Birth Defects Data from Surveillance Hospitals in Hubei Province, China, 200l – 2008

Tu, Lh; Li, H; Zhang, Hp; Li, Xd; Lin, Jj; Xiong, Cl

Department of Public Health spot-checked nine cities and seventeen counties in 2008, finding that the rate of missing report of surveillance hospitals was 15.72%. (1). The prevalence of 2008 was 13.85‰, a little higher than the national average prevalence (13.49‰). The data indicated an increase of BD prevalence, the same trend as the whole nation (2) . To speculate, it may relate to several things. First, surveillance system was improved to make the data more genuine, especially with the advanced prenatal diagnostic techniques and expertise skills. Second, as the forcible premarital health assessment was cancelled, the risks of BD were increased. Furthermore, as modernization of the city, pollution and other modern life-related risks and lifestyle (e.g. delayed childbearing) (3) were responsible too. The prevalence in urban and rural were of no significant difference in 2008, different from the earlier data published before 2008 which indicated that prevalence in rural was a little higher than in urban (1). The enhanced maternal and child health care in rural may contribute to the offset. The difference of prevalence between male and female was significant; the former prevalence was much higher, which paralleled with the data previously published (4). Advanced maternal age (over 35 years old) was related to a higher BD prevalence, but with no significance compared to the younger group, different from a majority of the data previously published (4, 5) . The recent emphasis on the antenatal care and prenatal screening for pregnant women over 35 years old might be partly related to this difference. From 2002 to 2008, CLP and polydactyly were continuously on top two. This may relate to genetic and environmental factors. Genetic factors contributing to CLP have been identified for some syndromic cases and many genes associated with syndromic cases of CLP have also been identified to contribute to the incidence of isolated cases of CLP (6) . Besides, CLP and other congenital abnormalities have been linked to maternal hypoxia, as caused by e.g. maternal smoking (7-9), maternal alcohol abuse or some forms of maternal hypertension treatment (10) . Integration of genetic and environmental risk using different methods may generate a synthesis that will both better characterize etiologies, as well as provide access to better clinical care and prevention (11) . A case-control study by JY Luo, et al. (12) on polydactyly showed that heredity was the foremost risk factor. At the same time, CHD was growing year after year, ranking top three in 2008, which was partly due to improved prenatal diagnostic techniques and skills and increased environmental risks. With above three BDs, hydrocephaly, EEM and NTDs were still the main BDs and constituted over 50% of all BDs, while shooting up to 64% in 2003 probably due to severe acute respiratory syndrome (SARS) outbreak, which made hospitals screening for BD in a much more cautious way. The top six BDs in Hubei province were similar to national data, but their prevalences were all higher than national average ones except CHD (2) . Data published on Annual Report of the National Maternal and Child Health Care Surveillance and Communications in June, 2009 indicated that the prenatal diagnosis rate in Hubei province in 2008 was 14.29%, a bit lower than eastern coastal cities and provinces. All the data showed that there was more the maternal and child health care could do to improve the present situation. As peri