甘肃省5县市先天缺陷干预工程效果评价
|
摘要
目的
通过定量和定性研究,了解甘肃省5县(市)先天缺陷干预工程开展情况,探讨甘肃省先天缺陷重点干预对策,为进一步指导优生优育和有效预防先天缺陷发生提供科学依据。
方法
对甘肃省敦煌市、泾川县、徽县、渭源县和永靖县,2008年10月1日～2010年9月30日所有孕28周以上出生的新生儿(包括活产、死胎、死产)进行普查；比较分析敦煌市、泾川县、徽县、渭源县及永靖县基线及终末调查的孕28周以上出生的新生儿(包括活产、死胎、死产)先天缺陷发生率及构成的变化；采用1：1配对病例对照研究,分析176例先天缺陷儿母亲孕期暴露因素,对先天缺陷可能的危险因素采用单因素与多因素logistic回归分析；对县乡村妇幼专干和计生专干、基层医务人员和孕28周以上分娩的妇女进行问卷调查；同时对县级和乡级计生局及计生站的计生工作管理人员、县级和乡级医院妇保和妇产科专业技术人员及部分孕妇进行三个层面的定性访谈。
结果
(1)2009年5县(市)先天缺陷总发生率为7.49%o,居于前三位的先天缺陷病种分别为先天性心脏病、色素痣和神经管畸形；2010年5县(市)先天缺陷总发生率为8.35‰,居于前三位的先天缺陷病种分别为先天性心脏病、神经管畸形和色素痣、脑积水。2年间被调查各市/县先天缺陷发生率不尽相同,其中敦煌市先天缺陷发生率最高,为14.65‰,徽县先天缺陷发生率最低,为3.28%o。
(2)母亲患遗传病(OR=4.407,95%CI=0.925～21.008)、孕期患流感(OR=1.986,95%CI=0.992～3.976)、孕期服用保胎药(OR=2.466,95%CI=0.981～6.148)是围产儿先天缺陷发生的主要危险因素。
(3)被调查5县(市)围产儿先天缺陷发生率终末调查时为8.35%o,较基线调查时的14.02‰,下降了40.44%。基线与终末调查先天缺陷发生顺位及构成不同。
(4)5县(市)妇女叶酸知晓率和服用率分别为93.85%、84.92%,叶酸规范服用率为22.19%；育龄妇女主要通过计生系统宣传教育来了解叶酸相关知识。
(5)基层妇幼保健人员对相关知识如神经管畸形发生的时间、神经管畸形的诊断、生育神经管畸形儿的高危人群、增补叶酸人群正确应答率较低,均不到50.00%；其中35-44岁的工作人员接受培训(36.21%)、知道健康妇女需要补充叶酸(36.21%)、认为有必要向育龄妇女介绍叶酸的重要性(37.45%)、对妇女进行宣传教育(37.24%)、免费发放叶酸(37.24%)、指导并监督服用叶酸率(34.98%)较低。
(6)基层医务人员相关知识知晓率较低,知道我国神经管畸形发生存在性别差异的县级医务人员有123人,占51.04%,乡级医务人员有41人,占24.26%；知道生育神经管畸形儿高危人群的县、乡级医务人员分别有47人(19.50%)、42人(24.85%)。知道孕期叶酸缺乏会对孕妇、胎儿造成影响的县、乡级医务人员分别有89人(36.93%)、85人(50.30%)；会给每位育龄妇女讲解增补叶酸重要性的县、乡级医务人员分别有236人(97.93%)、169人(100.00%)；有129名(53.00%)县级医务人员和152名(89.94%)乡级医务人员接受相关知识的培训；通过专家讲座、培训获取相关知识的县级医务人员有169人(70.12%),乡级医务人员有92人(54.44%)。
结论
甘肃省5县(市)出生缺陷干预工程实施效果明显,育龄妇女自我保健认知得到进一步提高,但仍需进一步加强干预工程的宣传和实施力度,提高基层妇幼保健人员的综合业务素质。
Objective
In this study, we used both quantitative survey and qualitative interview to find out the monitoring work on congenital defects in five counties/cities of Gansu province, and then to discuss the key intervention countermeasure of congenital defects in Gansu province, in order to provide a scientific basis for guiding prepotency and effective intervention of congenital defects.
