Yen I H, Khoury M J, Erickson J D, James L M, Waters G D, Berry R J
Birth Defects and Genetic Diseases Branch, Centers for Disease Control, Atlanta, Ga. 30333.
Am J Dis Child. 1992 Jul;146(7):857-61. doi: 10.1001/archpedi.1992.02160190089028.
To describe the recent trends and epidemiologic characteristics of neural tube defects in the United States.
Ongoing surveillance data.
Two birth defect surveillance systems: the nationwide Birth Defects Monitoring Program and the Metropolitan Atlanta (Ga) Congenital Defects Program for 1970 through 1989 and 1968 through 1989, respectively.
Between 1970 and 1989, using discharge diagnoses of approximately 1 million live-born and stillborn infants per year, the Birth Defects Monitoring Program identified 15,503 cases of spina bifida and anencephaly. Between 1968 and 1989, using discharge diagnoses and clinical records until age 1 year of 38,000 infants per year, the Metropolitan Atlanta Congenital Defects Program identified 800 cases of spina bifida and anencephaly.
None.
MEASUREMENTS/MAIN RESULTS: Nationwide, neural tube defect rates have declined from 1.3 per 1000 births in 1970 to 0.6 per 1000 births in 1989. In Atlanta, neural tube defect rates have declined from 2.0 per 1000 births in 1968 to 0.6 per 1000 births in 1989. Several changes in the epidemiologic characteristics of neural tube defects were observed: (1) the proportion of spina bifida cases has increased; (2) the proportion of neural tube defect cases compared with the proportion of other unrelated defects has increased; (3) the race ratio of whites to other races for isolated neural tube defect cases has declined in Atlanta; and (4) the rate of isolated neural tube defects in females has also decreased.
The declining rates of neural tube defects can be partially explained by increased widespread prenatal diagnostic techniques, strongly suggesting the role of environmental factors in neural tube defects. In particular, the use of multivitamins and folic acid to prevent the occurrence of neural tube defects needs further evaluation. Nevertheless, the changing clinical and epidemiologic characteristics of cases over time points to the etiologic heterogeneity of these conditions.
描述美国神经管缺陷的近期趋势和流行病学特征。
持续监测数据。
两个出生缺陷监测系统：全国性的出生缺陷监测项目以及分别于1970年至1989年和1968年至1989年开展的佐治亚州亚特兰大大都会先天性缺陷项目。
在1970年至1989年期间，出生缺陷监测项目利用每年约100万例活产和死产婴儿的出院诊断信息，确定了15503例脊柱裂和无脑儿病例。在1968年至1989年期间，亚特兰大大都会先天性缺陷项目利用每年38000例婴儿的出院诊断信息及1岁前的临床记录，确定了800例脊柱裂和无脑儿病例。
无。
测量指标/主要结果：在全国范围内，神经管缺陷率已从1970年的每1000例出生1.3例降至1989年的每1000例出生0.6例。在亚特兰大，神经管缺陷率已从1968年的每1000例出生2.0例降至1989年的每1000例出生0.6例。观察到神经管缺陷的流行病学特征有若干变化：（1）脊柱裂病例的比例增加；（2）神经管缺陷病例与其他无关缺陷病例的比例增加；（3）在亚特兰大，孤立性神经管缺陷病例中白人与其他种族的种族比例下降；（4）女性孤立性神经管缺陷的发生率也有所下降。
神经管缺陷率下降部分可归因于产前诊断技术的广泛应用增加，这有力地表明环境因素在神经管缺陷中所起的作用。特别是，使用多种维生素和叶酸预防神经管缺陷的发生需要进一步评估。然而，随着时间推移病例临床和流行病学特征的变化表明这些疾病存在病因异质性。
