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A population-based case-control study of risk factors for neural tube defects in Shenyang, China

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Abstract

Purpose

To explore the risk factors for neural tube defects (NTD) in Shenyang, we carried out a population-based case-control study.

Methods

We used chi-square test or Fisher’s exact test to evaluate variations in the prevalence by selected covariates. Adjusted odds ratios and 95% confidence intervals were derived from univariate and multivariable conditional logistic models.

Results

A history of maternal previous birth defect-affected pregnancy was a risk factor for NTDs (adjusted OR = 4.00, 95%CI = 1.29–12.45). Risks for NTDs were significantly associated with exposure to maternal factors during the periconceptional period such as a history of fever or cold (adjusted OR = 6.36, 95%CI = 3.24–12.52), use of analgesic and antipyretic drugs (adjusted OR = 4.94, 95%CI = 1.79–13.63), oral contraceptive use (adjusted OR 2.06, 95%CI 1.16, 3.68), and passive smoking (adjusted OR = 2.24, 95%CI = 1.04–4.81). Folic acid tablets use and fresh vegetable or fruit consumption ≥6 meals a week in periconception appeared to be protective factors (adjusted OR 0.33, 0.55, and 0.40, and 95%CI 0.13–0.44, 0.30–1.01, and 0.21–0.74, respectively). Differences in risk were found between the two most common phenotypes of NTD, anencephaly, and spina bifida.

Conclusions

This study suggests that a history of previous birth defect-affected pregnancy, a history of maternal fever or cold, use of analgesics, antipyretics, and oral contraceptives, exposure to passive smoking, folic acid use, and consumption of fresh vegetable and fruit may be associated with NTD risk.

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References

  1. Sever L, Lynberg MC, Edmonds LD (1993) The impact of congenital malformations on public health. Teratology 48:547–549

    Article  CAS  PubMed  Google Scholar 

  2. Xiao KZ, Zhang ZY, Su YM, Liu FQ, Yan ZZ, Jiang ZQ et al (1990) Central nervous system congenital malformations, especially neural tube defects in 29 provinces, metropolitan cities and autonomous regions of China: Chinese Birth Defects Monitoring Program. Int J Epidemiol 19:978–982

    Article  CAS  PubMed  Google Scholar 

  3. Melnick M, Marazita ML (1998) Neural tube defects, methylenetetrahydrofolate reductase mutation, and north/south dietary differences in China. J Craniofac Genet Dev Biol 18:233–235

    CAS  PubMed  Google Scholar 

  4. Li Z, Ren A, Zhang L, Guo Z, Li Z (2006) A population-based case-control study of risk factors for neural tube defects in four high-prevalence areas of Shanxi province, China. Paediatr Perinat Epidemiol 20:43–53

    Article  PubMed  Google Scholar 

  5. Whiteman D, Murphy M, Hey K, O’Donnell M, Goldacre M (2000) Reproductive factors, subfertility, and risk of neural tube defects: a case-control study based on the Oxford Record Linkage Study Register. Am J Epidemiol 152:823–828

    Article  CAS  PubMed  Google Scholar 

  6. Carmichael SL, Shaw GM, Schaffer DM, Laurent C, Selvin S (2003) Dieting behaviors and risk of neural tube defects. Am J Epidemiol 158:1127–1131

    Article  PubMed  Google Scholar 

  7. Li Z, Ren A, Liu J, Pei L, Zhang L, Guo Z, Li Z (2007) Maternal flu or fever, medication use, and neural tube defects: a population-based case-control study in Northern China. Birth Defects Res A Clin Mol Teratol 79:295–300

    Article  CAS  PubMed  Google Scholar 

  8. Suarez L, Felkner M, Brender JD, Canfield M, Hendricks K (2008) Maternal exposures to cigarette smoke, alcohol, and street drugs and neural tube defect occurrence in offspring. Matern Child Health J 12:394–401

    Article  PubMed  Google Scholar 

  9. Wang W, Guan P, Xu W, Zhou B (2009) Risk factors for oral clefts: a population-based case-control study in Shenyang, China. Paediatr Perinat Epidemiol 23:310–320

    Article  PubMed  Google Scholar 

  10. Li Z, Ren A, Zhang L, Ye R, Li S, Zheng J, Hong S, Wang T, Li Z (2006) Extremely high prevalence of neural tube defects in a 4-county area in Shanxi Province, China. Birth Defects Res A Clin Mol Terato 76:237–240

    Article  CAS  Google Scholar 

  11. Botto LD, Lisi A, Bower C, Canfield MA, Dattani N, De Vigan C, De Walle H, Erickson DJ, Halliday J, Irgens LM, Lowry RB, McDonnell R, Metneki J, Poetzsch S, Ritvanen A, Robert-Gnansia E, Siffel C, Stoll C, Mastroiacovo P (2006) Trends of selected malformations in relation to folic acid recommendations and fortification: an international assessment. Birth Defects Res A Clin Mol Teratol 76:693–705

    Article  CAS  PubMed  Google Scholar 

  12. van der Pal-de Bruin KM, van der Heijden PG, Buitendijk SE, den Ouden AL (2003) Periconceptional folic acid use and the prevalence of neural tube defects in The Netherlands. Eur J Obstet Gynecol Reprod Biol 108:33–39

