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Background: Neural tube defects (neural tube defects, NTDs) is the most common birth defects in humans and the most severe deformity group, is a group of malformations in the embryonic development of the first 3 to 4 weeks due to spinal dysraphism, including no brain child, spina bifida and encephalocele. The NTDs have occurred around the world, the world still was born about 300 000NTDs newborns, even though many countries the implementation of folic acid supplements prevention of NTDs each year. It is estimated that nearly 40 countries around the world each year about occurred in 240,000 cases of folic acid can prevent spina bifida and anencephaly children, strengthened through the implementation of folic acid or the addition of folic acid, the number of cases successfully prevented about 22,000 cases per year, accounting for only 10% of . This shows that there may be other factors or multiple factors affect the preventive effect of folate. The study found that only 4.5 percent of the people in northern China NTDs high incidence of pregnancy start taking folic acid. Can not guarantee that the rate of folic acid in the case, we can not only rely on periconceptional folic acid supplementation NTDs primary prevention purposes. The data indicate that early pregnancy dietary factors may have an important role in the primary prevention of NTDs. Objective: explore NTDs occur in pregnant women in early dietary factors from a dietary perspective, provide recommendations for the guidance of pregnant women achieve the purpose of prevention of NTDs through reasonable diet during pregnancy to provide a scientific basis for the development of effective NTDs dietary nutrition interventions. Methods: A 1:1 matched case-control study to investigate in Shandong Province and Shanxi Province, 20 counties (districts) in the first two years of investigation time case group, matched by the children of women diagnosed fertility (induction of labor) NTDs the same area, the same hospital, the same year in childbirth, infants of women of reproductive health as a control group. The demographic characteristics of households face-to-face interviews to understand the object of study in early pregnancy dietary food types and frequency of research content. Results: The results show that, (1) study the demographic and health-related behavioral traits: the case group and the control group in the occupation, education level, household per capita income, the occupation of the spouses, the spouse of educational level and other demographic characteristics and reproductive history, early pregnancy BMI, planning to become pregnant, prenatal and postnatal care health education, aware of foods containing folic acid, the self-inductance of early pregnancy nutritional status, adjust the diet during early pregnancy, diet nutrition during pregnancy attitude difference was statistically significant. (2) trimester food intake frequency of NTDs relevance: edible beans and dairy (frequency ≥ 7 times / week), as well as the frequency of consumption of meat, poultry and fish, animal organs, fruits and nuts (3-6 times / week) associated with the consumption frequency of ≤ 1 times / month comparison, the apparent protective effect of NTDs; the nuts edible frequency gt; 1 times / month (with ≤ 1 times / month compared to) has a protective role (P lt; 0.05 ). In contrast, consumption of salty pickled kimchi class will increase the risk of NTDs occur and eating higher the frequency the greater the risk of NTDs (P lt; 0.05). Multivariate analysis results show that the frequency of animal offal, milk, nuts, salty pickled Kimchi consumption is still a significant difference (P lt; 0.05) between the case and control groups. The case group and control subjects in different age, occupation, education level, family economic level of women in the consumption of various food frequency varies from case to. (3) early pregnancy nutritional status of NTDs: self-inductance of the poor nutritional status of the case group compared with the self-inductance of a good nutritional status, and carries the risk of NTDs in children is 5.04 times that of the control group (OR = 5.45,95% CI: 3.55 -8.35), self-inductance of the poor nutritional status of women gave birth to children with risk of NTDs AR% ARP%, 80.2% and 54.8%, respectively. The case group subjects early pregnancy nutrition score was 15.48 ± 5.83 (-2-30), control group averaged 19.76 ± 5.13 (4-32), good the case group first trimester ratings nutritional status and poor ratio of 5.0% and 31.5%, respectively, compared with the control group (18.3% and 9.2%, respectively), the