A Study On Risk Factors And Prognoses Of Fetal Neural Tube Defects

Objective:To explore the risk factors,pregnancy outcomes and prognoses of fetal neural tube defects(NTDs)in Hainan Province.By early identification of high risk populations,it is possible to provide evidence for the preventions of NTDs,and thus put forward reasonable prevention and control suggestions.To understand the relationship between cadmium exposure during pregnancy and the risk of NTDs in offsprings.Methods:1.We collected data on pregnant women with fetal NTDs diagnosed by ultrasound during January 1st,2017 to June 30 th,2022 in two hospitals——The First Hospital Affiliated to Hainan Medical University,as well as Hainan Women and Children’s Medical Center.We collected 56 cases(including live birth,stillbirth and NTDs diagnosed by prenatal diagnosis),according to the Monitoring Program for Chinese birth defects.(1)Case group: 56 pregnant women with confirmed diagnoses were included.(2)Control group: 56 pregnant mothers from the same age range as the control group with healthy fetuses were selected as the control group by1:1 matched.We utilized SPSS 24.0 to carry out single factor conditional Logistic regression,and we applied statistically significant variables to the multivariate conditional Logistic regression model for statistical analysis.Therefore,a conditional Logistic regression model was established.2.We reviewed the published studies on the relationship between maternal cadmium exposure during pregnancy and the risk of NTDs in offsprings and conducted a meta-analysis Meta analysis.English language literatures are retrieved from Pub Med,Cochrane and Web of Science databases;Chinese literatures were retrived from China Journal full-text Database(CNKI),VIP Journal Database(VIP)and Wanfang Database.In addition,other literatures were reviewed from references.The literature quality was evaluated by Newcastle-Ottawa Scale(NOS)document quality evaluation table.Publication bias was tested by funnel chart and Egger’s test.All the analyses were carried out using statistical stata16.0 software.Results:1.Among the 56 cases with NTDs:5 have encephalocele(8.93%),18 have simple spina bifida(32.14%),2 have meningocele(3.57%),6 have myelomeningocele(10.71%),5 have lipomyelomeningocele(8.93%),13 have filum terminale type tethered cord(23.22%),4 have frenum type tethered cord(7.14%),3have spinal lipoma(5.36%).Of the 56 pregnant with neural tube defects,30 are combined with other birth defects.Among the mother carrying there fetuses with NTDs,17 chose to give birth(30.36%)and 39 chose to terminate their pregnancy(69.64%).Of the 17 children with NTDs,6 received surgical treatment after birth(35.29%),and 11 didn’t(64.71%).Among them,12 were asymptomatic(70.59%),3had mild symptoms(17.65%),and 2 had obvious symptoms(11.76%).2.The univariate analysis shows statistically significant differences between the case group and the control group regarding factors such as unintended pregnancy,pre-pregnancy guidance,pregnancy guidance and reasonable folic acid intake(P<0.05).Multivariate conditional logistic regression analysis of the above factors reveals that unplanned pregnancy is a strong risk factor for neural tube defects(OR=3.270,95%CI: 1.181-9.057);while pregnancy guidance can be a protective factor for NTDs(OR=0.278,95%CI: 0.066-1.177).3.Meta analysis shows that the level of cadmium in pregnant women with NTDs is higher than that normal pregnant women,the difference was statistically significant(P < 0.05).Conclusions:Receiving pre-pregnancy,pregnancy guidance,taking folic acid reasonably as prescribed,and avoiding high-risk factors such as unplanned pregnancy,can prevent NTDs.The prognoses of different types of NTDs are different,and surgical treatment is helpful to relieve the symptoms.Cadmium exposure in pregnant women will increase the risk of NTDs in their offspring.