    Article  PubMed  Google Scholar 

  13. Gu X, Lin L, Zheng X, Zhang T, Song X, Wang J, Li X, Li P, Chen G, Wu J, Wu L, Liu J (2007) High prevalence of NTDs in Shanxi Province: a combined epidemiological approach. Birth Defects Res A Clin Mol Teratol 79:702–707

    Article  CAS  PubMed  Google Scholar 

  14. Garabedian BH, Fraser FC (1993) Upper and lower neural tube defects: an alternate hypothesis. J Med Genet 30:849–851

    Article  CAS  PubMed  Google Scholar 

  15. Hall JG, Friedman JM, Kenna BA, Popkin J, Jawanda M, Arnold W (1998) Clinical, genetic, and epidemiological factors in neural tube defects. Am J Hum Genet 43:827–837

    Google Scholar 

  16. Hakosalo J, Saxen L (1971) Influenza epidemic and congenital defects. Lancet 2:1346–1347

    Article  CAS  PubMed  Google Scholar 

  17. Sandford MK, Kissling GE, Joubert PE (1992) Neural tube defect etiology: new evidence concerning maternal hyperthermia, health and diet. Dev Med Child Neurol 34:661–675

    Article  CAS  PubMed  Google Scholar 

  18. Zhang J, Cai WW (1993) Association of the common cold in the first trimester of pregnancy with birth defects. Pediatrics 92:559–563

    CAS  PubMed  Google Scholar 

  19. Shaw GM, Todoroff K, Velie EM, Lammer EJ (1998) Maternal illness, including fever, and medication use as risk factors for neural tube defects. Teratology 57:1–7

    Article  CAS  PubMed  Google Scholar 

  20. Shiota K (1982) Neural tube defects and maternal hyperthermia in early pregnancy: epidemiology in a human embryo population. Am J Med Genet 12:281–288

    Article  CAS  PubMed  Google Scholar 

  21. Kozer E, Nikfar S, Costei A, Boskovic R, Nulman I, Koren G (2002) Aspirin consumption during the first trimester of pregnancy and congenital anomalies: a meta-analysis. Am J Obstet Gynecol 187:1623–1630

    Article  PubMed  Google Scholar 

  22. Correy JF, Newman NM, Collins JA, Burrows EA, Burrows RF, Curran JT (1991) Use of prescription drugs in the first trimester and congenital malformations. Aust N Z J Obstet Gynaecol 31:340–344

    Article  CAS  PubMed  Google Scholar 

  23. Li DK, Daling JR, Mueller BA, Hickok DE, Fantel AG, Weiss NS (1995) Oral contraceptive use after conception in relation to the risk of congenital urinary tract anomalies. Teratology 51:30–36

    Article  CAS  PubMed  Google Scholar 

  24. Wang D, Yu X (2004) Morphological study on the neural tube defects caused by passive smoking. Wei Sheng Yan Jiu 33:147–150 (In Chinese)

    PubMed  Google Scholar 

  25. Worthington-Roberts B (1997) The role of maternal nutrition in the prevention of birth defects. J Am Diet Assoc 97:S184–S185

    Article  CAS  PubMed  Google Scholar 

  26. Velie EM, Block G, Shaw GM, Samuels SJ, Schaffer DM, Kulldorff M (1999) Maternal supplemental and dietary zinc intake and the occurrence of neural tube defects in California. Am J Epidemiol 150:605–616

    CAS  PubMed  Google Scholar 

  27. Ray JG, Blom HJ (2003) Vitamin B12 insufficiency and the risk of fetal neural tube defects. QJM 96:289–295

    Article  CAS  PubMed  Google Scholar 

  28. Rull RP, Ritz B, Shaw GM (2006) Neural tube defects and maternal residential proximity to agricultural pesticide applications. Am J Epidemiol 163:743–753

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

This research was supported by the Health Bureau of Shenyang. We are grateful to many local investigators in Shenyang for their assistance with data collection and to other staff who participated in this research project. We are most grateful to the two anonymous reviewers for their constructive comments.

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Authors and Affiliations

  1. Department of Epidemiology, School of Public Health, China Medical University, No 92, North Second Road, Heping District, Shenyang, 110001, Liaoning Province, People’s Republic of China

    Zhihua Yin, Wei Wang & Baosen Zhou

  2. Department of Maternal and Child Health, The Health Bureau of Shenyang, Shenyang, 110001, Liaoning Province, People’s Republic of China

    Wei Xu, Shiqi Zhang & Yajun Zheng

  3. Maternity and Child Healthcare Hospital of Liaoning Province, Shenyang, 110005, Liaoning Province, People’s Republic of China

    Changying Xu

Authors
  1. Zhihua Yin
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  2. Wei Xu
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  3. Changying Xu
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  4. Shiqi Zhang
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  5. Yajun Zheng
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  6. Wei Wang
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  7. Baosen Zhou
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Correspondence to Baosen Zhou.

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Yin, Z., Xu, W., Xu, C. et al. A population-based case-control study of risk factors for neural tube defects in Shenyang, China. Childs Nerv Syst 27, 149–154 (2011). https://doi.org/10.1007/s00381-010-1198-7

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  • DOI: https://doi.org/10.1007/s00381-010-1198-7

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