Methods
A general investigating was conducted on all the neonatus who were born in Dunhuang city, Jingchuan county, Hui county, Weiyuan county and Yongjing county in Gansu province from October1,2008to September30,2010. Compare with the birth defects incidence and constituent ratio of infant between baseline survey and terminal survey in Dunhuang, Jingchuan, Huixian, Weiyuan and Yongjing. A1:1matched case-control study was carried out to investigate176cases of birth defect children and their parents, to analyze the possible risk factors by simple and multiple factors Logistic regression. A questionnaire survey was conducted on these people who were family planning professionals and women and children health care professionals in five counties/cities. A qualitative investigation was conducted on managers, pregnant women and health technicians.
Results
(1) In2009, the incidence of congenital defects was7.49%o in five counties/cities, and the top three diseases were congenital heart disease, pigmented nevus and neural tube defects. The incidence of congenital defects in2010was8.35%o, and the top three diseases were congenital heart disease, neural tube defects and pigmented nevus, hydrocephalus. While each county (city) had different incidence of congenital defects, the highest congenital defects ratio was in Dun huang city, which was14.65%o, while the lowest ratio was in Hui county, which was3.28%o.
(2) The risk factors of perinatal birth defects were:genetic disease in mother (OR=4.407,95%CI=0.925-21.008); influenza suffering during pregnancy (OR=1.986,95%CI=0.992-3.976); tocolytic agent usage during pregnancy (OR=2.466,95%CI=0.981-6.148)
(3) In the five counties/cities, the congenital defects incidence of perinatal infants was8.35%o in the terminal survey, while baseline survey was14.02%o, the change was decreased by40.44%. The occurences and composition ratio sequences of congenital defects were different from terminal to baseline survey.
(4) The rate of folic acid awareness and intake rate were93.85%and84.89%, the rate of normative intake was21.89%. Women of reproductive age were mainly educated by birth control department to know the knowledge of folic acid.
(5) There was a low rate of correctly answer the questions of occurrence time of neural tube defects, diagnostic methods of neural tube defects, high-risk groups of children who had neural tube defects children, groups of folic acid supplement. The correct response rate was less than50%. Among the people who aged from35to44,36.21%had received professional training, aware of healthy women need to supplement folic acid, account for36.21%, People who thought it is necessary for reproductive women to supplement folic acid, account for37.45%, the rates of providing publicity and education for women and giving folic acid freely were both37.24%, the rate of guiding and supervising women taking folicacid was34.98%.
(6) There were123(51.04%) medical personnels at the county level know that birth defects existd gender difference, while there were41(24.26%) medical personnels in township level. There were47(19.50%) medical staff in county level,42(24.85%) medical staff in township level know the high-risk groups who could give birth to children of neural tube defects.89(36.93%) medical workers in county level, and85(50.30%) medical workers in township level know that folate deficiency during pregnancy could affect pregnant woman and fetus. There were236(97.93%) medical staff in county level, and169(100.00%) people in township level who would illustrate the importance of folic acid supplement for every woman of childbearing age. There were129(53.53%) medical workers in county level, and152(89.94%) in township level who had received training about folic acid. There were169(70.12%) medical staff in county level, and92(54.44%) in township level who obtained knowledge about folic acid by lectures and trainings.
Conclusion
The effect of birth defects intervention project is apparently, the cognition of self-care awareness has been further improved. Howerver, implementation efforts and propaganda work should be strengthened, the quality of comprehensive service of ordinary staff of should be improved.
