Department of Public Health and Primary Care, Institute of Public Health, University of Cambridge, Cambridge, UK.
BJOG. 2013 Apr;120(5):555-66. doi: 10.1111/1471-0528.12116. Epub 2013 Jan 18.
This study aims to model the impact of preconception care on births with congenital disorders at a national level.
Mathematical cross-sectional model based on life-table methodology.
Research conducted in Cambridge, United Kingdom.
Women aged 15-45 years in England, 2001.
A mathematical model was constructed based on cross-sectional data from women aged 15-45 years in England undertaking one of three interventions, so as to reflect different strategies of preconception care: folic acid supplementation and fortification (representing national, universal interventions); alcohol intervention (reflecting primary care strategies); and diabetes management (targeting a population of high-risk women with a known chronic disease).
Reduction in the prevalence of congenital disorders at birth.
Between 585 (lower estimate) and 1085 (upper estimate) congenital disorders could be prevented with a national preconception programme, based on a single-year national cohort in England. This represents an 8-15% reduction in annual notifications of congenital disorders in live births annually. According to modelled estimates, folic acid fortification or supplementation, alcohol intervention, and diabetic management may result in a 46, 32-62, 53, and 54% reduction in the live birth prevalence of specific congenital disorders, respectively. In an ideal scenario, the application of this model decreases the total annual number of congenital disorder notifications by approximately one-sixth.
A preconception care programme comprising three different strategies potentially can reduce the number of infants born with congenital disorders at a national level. This model provides strong support for preconception care to become a healthcare priority, and has major implications for healthcare planning.
本研究旨在建立全国范围内的出生先天缺陷预防模型。
基于寿命表方法的数学交叉模型。
英国剑桥开展的研究。
2001 年英国年龄在 15-45 岁的女性。
以英国年龄在 15-45 岁接受三种干预措施之一的女性的横截面数据为基础，建立数学模型，以反映不同的孕前保健策略：叶酸补充和强化（代表国家、普遍干预措施）；酒精干预（反映初级保健策略）；以及糖尿病管理（针对具有已知慢性疾病的高危女性人群）。
降低出生时先天缺陷的流行率。
在英格兰进行的一项基于英国单一年龄组队列的研究中，全国性的孕前保健计划可以预防 585 例（下限估计值）至 1085 例（上限估计值）的先天缺陷。这代表着每年出生的活产儿中每年出生的先天缺陷通知减少了 8-15%。根据模型估计，叶酸强化或补充、酒精干预和糖尿病管理可能使特定先天缺陷的活产儿患病率分别降低 46%、32-62%、53%和 54%。在理想情况下，应用该模型可使每年先天缺陷通知总数减少约六分之一。
由三种不同策略组成的孕前保健方案可能会降低全国范围内先天缺陷婴儿的数量。该模型为孕前保健成为医疗保健重点提供了有力支持，并对医疗保健规划具有重大意义。
