Preventing and reducing the occurrence of birth defects and ensuring the quality of the birth population from the source are the cornerstones of national health. Not long ago, the Shanghai Birth Defects Prevention and Health Care Center was officially established in the International Peace Maternal and Child Health Hospital of the China Welfare Association, what should be done to prevent birth defects? How do we build a birth defect prevention and control system? We had the honor to invite Cheng Weiwei, the chief physician of the Doctoral Supervisor of the International Peace Maternal and Child Health Hospital of the China Welfare Association, to talk about the importance of birth defect prevention and treatment.
[Birth defects, a wide-ranging concept]
Zhang Yixin:
Some time ago, our country of women and children set up the Shanghai Birth Defects Prevention and Health Care Center, can you first explain to us what is a birth defect, everyone is very concerned about what causes birth defects to occur.
Cheng Weiwei:
Birth defects, everyone may not be unfamiliar with this term, but from a medical point of view, how to explain birth defects more completely and accurately? Let's talk today.
Birth defects refer to some structural abnormalities that already exist at birth, including functional abnormalities, and when we see some introductions, we tend to pay more attention to structural abnormalities. For example, newborn rabbit lips, one more finger and so on. But in fact, birth defects are a relatively large range, including some functional abnormalities after birth, congenital lack of an enzyme, or other rare diseases. These can affect the growth and development of the child during future growth, and may even lead to life-threatening. So birth defects are a very broad concept.
So maybe we can talk about what kinds of diseases it contains like birth defects? Which diseases are among the more common birth defects?
There are actually many diseases of birth defects, some birth defects are related to heredity, such as chromosomal abnormalities, then the more representative chromosomal abnormalities are now Down syndrome, it is because there is an extra chromosome in the body, so that the genetic code of our entire body is a problem. We usually say that this person knows that he is a congenital fool at a glance, why is it called a congenital fool? Because of some obstacles in his intelligence, even if he can survive, his intelligence can only stay at the age of 5 to 6.
Not only that, but chromosomal abnormalities can also lead to abnormal developmental functions of the entire organ. Therefore, for these children with chromosomal abnormalities, the survival period after birth is not long, and it is easy to occur various diseases and die early. In addition to one more chromosome, there may be one less, and there are structural abnormalities, which can be summarized as chromosomal abnormalities.
There are also some chromosomes, although there is no abnormality, but there are structural abnormalities, such as congenital heart disease, which is currently the world's number one birth defect disease, because the heart structure is very complex, there are ventricles, atrium, and all kinds of aorta, it will appear structural abnormalities.
Others, although not apparent on the surface, are congenitally deficient in an enzyme, such as an abnormality in glucose conversion enzyme hexaphosphate, and there will be problems in the newborn's body. This requires timely detection after birth and long-term use of drugs.
【Three-level prevention, full chain prevention of birth defects】
You just gave so many examples, for a family, but encountering such birth defects, may be unbearable pain, how should we avoid tragedy from the source?
This problem deserves attention both at the government level and at the level of our ordinary people. In fact, our International Peace Maternal and Child Health Hospital has also been committed to exploration and research in this regard.
There are several major causes of birth defects, firstly related to family genetics, secondly related to the surrounding environment, and related to the infection of some diseases, as well as various comprehensive factors. In response to these problems, how to prevent and control them well, the relevant departments have launched a series of measures to prevent and treat birth defects, including premarital examinations, pre-pregnancy examinations, and examinations throughout pregnancy.
There are three levels of prevention for birth defects, which is also a full-chain prevention of birth defects.
Primary prevention is the prevention of the emergence of diseases. First of all, you should pay attention to your own health management, a couple wants to start conceiving a baby, it is best to go to the examination beforehand. You yourself may know what disease you have, but more often, the disease is hidden, including family hereditary diseases, although the daily disease does not occur, but if both husband and wife carry the disease-causing gene, then your baby may get sick, medically known as the carrier of genetic disease. Our hospital has a pre-pregnancy clinic, a premarital clinic, and can do carrier screening programs.
In addition, if you are engaged in some kind of work, or if there are some risk factors in your family environment, including physical chemistry, then avoid these risk factors when planning pregnancy. Now there are more types of diseases, so when you choose drugs, some drugs are irritating to the embryo, and some drugs are not self-deceptive. Primary prevention is the initiation of prevention before the embryo forms.
