在中国，围孕期补充叶酸可预防罕见和常见的神经管缺陷。
Periconceptional folic acid use prevents both rare and common neural tube defects in China.
机构信息
National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.
Institute of Reproductive and Child Health, School of Public Health, Peking University, Beijing, China.
出版信息
Birth Defects Res. 2022 Mar;114(5-6):184-196. doi: 10.1002/bdr2.1983. Epub 2022 Jan 31.
BACKGROUND
Neural tube defects (NTDs) encompass a variety of distinct types. We assessed if the preventive effect of folic acid (FA) varied by NTD type and infant sex.
METHODS
We examined all pregnancies with NTD status confirmation from a pregnancy-monitoring system in selected locations in northern and southern regions of China between 1993 and 1996. Women who took 400 μg of FA daily during 42 days after last menstrual period were considered FA users. We analyzed NTD prevalence by FA use status, NTD type, geographic region, and infant sex.
RESULTS
Among 626,042 pregnancies, 700 were affected by an NTD. Among FA nonusers, 65 pregnancies (8.8 per 10,000) in the north and 51 pregnancies (1.2 per 10,000) in the south were affected by one of the two rare NTDs, that is, craniorachischisis, iniencephaly. FA use prevented occurrence of these two rare NTDs and reduced the prevalence of spina bifida (SB) by 78% (from 17.9 to 3.9 per 10,000) in the north and 51% (from 2.4 to 1.2 per 10,000) in the south. Among FA users, SB prevalence, including SB with high lesion level, was significantly reduced in both geographic regions. FA use reduced prevalence of anencephaly and encephalocele by 85% and 50%, respectively in the north, while it did not reduce the prevalence of these two NTDs in the south. There was a greater reduction in NTD prevalence in female than in male infants and fetuses.
CONCLUSIONS
This is the first study to show that FA prevents the entire spectrum of NTD types.
背景
神经管缺陷（NTDs）包含多种不同类型。我们评估了叶酸（FA）的预防效果是否因 NTD 类型和婴儿性别而异。
方法
我们检查了 1993 年至 1996 年在中国北部和南部选定地区的妊娠监测系统中所有 NTD 状态确认的妊娠。在末次月经后 42 天内每天服用 400μg FA 的女性被认为是 FA 使用者。我们根据 FA 使用情况、NTD 类型、地理区域和婴儿性别分析 NTD 患病率。
结果
在 626,042 例妊娠中，有 700 例受到 NTD 影响。在 FA 非使用者中，北方有 65 例（每 10,000 例 8.8 例），南方有 51 例（每 10,000 例 1.2 例）受到两种罕见 NTD 之一的影响，即颅裂和无脑畸形。FA 使用可预防这两种罕见的 NTD 发生，并使北方 SB 的患病率降低 78%（从每 10,000 例 17.9 例降至 3.9 例），南方降低 51%（从每 10,000 例 2.4 例降至 1.2 例）。在 FA 使用者中，北方和南方 SB 患病率（包括高病变水平的 SB）均显著降低。FA 使用使北方无脑畸形和脑膨出的患病率分别降低 85%和 50%，而在南方并未降低这两种 NTD 的患病率。女性婴儿和胎儿的 NTD 患病率降低幅度大于男性。
结论
这是第一项表明 FA 可预防所有 NTD 类型的研究。
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