通过定量和定性研究,了解甘肃省5县(市)先天缺陷干预工程开展情况,探讨甘肃省先天缺陷重点干预对策,为进一步指导优生优育和有效预防先天缺陷发生提供科学依据。
方法
对甘肃省敦煌市、泾川县、徽县、渭源县和永靖县,2008年10月1日～2010年9月30日所有孕28周以上出生的新生儿(包括活产、死胎、死产)进行普查；比较分析敦煌市、泾川县、徽县、渭源县及永靖县基线及终末调查的孕28周以上出生的新生儿(包括活产、死胎、死产)先天缺陷发生率及构成的变化；采用1：1配对病例对照研究,分析176例先天缺陷儿母亲孕期暴露因素,对先天缺陷可能的危险因素采用单因素与多因素logistic回归分析；对县乡村妇幼专干和计生专干、基层医务人员和孕28周以上分娩的妇女进行问卷调查；同时对县级和乡级计生局及计生站的计生工作管理人员、县级和乡级医院妇保和妇产科专业技术人员及部分孕妇进行三个层面的定性访谈。
结果
(1)2009年5县(市)先天缺陷总发生率为7.49%o,居于前三位的先天缺陷病种分别为先天性心脏病、色素痣和神经管畸形；2010年5县(市)先天缺陷总发生率为8.35‰,居于前三位的先天缺陷病种分别为先天性心脏病、神经管畸形和色素痣、脑积水。2年间被调查各市/县先天缺陷发生率不尽相同,其中敦煌市先天缺陷发生率最高,为14.65‰,徽县先天缺陷发生率最低,为3.28%o。
(2)母亲患遗传病(OR=4.407,95%CI=0.925～21.008)、孕期患流感(OR=1.986,95%CI=0.992～3.976)、孕期服用保胎药(OR=2.466,95%CI=0.981～6.148)是围产儿先天缺陷发生的主要危险因素。
(3)被调查5县(市)围产儿先天缺陷发生率终末调查时为8.35%o,较基线调查时的14.02‰,下降了40.44%。基线与终末调查先天缺陷发生顺位及构成不同。
(4)5县(市)妇女叶酸知晓率和服用率分别为93.85%、84.92%,叶酸规范服用率为22.19%；育龄妇女主要通过计生系统宣传教育来了解叶酸相关知识。
(5)基层妇幼保健人员对相关知识如神经管畸形发生的时间、神经管畸形的诊断、生育神经管畸形儿的高危人群、增补叶酸人群正确应答率较低,均不到50.00%；其中35-44岁的工作人员接受培训(36.21%)、知道健康妇女需要补充叶酸(36.21%)、认为有必要向育龄妇女介绍叶酸的重要性(37.45%)、对妇女进行宣传教育(37.24%)、免费发放叶酸(37.24%)、指导并监督服用叶酸率(34.98%)较低。
(6)基层医务人员相关知识知晓率较低,知道我国神经管畸形发生存在性别差异的县级医务人员有123人,占51.04%,乡级医务人员有41人,占24.26%；知道生育神经管畸形儿高危人群的县、乡级医务人员分别有47人(19.50%)、42人(24.85%)。知道孕期叶酸缺乏会对孕妇、胎儿造成影响的县、乡级医务人员分别有89人(36.93%)、85人(50.30%)；会给每位育龄妇女讲解增补叶酸重要性的县、乡级医务人员分别有236人(97.93%)、169人(100.00%)；有129名(53.00%)县级医务人员和152名(89.94%)乡级医务人员接受相关知识的培训；通过专家讲座、培训获取相关知识的县级医务人员有169人(70.12%),乡级医务人员有92人(54.44%)。
结论
甘肃省5县(市)出生缺陷干预工程实施效果明显,育龄妇女自我保健认知得到进一步提高,但仍需进一步加强干预工程的宣传和实施力度,提高基层妇幼保健人员的综合业务素质。
Objective
In this study, we used both quantitative survey and qualitative interview to find out the monitoring work on congenital defects in five counties/cities of Gansu province, and then to discuss the key intervention countermeasure of congenital defects in Gansu province, in order to provide a scientific basis for guiding prepotency and effective intervention of congenital defects.
Methods
A general investigating was conducted on all the neonatus who were born in Dunhuang city, Jingchuan county, Hui county, Weiyuan county and Yongjing county in Gansu province from October1,2008to September30,2010. Compare with the birth defects incidence and constituent ratio of infant between baseline survey and terminal survey in Dunhuang, Jingchuan, Huixian, Weiyuan and Yongjing. A1:1matched case-control study was carried out to investigate176cases of birth defect children and their parents, to analyze the possible risk factors by simple and multiple factors Logistic regression. A questionnaire survey was conducted on these people who were family planning professionals and women and children health care professionals in five counties/cities. A qualitative investigation was conducted on managers, pregnant women and health technicians.
