A total of 1799914 perinatal cases were monitored in Sichuan Province in the 14 years from 2006 to 2019; of these, 26,797 birth defects were diagnosed between 28 weeks of pregnancy and 7 days after birth, with an average birth defect rate of 148.88 per 10,000. The average rates of birth defects in the region of the mother (urban, rural) and sex of the baby (male, female) were 237.01, 87.63, 166.47 and 129.63 per 10,000, respectively. The average rates of birth defects for maternal ages of < 20, 20–25, 25–30, 30–35, > 35 years were 142.77, 133.01, 147.96, 170.39 and 180.37 per 10,000, respectively. The P values of the chi-square test for sex of the baby, region of the mother and maternal age were less than 0.01, which was significantly different. (Table 1)
Table 1
Analysis of the occurrence of BD in the province
|
Number of perinatal babies
|
Number of birth defects
|
total
|
Chi-square value
|
P values
|
Whole province
|
1799914
|
26797
|
148.88
|
—
|
—
|
Maternal region
|
|
|
|
6624.62
|
< 0.001
|
urban
|
738230
|
17497
|
237.01
|
|
|
rural
|
1061642
|
9303
|
87.63
|
|
|
Sex
|
|
|
|
415.63
|
< 0.001
|
male
|
937116
|
15600
|
166.47
|
|
|
female
|
862426
|
11180
|
129.63
|
|
|
Maternal age (years)
|
|
|
|
30057.25
|
< 0.001
|
< 20
|
57924
|
827
|
142.77
|
|
|
20-
|
504533
|
6711
|
133.01
|
|
|
25-
|
696004
|
10298
|
147.96
|
|
|
30-
|
364108
|
6204
|
170.39
|
|
|
> 35
|
177303
|
3198
|
180.37
|
|
|
The incidence of BDs in the province from 2006 to 2019 gradually increased to a peak and then steadily declined. It rose from 111.28 per 10,000 in 2006 to 182.97 per 10,000 in 2009 and then gradually decreased to 136.93 per 10,000 in 2019. The incidence of BDs in urban areas rose from 131.76 per 10,000 in 2006 to 284.96 per 10,000 in 2015, gradually decreased and then stabilized at approximately 280.86 per 10,000 in 2019. The incidence of BDs in rural areas rose from 94.06 per 10,000 in 2006 to 148.42 per 10,000 in 2009 and then gradually dropped to 61.09 per 10,000 in 2019. The incidence of BDs in males rose from 11.302 per 10,000 in 2006 to 221.28 per 10,000 in 2009 and then gradually decreased to 1,446.4 per 10,000 in 2019. The incidence of BDs in females rose from 106.65 per 10,000 in 2006 to 170.58 per 10,000 in 2009 and then gradually decreased to 127.69 per 10,000 in 2019. The BD incidence among mothers under 20 years of age rose from 117.65 per 10,000 in 2006 to 187.16 per 10,000 in 2009 and then fell to 111.38 per 10,000 in 2019. The incidence of BDs among mothers aged 20–25 increased from 103.15 in 2006. The rate of BDs in mothers aged 25–30 years increased from 109.95 per 10,000 in 2006 to 195.58 per 10,000 in 2009 and then decreased to 2019, and that in mothers aged 30–35 years increased from 111.15 per 10,000 in 2006 to 235.90 per 10,000 in 2014 and then decreased to 156.86 per 10,000 in 2019. BD in maternal age over 35 years The incidence rate rose from 136.45 per 10,000 in 2006 to 216.19 per 10,000 in 2015 and then dropped to 178.62 per 10,000 in 2019[10–15] (Table 2 and Figs. 1–3).
