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Objective To investigate the method and the feasibility of a population-based birth defects monitoring, describe the occurrence and distribution characteristics of Ma'anshan City, Anhui Province, birth defects, analysis of pregnancy for six months and first trimester exposure to environmental factors associated with the incidence of birth defects, the government provide the basis for formulating the decision-making for the prevention of birth defects. Maternal and child health institutions in Ma'anshan City, Anhui Province, four set survey points between October 1, 2008 to September 2009, 30, came to establish Perinatal Care Manual and the medical examination of pregnant women during pregnancy survey. Survey include: general demographic characteristics of pregnant women and their husbands, couples before pregnancy six months of exposure to the environment, and environmental exposure of pregnant women in early pregnancy, and pregnancy outcome. χ2 test the differences between the different groups, or whether there is a trend of incidence for inspection and birth defects; multivariate unconditional logistic regression analysis was used to analyze the incidence of birth defects possible risk factors and protective factors. The results ended September 30, 2009, a total of 2861 pregnant women into the queue; March 31, 2010, the 1899 follow-up to the outcome. Pregnant women, average age of 26.99 years (20 to 46 years old), the husband the average age of 29.80 years old (21 years old to 53 years old). Pregnant women and their spouse's level of education at the undergraduate and above the proportion were 19.6% and 27.1%; pregnant women urban hukou accounted for 80.8%, 87.4% live in urban areas. Follow-up 1926 cases of birth outcomes, including twins, 27 pairs of 1872 cases of single births; men and women in the proportion of 53.2% and 43.8% (57 cases gender prenatal diagnostic or therapeutic induction of labor reasons unclear , accounting for 3.0% of all fetal infant). All live births, a minimum age of 49 days, a maximum of 14 months; the total of 502 cases of adverse pregnancy outcomes, incidence 260.64 ‰, including types and their incidence were: spontaneous abortion 18.69 ‰, stillbirth 6.75 ‰ , premature 49.33 ‰, prolonged pregnancy 14.02 ‰, low birth weight 20.77 ‰, less than gestational age children 27.00 ‰ huge child 105.92 ‰ defective children 62.31 ‰. Male and female incidence of adverse pregnancy outcomes were 256.84 ‰ and 216.57 ‰ difference was statistically significant (χ 2 = 4.12, P = 0.042). The birth defects were found in 120 cases of birth defects The overall incidence rate of 62.31 ‰. Birth defects monitoring requirements of the National Conventional rate of 42.58 ‰ (82 cases, 68.3%), the study adds to the monitoring of birth defects (including visual impairment, hearing impairment, congenital scalp scar, cheekbones depression and mental retardation) occurred rate of 19.73 ‰ (38 cases, 31.7%). Single defect rate 51.92 ‰ (100 cases, 83.3%), the multiple defects incidence of 10.38 ‰ (20 cases, 16.7%). Incidence of birth defects in the male rate of 59.57 ‰ (61 cases, 50.8%), the incidence of birth defects in the female rate of 54.44 ‰ (46 cases, 38.3%). No significant difference in the overall incidence of birth defects between different gender (χ2 = 0.23, P = 0.635). Various types of defects, the incidence of visual impairment in the differences between men and women was statistically significant (χ 2 = 5.56, p = 0.018), remaining the incidence of birth defects was no significant difference between men and women. Incidence among the top six types of defects: congenital heart disease (10.90 ‰), visual impairment (9.87 ‰), hemangioma (8.83 ‰), hearing impairment (7.79 ‰), umbilical hernia (6.23 ‰) and nerve tube defects (4.67 ‰). Congenital malformations circulatory system accounted for 19.2%, the occurrence rate of 11.94 per thousand in the first row; nervous system malformations, eyes, ears, face and neck deformity, visual impairment, hearing impairment, and hemangioma relatively large incidence of 5.00 ‰. Prenatal diagnosis of birth defects was 14.2%, which belong to the national routine monitoring defects prenatal diagnosis rate was 20.7%. All anencephaly (n = 1), anorectal atresia or stenosis (n = 1), and gastroschisis (n = 1), abnormal brain development (3 cases), single umbilical artery (n = 2) were made in prenatal diagnosis; partially cleft lip (3/4), kidney abnormalities (2/3) and congenital hydrocephalus (1/2) are also prenatal confirm the diagnosis. Three cases in the prenatal clear diagnosis (14.3%) of 21 patients with congenital heart disease. 