Results
(1) In2009, the incidence of congenital defects was7.49%o in five counties/cities, and the top three diseases were congenital heart disease, pigmented nevus and neural tube defects. The incidence of congenital defects in2010was8.35%o, and the top three diseases were congenital heart disease, neural tube defects and pigmented nevus, hydrocephalus. While each county (city) had different incidence of congenital defects, the highest congenital defects ratio was in Dun huang city, which was14.65%o, while the lowest ratio was in Hui county, which was3.28%o.
(2) The risk factors of perinatal birth defects were:genetic disease in mother (OR=4.407,95%CI=0.925-21.008); influenza suffering during pregnancy (OR=1.986,95%CI=0.992-3.976); tocolytic agent usage during pregnancy (OR=2.466,95%CI=0.981-6.148)
(3) In the five counties/cities, the congenital defects incidence of perinatal infants was8.35%o in the terminal survey, while baseline survey was14.02%o, the change was decreased by40.44%. The occurences and composition ratio sequences of congenital defects were different from terminal to baseline survey.
(4) The rate of folic acid awareness and intake rate were93.85%and84.89%, the rate of normative intake was21.89%. Women of reproductive age were mainly educated by birth control department to know the knowledge of folic acid.
(5) There was a low rate of correctly answer the questions of occurrence time of neural tube defects, diagnostic methods of neural tube defects, high-risk groups of children who had neural tube defects children, groups of folic acid supplement. The correct response rate was less than50%. Among the people who aged from35to44,36.21%had received professional training, aware of healthy women need to supplement folic acid, account for36.21%, People who thought it is necessary for reproductive women to supplement folic acid, account for37.45%, the rates of providing publicity and education for women and giving folic acid freely were both37.24%, the rate of guiding and supervising women taking folicacid was34.98%.
(6) There were123(51.04%) medical personnels at the county level know that birth defects existd gender difference, while there were41(24.26%) medical personnels in township level. There were47(19.50%) medical staff in county level,42(24.85%) medical staff in township level know the high-risk groups who could give birth to children of neural tube defects.89(36.93%) medical workers in county level, and85(50.30%) medical workers in township level know that folate deficiency during pregnancy could affect pregnant woman and fetus. There were236(97.93%) medical staff in county level, and169(100.00%) people in township level who would illustrate the importance of folic acid supplement for every woman of childbearing age. There were129(53.53%) medical workers in county level, and152(89.94%) in township level who had received training about folic acid. There were169(70.12%) medical staff in county level, and92(54.44%) in township level who obtained knowledge about folic acid by lectures and trainings.
Conclusion
The effect of birth defects intervention project is apparently, the cognition of self-care awareness has been further improved. Howerver, implementation efforts and propaganda work should be strengthened, the quality of comprehensive service of ordinary staff of should be improved.
引文
[1]安笑兰,符绍莲.环境优生学[M].北京：北京医科大学中国协和医科大学联合出版社,1995：32.
[2]Baird PA,Anderson TW,Newcombe HB,et al.Genetic disorders in children and young adults:a population study.AmJ Hum Genet,1998,42:677-693.
[3]李智文,张乐,任爱国,等.叶酸与人类出生缺陷.中国生育健康杂志,2003,24(60)：374-377.
[4]张丹妍.出生缺陷的研究进展[J].中国优生优育,2010,16(1)：4-7.
[5]张国华,马二玲,张静茹等.出生缺陷干预措施研究进展[J].河北医药,2010,32(11)：1454-1455.
[6]Rosano A,Botto LD,Botting B,et al.Infant mortality and congenital anomalies from 1950 to 1994:an international perspective[J].Epidemiol Community Health,2000,54:660-666.
[7]Global Report on Birth Defects. The hidden toll of dying and disabled children. http://www. march ofdimes.com/March of Dimes Birth Defects Foundation.2006.
[8]朱军.出生缺陷的诊断与防治[J].中国实用妇科与产科杂志,2002,18(9)：513-514.
[9]薛云,许侠,刘晓曦.我国新生儿疾病筛查现状及面临的挑战[J].中国妇幼保健,2008,(23)：3650-3652.
[10]张璐.开展出生缺陷干预工程利国利民——访国家计生委出生缺陷干预工程首席科学家郑晓瑛教授[J].中国计划生育学杂志,2000,12：536-537.
[11]贾士美,庞兴仁.浅谈出生缺陷与出生缺陷干预工工程[J].中国农村卫生事业管理,2002,22(2)：52-53.