Table 2
The incidence of BDs by characteristics in the province from 2006 to 2019 (1/10,000)
|
2006
|
2007
|
2008
|
2009
|
2010
|
2011
|
2012
|
2013
|
2014
|
2015
|
2016
|
2017
|
2018
|
2019
|
Whole province
|
111.28
|
123.42
|
152.71
|
182.97
|
172.86
|
160.91
|
157.21
|
154.41
|
144.6
|
162.57
|
140.88
|
137.57
|
137.07
|
136.93
|
Maternal region
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
urban
|
131.76
|
145.52
|
189.71
|
260.90
|
271.48
|
211.42
|
206.31
|
225.84
|
251.79
|
284.96
|
259.03
|
246.63
|
257.52
|
280.86
|
rural
|
94.06
|
102.25
|
119.91
|
148.42
|
91.62
|
119.96
|
115.50
|
99.91
|
69.30
|
77.80
|
64.47
|
68.13
|
65.62
|
61.09
|
Sex
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
male
|
113.02
|
131.81
|
167.50
|
221.28
|
188.76
|
173.31
|
174.27
|
171.46
|
165.31
|
187.65
|
162.05
|
158.16
|
150.91
|
144.64
|
female
|
106.65
|
111.01
|
131.71
|
170.58
|
151.75
|
143.47
|
137.69
|
134.14
|
121.98
|
134.87
|
116.64
|
113.08
|
121.26
|
127.69
|
Maternal age (years)
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
< 20
|
117.65
|
122.57
|
125.41
|
187.16
|
183.7
|
129.78
|
149.73
|
145.9
|
142.12
|
104.45
|
190.39
|
128.01
|
105.83
|
111.38
|
20-
|
103.15
|
118.75
|
142.63
|
156.12
|
154.82
|
146.09
|
147.59
|
136.79
|
120.54
|
120.82
|
130.70
|
103.02
|
117.13
|
107.05
|
25-
|
109.95
|
117.5
|
155.01
|
195.58
|
171.86
|
161.64
|
151.62
|
158.72
|
124.95
|
169.78
|
148.71
|
131.25
|
123.44
|
130.50
|
30-
|
111.15
|
136.26
|
153.62
|
205.16
|
187.79
|
174.74
|
175.72
|
164.29
|
235.90
|
194.91
|
136.63
|
164.00
|
161.20
|
156.86
|
> 35
|
136.45
|
131.02
|
182.87
|
192.01
|
209.85
|
196.7
|
184.72
|
177.39
|
180.73
|
216.19
|
123.16
|
174.08
|
177.95
|
178.62
|
The incidence of BD in the province varied from year to year. Major deformity gradually transitioned from body surface deformities to visceral deformities, and the primordial deformity transitioned from congenital ear malformation (CEM) in 2006–2012 to congenital heart disease (CHD) in 2013–2019. The incidence of BD in urban areas transitioned from CEM in 2006–2011 to CHD in 2012–2019. The incidence of birth defects in rural areas transitioned from cleft lip with or without cleft palate in 2006 to CEM in 2008 and then to polydactyly in 2014–2019. The incidence of birth defects in males transitioned from CEM in 2006 to CHD in 2013–2019; that in females transitioned from CEM 2006–2011 to CHD in 2012–2019 (Table 3). The first occurrence of BDs in the province changed mainly among CEM, polydactyly, and CHD (Figs. 1–3).
Table 3
The first occurrence of BD in the province from 2006 to 2019 (1/10,000)
years
|
The province's first order deformity
|
first order deformity in urban areas
|
first order deformity in rural areas
|
first order deformity in males
|
first order deformity in females
|
2006
|
CEM
|
18.26
|
CEM
|
26.74
|
CLP
|
17.41
|
CEM
|
18.13
|
CEM
|
18.44
|
2007
|
CEM
|
22.07
|
CEM
|
33.25
|
Polydactyly
|
17.09
|
Polydactyly
|
25.25
|
CEM
|
20.05
|
2008
|
CEM
|
25.69
|
CEM
|
34.28
|
CEM
|
18.07
|
CEM
|
24.94
|
CEM
|
26.07
|
2009
|
CEM
|
40.28
|
CEM
|
57.12
|
CEM
|
26.46
|
CEM
|
41.26
|
CEM
|
38.82
|
2010
|
CEM
|
37.51
|
CEM
|
63.02
|
CEM
|
16.50
|
CEM
|
39.48
|
CEM
|
35.37
|
2011
|
CEM
|
31.61
|
CEM
|
43.87
|
CEM
|
21.67
|
CEM
|
33.20
|
CEM
|
29.71
|
2012
|
CEM
|
26.95
|
CHD
|
40.40
|
CEM
|
20.49
|
CEM
|
28.48
|
CHD
|
26.04
|
2013
|
CHD
|
34.42
|
CHD
|
64.66
|
CEM
|
16.41
|
CHD
|
34.35
|
CHD
|
34.23
|
2014
|
CHD
|
33.12
|
CHD
|
70.12
|
Polydactyly
|
12.34
|
CHD
|
35.41
|
CHD
|
30.50
|
2015
|
CHD
|
48.75
|
CHD
|
103.66
|
Polydactyly
|
15.09
|
CHD
|
51.43
|
CHD
|
45.87
|
2016
|
CHD
|
36.80
|
CHD
|
84.84
|
Polydactyly
|
13.28
|
CHD
|
35.75
|
CHD
|
37.94
|
2017
|
CHD
|
27.72
|
CHD
|
64.01
|
Polydactyly
|
13.38
|
CHD
|
26.63
|
CHD
|
28.68
|
2018
|
CHD
|
30.66
|
CHD
|
69.44
|
Polydactyly
|
14.70
|
CHD
|
27.45
|
CHD
|
33.99
|
2019
|
CHD
|
38.87
|
CHD
|
94.07
|
Polydactyly
|
14.79
|
CHD
|
39.93
|
CHD
|
38.40
|