difference was statistically significant (P lt; 0.05), the case group nutritional status of women in early pregnancy was significantly lower than the control group, adjustment after confounding factors, poor nutritional status of the case group study compared the nutritional status of women gave birth NTDs children's risk control group, 8.38-fold (95% CI :4.57-15.4). (4) early pregnancy dietary adjustments associated with NTDs: early pregnancy, 327 (71.2%) in the control group conscious dietary adjustment, significantly higher than the case group and 209 (45.5%), the difference was statistically significant (P = 0.000), after adjusting for confounding factors, the the unadjusted dietary woman of NTDs risk adjustment meals 2.73 times (OR = 2.73,95% CI :2.04-3 .65). Univariate analysis showed adjust dietary crowd early pregnancy increases the intake of meat, eggs, beans, milk, vegetables, fresh fruit, cereals, seafood, sesame seeds, reduce pickles, homemade pickles, kimchi , alcohol, coffee intake can be reduced to varying degrees of NTDs risk (P lt; 0.05). Multivariate analysis showed that early pregnancy increases the meat still has a significant difference, OR = 0.645,95% CI :0.418-0 .996, as a protective factor. Meat intake on the NTDs risk of women's reproductive AR% ARP% respectively for 55.1% and 11.9%, respectively. Women not adjusted diet, the case and control groups were 52% and 59.8% of the people do not consider it necessary to adjust, respectively, 19.6% and 14.4% want to adjust the diet but do not know how to adjust. The women adjust dietary consumption of fish, meat, poultry, organ meats, eggs, beans, milk, vegetables, fruits, nuts frequency significantly higher than the unadjusted dietary women, consumption of salty pickled kimchi class frequency significantly lower than the unadjusted dietary women. (5) first trimester nutrition attitude of NTDs in relevance and impact factors: women's negative nutritional attitude will increase NTDs occur risk adjustment for confounding factors, OR = 2.93,95% CI :2.18-3 .96, P lt; 0.001 . The the negative nutritional attitude of the women gave birth to children with risk of NTDs AR% ARP% to 65.9% and 36.7%, respectively. Early pregnancy positive nutrition attitude of women is higher than the frequency of consumption of meat, poultry and fish, eggs, beans, milk, vegetables, fruits, nuts negative nutritional attitudes of women, the difference was statistically significant (P lt; 0.05), food frequency the higher the risk of NTDs occur more obvious the lower the low. Multivariate analysis, did not receive health education (OR = 1.75,95% CI :1.23-2 .48), no adjustment of dietary (OR = 3.83,95% CI :2.79-5 .25) will affect women in early pregnancy nutrition attitude (P lt ; 0.01); addition, women in early pregnancy nutrition attitude also by women's educational level (OR = 0.611,95% CI.0.431-0.866) as well as their spouses age (OR = 1.41,95% CI :1.01-1 .97). (6) planning to become pregnant, and adjust meals, health education, and early pregnancy nutrition attitude summed risk of NTDs exist interaction. Conclusion: (1) early pregnancy increase the intake of meat, eggs, beans, milk, vegetables, fresh fruit, cereals, seafood, sesame seeds, or reduce the pickles, homemade pickles, pickles, wine, coffee intake can make NTDs risk in different degrees of reduction. (2) edible beans, milk, vegetables frequency ≥ 7 times / week, and the consumption of meat, poultry and fish, animal organs, fruits, nuts frequency of 3 to 6 times / week of NTDs has a strong protective effect. (3) women in early pregnancy adjustment meals and have a positive nutrition attitude can significantly increase their consumption of fish, meat, poultry, organ meats, eggs, beans, milk, vegetables, fruits, nuts frequency reduce pickles, homemade pickles. kimchi consumption frequency, thereby improving their nutritional status. (4) women received health education or planning a pregnancy can significantly improve their first trimester nutrition attitude and take the initiative to adjust the diet structure of behavior. Recommendation: pregnant woman the nutrition attitudes tend to be around the crowd whose husband impact. Therefore, the strength and breadth of nutrition education during pregnancy needs to be strengthened, missionary object In addition to the pregnant woman, her husband and other family members should both. In addition, the promotion of women of childbearing age dietary diversification do both to increase the variety of nutrients, and the variety of food nutrients play a complementary role, thereby increasing the nutritional prevention of NTDs effect.
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