[12]贾士美,庞兴仁.出生缺陷干预工程一二三[J].知识长廊,46-47.
[13]国家人口和计划生育委员会关于开展出生缺陷一级预防工作的指导意见,人口计生委科技司,2007.
[14]江帆.全国出生缺陷交流会——江帆主任讲话_努力开创出生缺陷一级预防工作新局面——在全国出生缺陷一级预防工作交流会上的讲话.2009.
[15]郑英.孕产妇死亡率、儿童死亡率水平及影响因素分析[D].大连：大连医科大学,2007.
[16]认真开展出生缺陷干预工程----在出生缺陷干预工程基线调查培训班上的讲话,2006.http://www.gsj sw.gov. cn/html/xmj s/163959_267.html
[17]甘肃开展出生缺陷干预惠及数万群众,2006.http://www.gsjsw.gov.cn/html/pic/10_55_41_823.html
[18]全国妇幼卫生工作会议书面交流材料之二：河北省卫生厅-狠抓三级预防措施切实提高出生人口素质,2006年全国妇幼卫生工作会议http://www.moh.gov.cn/publicfiles/business/htmlfiles/wsb/pM30303/200804/22400.htm
[19]詹思延.循证医学和循证保健[M].北京：北京医科大学出版社,2002.
[20]李庆业.出生缺陷的研究进展[J].国外医学社会医学分册,2001,18(2)：64-67.
[21]全国妇幼卫生监测及年报通讯.卫生部妇幼保健与社区卫生司主办,2010,4：35.
[22]杨杨,曾令霞,颜虹.陕西省出生缺陷患病情况分析[J].中国公共卫生,2011,27(3)：316-317.
[23]张宏,霍正浩,刘兰,等.宁夏回族自治区出生缺陷危险因素分析[J].中国妇幼保健,2011,26(13)：2001-2003.
[24]刘健男.青海省10年出生缺陷监测结果分析[J].高原医学杂志,2011,21(3)：59-61.
[25]Qian Ruo-yun,Liu Hong,Zhong Nan,et al.Analysis of birth defects in xinjiang multi-ethnic region[J] Journal of Clinical Rehabilitative Tissue Engineering Research,2011,15(20):3797-3800.
[26]郭金仙,李怡林,邱伟涛,等.甘肃省围产儿出生缺陷发生现状及对策[J].卫生职业教 育,2006,24(18)：76-77.
[27]丁秀琴,郭瑛泉,张玲.甘肃省2001年～2008年围产儿出生缺陷监测结果分析[J].中国优生与遗传杂志,2011,1,(19)：94-96.
[28]白亚娜,张文辉,裴洪波,等.甘肃省出生缺陷基线调查[J].中国计划生育学杂志,2004,6,：350-352.
[29]方玉霞,叶荣伟,赵亚玲,等.妇女增补叶酸预防神经管畸形发生的最佳时点[J].中国妇幼保健,2009,2,：223-227.
[30]肖体红,范建英.奎屯垦区1994-2003年围产儿出生缺陷与干预措施[J].中国妇幼保健,2006,7,(21)：925-926.
[31]吴朝波,陈晓霞,周春来.115例新生儿先天性心脏病临床特点及早期诊断[J].广西医科大学学报,2010,27,(5)：748-750.
[32]赵秀艳.福州市出生缺陷的流行病学研究[D].福建：福建医科大学,2007：35.
[33]董志忠,李秀乐.热的致畸性研究[J].国外医学卫生学分册,1994,21(3)：147-149.
[34]杨思源.小儿心脏病学[M].北京：人民卫生出版社,2005：24.
[35]农俊.104例先天性心脏病的超声诊断分析[J].吉林医学,2010,31(36)：6789.
[36]王敏珍,郑山,白亚娜等.甘肃省农村孕产妇服用叶酸时间分布现状分析[J].中国公共卫生,2011,27(3)：367-368.
[37]黄小玲,罗新.第十八届F IGO世界妇产科学术会议纪要—孕期营养与孕产妇管理[J].中国实用妇科与产科杂志.2007,23(11)：892-893.
[38]沈立萍,仇小强,曾小云等.广西健康育龄妇女亚甲基四氢叶酸还原酶基因多态性与妊娠结局的关系[J].中国临床康复,2005,7(27)：8-9.
