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Open Access Open Badges Research article

Identifying environmental risk factors for human neural tube defects before and after folic acid supplementation

Yilan Liao13, Jinfeng Wang1*, Xinhu Li2, Yaoqin Guo1 and Xiaoying Zheng3*

Author Affiliations

1 Institute of Geographical Sciences and Nature Resources Research, Chinese Academy of Sciences, Beijing100101, PR China

2 Institute of Urban Environment, Chinese Academy of Sciences, Xiamen361003, PR China

3 Institute of Population Research, Peking University, Beijing100871, PR China

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BMC Public Health 2009, 9:391  doi:10.1186/1471-2458-9-391

Published: 16 October 2009



Birth defects are a major cause of infant mortality and disability in many parts of the world. Neural tube defects (NTDs) are one of the most common types of birth defects. In 2001, the Chinese population and family planning commission initiated a national intervention program for the prevention of birth defects. A key step in the program was the introduction of folic acid supplementation. Of interest in the present study was to determine whether folic acid supplementation has the same protective effect on NTDs under various geographical and socioeconomic conditions within the Chinese population and the nature in which the influence of environmental factors varied after folic acid supplementation.


In this study, Heshun was selected as the region of interest as a surrogate for helping to answer some of the questions raised in this study on the impact of the intervention program. Spatial filtering in combination with GIS software was used to detect annual potential clusters from 1998 to 2005 in Heshun, and Kruskal-wallis test and multivariate regression were applied to identify the environmental risk factors for NTDs among various regions.


In 1998, a significant (p < 0.100) NTDs cluster was detected in the west of Heshun. After folic acid supplementation, the significant clusters gradually moved from west to east. However, during the study period, most of the clusters appeared in the middle region of Heshun where more than 95 percent of the coal mines of Heshun are located. For the analysis, buffer regions of the coal mine zone were built in a GIS environment. It was found that the correlations between environmental risk factors and NTDs vary among the buffer regions.


This suggests that the government needs to adapt the intervention measures according to local conditions. More attention needs to be paid to the poor and to people living in areas near coal mines.