| Background:Neural tube defects (NTDs) are common and serious birth defects that are secondary to abnormal neural tube closure and occur in fetuses between the third and fourth weeks of gestational age. Anencephaly, spina bifida, and encephalocele are the three major types of NTDs. They occur in every area around the world. Despite implementation of folic acid supplements of preventative measures for NTDs, they still affect approximately 300 000 newborns worldwide each year. So far, periconceptional FA supplementation programs have been implemented by fewer than 40 countries for many years, but only 10% of the estimated 240 000 annual cases of folic acid-preventable NTDs have prevented. It has become apparent that this explanation may not account for many cases of NTD prevention. This suggests that other factors may be essential to the effectiveness of FA prevention. Furthermore, only 4.5% of participants in northern China that had a high prevalence of NTDs started taking folic acid before pregnancy. If the rate of taking folic acid still remains low, we could not just rely on periconceptional FA supplementation to prevent NTDs. Therefore, to further reduce NTDs, other modifiable risk factors must be found. Dietary nutrition is a case in point.Objectives:To explore the role of nutrition factors on the pathogenesis of NTDs in women of childbearing age, from the perspective of the overall diet, to provide reasonable recommendations on diet for pregnant women to prevent NTDs, and to supply scientific basis for the decision-makers to develop interventions measures, then further reduce the incidence and recurrence rate of NTDs.Methods:This study is a 1:1 matched case-control designed to evaluate the risks and safety of various antenatal exposures in relation to NTDs. The project was conducted in 20 districts in Shanxi and Shandong provinces. Cases were women who had delivered babies with NTDs. Controls were women who delivered babies without identified malformations. The matching criteria included women living the same area and giving birth in the same hospital in the same year. All the case and control mothers gave birth to infants within two years before the survey dates, which were between March and December 2008 in Shanxi and Shan dong provinces. Exposure information was collected during the research by trained interviewers through face-to-face interviews, using structured questionnaires. The questionnaire consisted of questions on demographic information, diet type and frequency of food in early pregnancy.Results:Results show that, (1) The maternal occupation, maternal education degree, paternal occupation, paternal education level, household per capita income, birth history, BMI in early pregnancy phase,,adjusting their dietary pattern, their nutrition condition, and nutrition attitude during early pregnancy, health education, planning pregnancy were significant difference in the cases and in the controls.(2) Diet frequency and NTDs:Intake beans and milk more than 7 times per week (compared to less than 1 times per month) are strongest protective effect against NTDs. Intake meats, animal offal, fruits, nuts 3 to 6 times per week (compared to less than 1 times per month) are strongest protective effect against NTDs. For the nuts, compared to less than 1 times per month, regardless of the frequency consumed, intake of nuts more than one times per month has a protective effect (P<0.05), on the contrast, intake pickles regardless of how much intake, will increase the risk of NTDs, and the higher the frequency of consumption, the greater for NTDs risk (P<0.05). Multivariate analysis showed that the frequency of animal offal, milk, nuts, pickles consumption still has a significant difference between the two groups (P<0.05). The frequencies of women intake dietary food are difference in different ages, occupation, education degree, and family economic levels.(3) Nutritional status in early pregnancy stage:The rate of women who thought their nutrition condition were good during pregnancy in the cases are higher than those in the controls (P=0.000). After adjust the confounding factors, women who thought their nutrition condition were bad during pregnancy were risk for having NTDs babies, with OR value and their 95% confidence intervals were 5.45(3.55-8.35),. Attributable risk percents (AR%) was 80.2%and population attributable risk percents (PAR%) was 54.8%. The total score range of nutrition survey score in case group of is-2 to 30, the average score is (15.48±5.83), and in the control group the total score ranged from 4 to 32 points, the average is (19.76±5.13) points.5.0% in the case group had better nutritional status in early pregnancy, and 31.5% had poor nutritional status; in the control group,18.3% had good nutritional status during early pregnancy,9.2% had poor nutritional status; nutritional status during early pregnancy in case group was significantly lower than the control group, the difference was statistically significant (P<0.05), after adjusting for confounding factors, poor nutritional status for the risk of NTDs is 8.38 times (95%CI:4.57-15.4) than the control group.