[39]林锦玉.口服斯利安防治习惯性流产的临床效果观察[J].中国妇幼保健,2007,22：3222.
[40]王莲萍,丁昌芝,汤成菊.马鞍山市孕期妇女服用叶酸状况及其影响因素分析[J].安徽预防医学杂志,2010,16(1)：35-45.
[41]Zhiwen Li, Aiguo Ren, Yue Zhang. Periconceptional use of folic acid in Shanxi Province of Northern China [J]. Public Health Nutrition,2007,10(S):471-476.
[42]Pacheco SS, Braga C, de Souza A I, et al. Effects of folic acid fortification on the prevalence of neural tub e defects [J]. Rev Saude Publica,2009,43(4):565-571.
[43]朱军,王和.增补小剂量叶酸预防神经管畸形[M].四川：成都时代出版社,2008：1-30.
[44]关辉,王倩.丰台区叶酸预防神经管畸形现状分析[J].中国优生优育,2001,12(4)：176.
[45]吕云,陈静琴,林主荣等.南京地区推广叶酸预防神经管畸形新技术的效果分析[J].中国妇幼保健,2002,17(2)：123.
[46]Boulet SL,Johnson K,Parker C,et al.A perspective of preconception health activities in the united atates.Matern Child HealthJ,2006,10(51):13-20.
[2]Baird PA,Anderson TW,Newcombe HB,et al.Genetic disorders in children and young adults:a population study.AmJ Hum Genet,1998,42:677-693.
[3]李智文,张乐,任爱国,等.叶酸与人类出生缺陷.中国生育健康杂志,2003,24(60)：374-377.
[4]张丹妍.出生缺陷的研究进展[J].中国优生优育,2010,16(1)：4-7.
[5]张国华,马二玲,张静茹等.出生缺陷干预措施研究进展[J].河北医药,2010,32(11)：1454-1455.
[6]Rosano A,Botto LD,Botting B,et al.Infant mortality and congenital anomalies from 1950 to 1994:an international perspective[J].Epidemiol Community Health,2000,54:660-666.
[7]Global Report on Birth Defects. The hidden toll of dying and disabled children. http://www. march ofdimes.com/March of Dimes Birth Defects Foundation.2006.
[8]朱军.出生缺陷的诊断与防治[J].中国实用妇科与产科杂志,2002,18(9)：513-514.
[9]薛云,许侠,刘晓曦.我国新生儿疾病筛查现状及面临的挑战[J].中国妇幼保健,2008,(23)：3650-3652.
[10]张璐.开展出生缺陷干预工程利国利民——访国家计生委出生缺陷干预工程首席科学家郑晓瑛教授[J].中国计划生育学杂志,2000,12：536-537.
[11]贾士美,庞兴仁.浅谈出生缺陷与出生缺陷干预工工程[J].中国农村卫生事业管理,2002,22(2)：52-53.
[12]贾士美,庞兴仁.出生缺陷干预工程一二三[J].知识长廊,46-47.
[13]国家人口和计划生育委员会关于开展出生缺陷一级预防工作的指导意见,人口计生委科技司,2007.
[14]江帆.全国出生缺陷交流会——江帆主任讲话_努力开创出生缺陷一级预防工作新局面——在全国出生缺陷一级预防工作交流会上的讲话.2009.
[15]郑英.孕产妇死亡率、儿童死亡率水平及影响因素分析[D].大连：大连医科大学,2007.
[16]认真开展出生缺陷干预工程----在出生缺陷干预工程基线调查培训班上的讲话,2006.http://www.gsj sw.gov. cn/html/xmj s/163959_267.html
[17]甘肃开展出生缺陷干预惠及数万群众,2006.http://www.gsjsw.gov.cn/html/pic/10_55_41_823.html
[18]全国妇幼卫生工作会议书面交流材料之二：河北省卫生厅-狠抓三级预防措施切实提高出生人口素质,2006年全国妇幼卫生工作会议http://www.moh.gov.cn/publicfiles/business/htmlfiles/wsb/pM30303/200804/22400.htm
[19]詹思延.循证医学和循证保健[M].北京：北京医科大学出版社,2002.
