Botto Lorenzo D, Lisi Alessandra, Bower Carol, Canfield Mark A, Dattani Nirupa, De Vigan Catherine, De Walle Hermien, Erickson David J, Halliday Jane, Irgens Lorentz M, Lowry R Brian, McDonnell Robert, Metneki Julia, Poetzsch Simone, Ritvanen Annukka, Robert-Gnansia Elisabeth, Siffel Csaba, Stoll Claude, Mastroiacovo Pierpaolo
Department of Pediatrics, University of Utah, Salt Lake City, Utah, USA.
Birth Defects Res A Clin Mol Teratol. 2006 Oct;76(10):693-705. doi: 10.1002/bdra.20307.
Two crucial issues relative to the benefits and impact of folic acid in the prevention of birth defects are whether supplementation recommendations alone, without fortification, are effective in reducing the population-wide rates of neural tube defects (NTDs), and whether such policies can reduce the occurrence of other birth defects. Using data from 15 registries, we assessed rates and trends of 14 major defects, including NTDs, in areas with official recommendations or fortification to assess the effectiveness of recommendations and fortification on a wide range of major birth defects.
We evaluated surveillance data through 2003 on major birth defects from population-based registries from Europe, North America, and Australia. All included ascertainment of pregnancy terminations (where legal). Trends before and after policies or fortification were assessed via Poisson regression and were compared via rate ratios.
Significant changes in trends were seen for NTDs in areas with fortification but not in areas with supplementation recommendations alone. For other major birth defects, there was an overall lack of major trend changes after recommendations or fortification. However, some significant declines were observed for select birth defects in individual areas.
Recommendations alone remain an ineffective approach in translating the known protective effect of folic acid in population-wide decline in NTD rates. Fortification appears to be effective in reducing NTDs. The effect on other birth defects remains unclear.
与叶酸预防出生缺陷的益处和影响相关的两个关键问题是，仅补充建议（不进行强化）是否能有效降低神经管缺陷（NTDs）的全人群发病率，以及此类政策是否能减少其他出生缺陷的发生。我们利用15个登记处的数据，评估了有官方建议或强化措施的地区14种主要缺陷（包括神经管缺陷）的发病率和趋势，以评估建议和强化措施对多种主要出生缺陷的有效性。
我们评估了截至2003年来自欧洲、北美和澳大利亚基于人群登记处的主要出生缺陷监测数据。所有数据均包括对终止妊娠情况（如合法）的确定。通过泊松回归评估政策或强化措施前后的趋势，并通过发病率比进行比较。
在有强化措施的地区，神经管缺陷的趋势有显著变化，但在仅有补充建议的地区则没有。对于其他主要出生缺陷，在建议或强化措施实施后，总体上缺乏主要趋势变化。然而，在个别地区，某些特定出生缺陷出现了显著下降。
仅靠建议在将叶酸已知的预防效果转化为全人群神经管缺陷发病率下降方面仍然是一种无效的方法。强化措施似乎能有效降低神经管缺陷。对其他出生缺陷的影响仍不明确。