(4) Dietary types and NTDs:The rate of women who adjust their dietary pattern in the cases (45.5%) are lower than those in the controls (71.2%) (P=0.000). After adjust the confounding factors, women who were not change the dietary pattern during early pregnancy were risk for having NTDs babies, with OR value and their 95% confidence intervals were 2.73(2.04-3.65). Attributable risk percents (AR%) was 63.4% and population attributable risk percents (PAR%) was 34.2%. Univariate analysis shows that increasing meats, eggs, beans, milk, vegetables, fresh fruits, grains, seafood, sesame seeds and reducing the intake of pickled vegetables, homemade pickles, alcohol, coffee intake in early pregnancy phase are statistically significant (P<0.05), and the incidence of NTDs risks can reduce in different levels. Multivariate analysis shows that increasing meats in early pregnancy stage still has a statistically significant difference, with OR=0.645,95% CI:0.418-0.996, as protective factors. AR% and ARP% of the risk of NTDs for women whom increased meats intake were 55.1% and 11.9%, respectively.In the women of whom not adjust dietary pattern,52% of the case group and 59.8% of the control group thought they did not need for improvement,19.6% of the case group and and 14.4% of the control group wanted to improve the diet, but they did not know how to improve.The frequencies of intaking meat, animal offal, eggs, beans, milk, vegetables, fruits, nuts of women who improved their dietary pattern, were significantly higher than women who did not improve dietary pattern. Contrast for the pickles.(5) Nutrition attitude and NTDs:The rate of women who had positive nutrition attitudes during early pregnancy in the cases are higher than those in the controls (P=0.000). After adjust the confounding factors, women who had negative nutrition attitudes during early pregnancy were risk for having NTDs babies, with OR value and their 95% confidence intervals were 2.93(2.18-3.96). Attributable risk percents (AR%) was 65.9%, and opulation attributable risk percents(PAR%) was 36.7%, respectively. The frequencies intake meats, eggs, beans, milk, vegetables, fruits, nuts of women with difference nutrition attitude are difference, and the difference was statistically significant (P<0.05). Multivariate analysis showed that not receive health education (OR= 1.75,95%CI:1.23-2.48), not improve dietary pattern (OR=3.83, 95% CI:2.79-5.25) during early pregnancy may negatively affect women's nutrition attitude (P<0.01). Furthermore, the nutrition attitude of women can also be affected by maternal education degree (OR= 0.611,95% CI:0.431-0.866) and paternal ages (OR=1.41,95%CI:1.01-1.97).(6) Planning pregnancy and changing dietary pattern, health education and dietary nutrition attitudes in early pregnancy exist additive interaction for the occurrence of NTDs.Conclusions:(1) Increasing meats, eggs, beans, milk, vegetables, fresh fruits, grains, seafood, sesame seeds, and reducing the intake of pickled vegetables, homemade pickles, alcohol, coffee intake in early pregnancy phase are statistically significant different (P<0.05), and the incidence of NTDs risks can be reduced in different levels.(2) Intake beans and milk more than 7 times per week are strongest protective effect against NTDs. Intake meats, animal offal, fruits, nuts 3 to 6 times per week are strongest protective effect against NTDs.(3) Women who adjusted their dietary pattern, and having positive nutrition attitude during early pregnancy tended to add the frequencies of intaking meats, plucks, eggs, beans, milk, vegetables, fruits, nuts, and reduce the frequencies of intaking pickles.(4) Women who accepted health education or plan pregnancy may significantly change their nutrition attitudes and adjust their diatery partern. Suggestion:Nutrition attitude of pregnant women tend to be affected by their around people such as husband. Therefore, it is needed to improve the intensity and breadth of nutrition education for pregnant women, in addition to themselves, but also taking into account their husbands and other family members. Diet should be diversified, not only we can choose a variety of nutrients, but also the nutritional composition of various foods from the complementary, thus increasing the preventive effect of NTDs. |
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