[20]李庆业.出生缺陷的研究进展[J].国外医学社会医学分册,2001,18(2)：64-67.
[21]全国妇幼卫生监测及年报通讯.卫生部妇幼保健与社区卫生司主办,2010,4：35.
[22]杨杨,曾令霞,颜虹.陕西省出生缺陷患病情况分析[J].中国公共卫生,2011,27(3)：316-317.
[23]张宏,霍正浩,刘兰,等.宁夏回族自治区出生缺陷危险因素分析[J].中国妇幼保健,2011,26(13)：2001-2003.
[24]刘健男.青海省10年出生缺陷监测结果分析[J].高原医学杂志,2011,21(3)：59-61.
[25]Qian Ruo-yun,Liu Hong,Zhong Nan,et al.Analysis of birth defects in xinjiang multi-ethnic region[J] Journal of Clinical Rehabilitative Tissue Engineering Research,2011,15(20):3797-3800.
[26]郭金仙,李怡林,邱伟涛,等.甘肃省围产儿出生缺陷发生现状及对策[J].卫生职业教 育,2006,24(18)：76-77.
[27]丁秀琴,郭瑛泉,张玲.甘肃省2001年～2008年围产儿出生缺陷监测结果分析[J].中国优生与遗传杂志,2011,1,(19)：94-96.
[28]白亚娜,张文辉,裴洪波,等.甘肃省出生缺陷基线调查[J].中国计划生育学杂志,2004,6,：350-352.
[29]方玉霞,叶荣伟,赵亚玲,等.妇女增补叶酸预防神经管畸形发生的最佳时点[J].中国妇幼保健,2009,2,：223-227.
[30]肖体红,范建英.奎屯垦区1994-2003年围产儿出生缺陷与干预措施[J].中国妇幼保健,2006,7,(21)：925-926.
[31]吴朝波,陈晓霞,周春来.115例新生儿先天性心脏病临床特点及早期诊断[J].广西医科大学学报,2010,27,(5)：748-750.
[32]赵秀艳.福州市出生缺陷的流行病学研究[D].福建：福建医科大学,2007：35.
[33]董志忠,李秀乐.热的致畸性研究[J].国外医学卫生学分册,1994,21(3)：147-149.
[34]杨思源.小儿心脏病学[M].北京：人民卫生出版社,2005：24.
[35]农俊.104例先天性心脏病的超声诊断分析[J].吉林医学,2010,31(36)：6789.
[36]王敏珍,郑山,白亚娜等.甘肃省农村孕产妇服用叶酸时间分布现状分析[J].中国公共卫生,2011,27(3)：367-368.
[37]黄小玲,罗新.第十八届F IGO世界妇产科学术会议纪要—孕期营养与孕产妇管理[J].中国实用妇科与产科杂志.2007,23(11)：892-893.
[38]沈立萍,仇小强,曾小云等.广西健康育龄妇女亚甲基四氢叶酸还原酶基因多态性与妊娠结局的关系[J].中国临床康复,2005,7(27)：8-9.
[39]林锦玉.口服斯利安防治习惯性流产的临床效果观察[J].中国妇幼保健,2007,22：3222.
[40]王莲萍,丁昌芝,汤成菊.马鞍山市孕期妇女服用叶酸状况及其影响因素分析[J].安徽预防医学杂志,2010,16(1)：35-45.
[41]Zhiwen Li, Aiguo Ren, Yue Zhang. Periconceptional use of folic acid in Shanxi Province of Northern China [J]. Public Health Nutrition,2007,10(S):471-476.
[42]Pacheco SS, Braga C, de Souza A I, et al. Effects of folic acid fortification on the prevalence of neural tub e defects [J]. Rev Saude Publica,2009,43(4):565-571.
[43]朱军,王和.增补小剂量叶酸预防神经管畸形[M].四川：成都时代出版社,2008：1-30.
[44]关辉,王倩.丰台区叶酸预防神经管畸形现状分析[J].中国优生优育,2001,12(4)：176.
[45]吕云,陈静琴,林主荣等.南京地区推广叶酸预防神经管畸形新技术的效果分析[J].中国妇幼保健,2002,17(2)：123.
[46]Boulet SL,Johnson K,Parker C,et al.A perspective of preconception health activities in the united atates.Matern Child HealthJ,2006,10(51):13-20.