120 cases of defective children in 101 cases (84.2%) survived, stillbirth 3 cases (2.5%) died within 7 days after birth one cases, 15 cases (12.5%) in the induction of labor after diagnosis. The mother is the town accounts, agriculture accounts incidence of birth defects were 63.89 ‰ and 54.79 ‰. The highest incidence of mothers aged 35 years or more birth defects, but among the age group, the defect rate difference was not statistically significant (χ2 = 2.54, P = 0.468); mother pre-pregnancy body mass index grouping between the incidence of birth defects no statistically significant differences; family income is low, the incidence of birth defects, high group were 70.58 ‰, 51.55 ‰ and 34.19 ‰ difference between the groups was statistically significant (χ 2 = 4.25, P = 0.039 ); incidence of birth defects with the improvement of the father's cultural level the lowering trend (χ2 = 7.91, P = 0.005), the incidence of birth defects have also been reduced with the mother cultural level, but the difference was not statistically significant (χ2 = 2.22, P = 0.528). The number of pregnancies in the five and above, pregnant women giving birth fetal birth defects incidence 142.86 ‰, the defect rate difference was statistically significant (χ 2 = 6.04, P = 0.049) between the groups of different number of pregnancies; previous induced abortion , stillbirths, mole history of adverse pregnancy pregnant women, fetal birth defects in infants whose birth incidence 136.36 ‰, the history of adverse pregnancy pregnant fetal birth defects occurrence rate of 58.53 ‰, the difference was statistically significance (χ2 = 8.72, P = 0.003); incidence of birth defects in mothers without previous natural history of abortion, with or without a history of abortion, whether gynecological diseases, the parents whether slow history, the presence or absence of hereditary diseases and defects differences between the groups were not statistically significant; the pregnancy high packet family atmosphere (χ2 = 5.25, P = 0.022) in the high incidence of self-rated family atmosphere the low packet pregnant women fetal birth defects of the baby's self-assessment; pregnant women in the first half of pregnancy pesticide exposure group and the non-exposed group of birth defects incidence 200.00 ‰ and 60.67 ‰, respectively, the difference between the groups was statistically significant (χ2 = 4.42, P = 0.036); early pregnancy copiers with the not use copiers group born defect rate 90.90 ‰ and 56.80 ‰, the difference between the groups was statistically significant (χ 2 = 5.00, P = 0.025); six months before pregnancy, the husband vibration exposure group and the non-exposed group of birth defects incidence is 88.24 ‰ and 55.00 ‰, respectively, between the two groups difference was statistically significant (χ2 = 6.07, P = 0.014); weekly alcohol reached three above and three below group of birth defects incidence 114.29 ‰ and 57.99 ‰ difference between the groups was statistically significant (χ2 = 5.85 , P = 0.009). Influencing factors after birth defect Multivariate Logistic regression analysis drawn: mothers with previous history of adverse pregnancy (OR = 2.44, 95% CI: 1.27 ~~ 4.68), pre-pregnancy six months exposure to pesticides (OR = 4.14,95% CI: 1.33 to 12.88), early pregnancy using the copier (OR = 2.17,95% CI: 1.37 ~ 3.42) risk factors for birth defects; the the father highly educated protective factors for birth defects (OR = 0.49, 95% CI: from 0.26 ~~ 0.90) . Conclusion population-based monitoring is a powerful method of birth defects data. Ma'anshan City, Anhui Province, a higher incidence of birth defects, may be the result of multiple factors. Pregnancy for six months and during pregnancy to reduce the adverse environmental factors, to improve the level of prenatal diagnosis may have some significance in reducing birth defects.
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