育龄妇女每日服用叶酸。犹他州叶酸教育运动从1996年开始向所有育龄妇女传达这一信息。此外，谷物强化在1996年是自愿的，1998年成为强制性的，此时NTD患病率降至最低水平。这些因素可能共同促成了犹他州NTD患病率的下降，证明了一项重要公共卫生努力的积极影响。
