Liu Jufen, Zhang Le, Li Zhiwen, Jin Lei, Zhang Yali, Ye Rongwei, Liu Jianmeng, Ren Aiguo
Institute of Reproductive and Child Health/Ministry of Health Key Laboratory of Reproductive Health; Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China.
Birth Defects Res A Clin Mol Teratol. 2016 Apr;106(4):267-74. doi: 10.1002/bdra.23486. Epub 2016 Feb 16.
The prevalence of neural tube defects (NTDs) in northern China is among the highest in the world. A massive folic acid supplementation program as a specific countermeasure was introduced in 2009. Examining trends in NTD prevalence may provide evidence for future intervention.
Data for 2000 to 2014 in five counties in northern China were obtained through a population-based birth defects surveillance system. All live births, stillbirths of over 20 gestational weeks, and pregnancy terminations because of NTDs at any gestational age were recorded. The prevalence of NTDs by gestational weeks (< 28 vs. ≥ 28), by calendar year, and by subtype was presented.
From 2000 to 2014, a total of 234,225 births and 2027 cases of NTDs were recorded. The prevalence of total NTDs was extremely high during 2000 to 2004, but it began to decrease continuously thereafter, from a peak of 120.0/10,000 in 2004 to a low of 31.5/10,000 in 2014. A significant decrease (60%) was observed from 78.8/10,000 in 2009 to 31.5/10,000 in 2014, 5 years after the folic acid supplementation program was introduced. All three major subtypes, namely anencephaly, spina bifida, and encephalocele, showed a decline over this period. Although the perinatal (≥ 28 gestational weeks) prevalence of NTDs decreased progressively, the pre-perinatal (< 28 gestational weeks) prevalence of NTDs remained high until 2011 and then decreased.
The prevalence of NTDs remains high despite a substantial and continuous decrease over the past 15 years. To further reduce NTD risk in the population, fortification staples with folic acid should be considered.
中国北方神经管缺陷（NTDs）的患病率位居世界前列。2009年启动了一项大规模补充叶酸计划作为具体应对措施。研究NTD患病率的变化趋势可为未来干预提供依据。
通过基于人群的出生缺陷监测系统获取中国北方五个县2000年至2014年的数据。记录所有活产、孕20周以上的死产以及任何孕周因NTDs而终止的妊娠。按孕周（<28周与≥28周）、历年和亚型呈现NTDs的患病率。
2000年至2014年，共记录了234,225例出生和2027例NTDs病例。2000年至2004年期间，NTDs的总患病率极高，但此后开始持续下降，从2004年的峰值120.0/10,000降至2014年的低点31.5/10,000。在引入叶酸补充计划5年后，即2009年至2014年期间，观察到显著下降（60%），从78.8/10,000降至31.5/10,000。所有三种主要亚型，即无脑儿、脊柱裂和脑膨出，在此期间均呈下降趋势。尽管NTDs的围产期（≥28孕周）患病率逐渐下降，但NTDs的产前（<28孕周）患病率在2011年之前一直居高不下，随后下降。
尽管在过去15年中NTDs患病率大幅持续下降，但仍处于较高水平。为进一步降低人群中NTDs的风险，应考虑强化主食添加叶酸。
