Prevention of neural tube defects with folic acid: The Chinese experience.
Prevention of neural tube defects with folic acid: The Chinese experience.
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DOI：
10.5409/wjcp.v4.i3.41
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发表时间：
2015-08-08
期刊：
影响因子：
--
通讯作者：
Ren, Ai-Guo
中科院分区：
文献类型：
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作者：
Ren, Ai-Guo
神经管缺陷（NTDs）是一组先天性中枢神经系统畸形，是由胚胎神经管在受孕28天关闭失败引起的。无脑畸形和脊柱裂是两种主要亚型。无脑畸形胎儿通常是死产或因产前诊断而选择性流产，或在出生后不久死亡。大多数患有脊柱裂的婴儿是活产的，通过适当的手术治疗，可以存活到成年。然而，这些儿童往往有终身的身体残疾。中国是世界上被忽视热带病发病率最高的国家之一。膳食中叶酸摄入不足被认为是造成这种群集的主要原因。与许多其他国家将主食强化叶酸作为预防被忽视热带病的公共卫生策略不同，中国政府通过2009年启动的一项全国性项目，向所有有农村户口并计划怀孕的妇女免费提供叶酸补充剂。该计划启动两到三年后，在NTD患病率最高的地区，叶酸补充率提高到85%。怀孕早期和中期妇女的平均血浆叶酸水平是该计划实施前的两倍。然而，大多数女性在知道自己怀孕后就开始服用叶酸补充剂。这对于保护胚胎神经管来说已经太晚了。在对报告补充叶酸的妇女进行的项目后调查中，不到四分之一的妇女在怀孕前开始补充叶酸，这表明其余四分之三的胎儿在神经管形成期间没有受到保护。因此，主食强化叶酸应被视为预防ntd的优先事项。
Neural tube defects (NTDs) are a group of congenital malformations of the central nervous system that are caused by the closure failure of the embryonic neural tube by the 28(th) day of conception. Anencephaly and spina bifida are the two major subtypes. Fetuses with anencephaly are often stillborn or electively aborted due to prenatal diagnosis, or they die shortly after birth. Most infants with spina bifida are live-born and, with proper surgical treatment, can survive into adulthood. However, these children often have life-long physical disabilities. China has one of the highest prevalence of NTDs in the world. Inadequate dietary folate intake is believed to be the main cause of the cluster. Unlike many other countries that use staple fortification with folic acid as the public health strategy to prevent NTDs, the Chinese government provides all women who have a rural household registration and who plan to become pregnant with folic acid supplements, free of charge, through a nation-wide program started in 2009. Two to three years after the initiation of the program, the folic acid supplementation rate increased to 85% in the areas of the highest NTD prevalence. The mean plasma folate level of women during early and mid-pregnancy doubled the level before the program was introduced. However, most women began taking folic acid supplements when they knew that they were pregnant. This is too late for the protection of the embryonic neural tube. In a post-program survey of the women who reported folic acid supplementation, less than a quarter of the women began taking supplements prior to pregnancy, indicating that the remaining three quarters of the fetuses remained unprotected during the time of neural tube formation. Therefore, staple food fortification with folic acid should be considered as a priority in the prevention of NTDs.