Secondary prevention refers to the ability to screen out these diseases in a timely manner, and the work in this regard falls more on our medical institutions. From the perspective of the prevention and treatment of defects, how to detect possible birth defects through our examination methods in various medical institutions that have the ability to deliver and deliver babies, and all hospitals with obstetrics departments. There are many prenatal diagnosis centers and specialized outpatient clinics for fetal medicine in Shanghai.
Tertiary prevention refers to how the disease or defect has been formed, and how the child can alleviate this defect after birth, especially the impact on future health and growth and development. At present, newborns have many congenital disease screenings, including screening for congenital heart disease and so on. If these diseases can be intervened as soon as possible in early screening, it can improve the future growth and development of the child and the quality of life.
What are the main aspects of the prevention and control system of the whole chain of birth defects? What is the relationship between this and the shanghai birth defects prevention and health care center that we mentioned at the beginning?
In fact, the concept of full-chain prevention and control that we put forward is to condense together what I just said. From the beginning of embryogenesis, a number of preventive interventions are carried out until early detection after birth. Because of many diseases, from the current development of medicine, it is no longer a problem.
Including various rare diseases reported by the media some time ago, although the incidence of these diseases in the population is relatively low, and it is difficult to treat in the past. However, with the development of medicine, more understanding of its causes can be studied related specific drugs. For example, some time ago, the media reported that spinal muscular atrophy (SMA) was previously untreatable, and now there are drugs that can be treated, and the national medical insurance has reduced the cost of the original 700,000 injections to 33,000 injections now, which can benefit many families and save children.
【Strengthen prevention and control, starting from marriage examination】
So the Shanghai Birth Defects Prevention and Health Care Center, so what exactly is this center doing? Can you tell us about it?
The Birth Defects Prevention and Health Center, in fact, is to carry out the whole chain of services around our birth defects. At present, the marriage examination rate in Shanghai is very low, and the Shanghai Municipal Health Commission also attaches great importance to this problem. The low marriage test rate means that a couple seems to be normal, but in fact he does not know what diseases will exist in his body. Because we hope that starting from the marriage examination, we can strengthen prevention and control and move the time window forward.
In addition, we also have a preconception clinic, which provides some health examinations for couples who are trying to become pregnant, and can prevent and control birth defects from the second step. After that, we will enter our pregnancy examination, preferably from the first trimester, because if the fetus has been formed in the middle and late stages, it will be very serious, and then let the family decide whether to leave the child, often the harm to them is relatively large.
For newborns, there are 4 kinds of early screening in Shanghai, including congenital heart disease and so on. If detected early, early medication can greatly improve the future health of the child.
The relevant departments awarded the brand of Shanghai Birth Defects Prevention and Health Center to the national women and babies, which is actually a recognition of our hospital's work in this field. What measures or experience do you think can be learned and promoted by women and children in China?
Our hospital not only puts its foothold in its own hospital, the prevention and control of birth defects needs the attention of the whole society, so we have also done a lot of science popularization, whether it is our pregnant women's school, or a talent training base for birth defects, we hope to train the personnel of various grass-roots medical institutions, we have theoretical training, but also practical operation. This is the first line to train some of our talents in the prevention and control of birth defects through the line of doctors.
The second line is to do popular science, all the doctors in the pregnant women's school are very enthusiastic, they have compiled a series of books, and some popular science short dramas, go to the community to publicize to the general public, how to prevent our birth defects.
In addition, as we just said, our hospital has a full chain of prevention and control, and no other hospital in Shanghai has such a complete chain at present.
[The development of modern medicine makes birth defects no longer terrible]
So for expectant mothers and couples who are trying to conceive, if there is a possibility of fetal birth defects, what medical means can we really help them?
I want to do more science for everyone through today's program. We should not think it is scary when we talk about birth defects, and with the development of medicine, many defects can be solved by existing medical means, such as congenital heart disease. I have been practicing medicine for more than 30 years, in the past, I may find out that there is a problem with the child, the parents' attitude is very resolute, we must induce labor, we want a completely healthy baby. But it is difficult to say the words "complete health", some diseases can be found in the womb, and some can only occur at the age of five or six.
To take a simple example, congenital heart disease is currently ranked first among all birth defects and has been 10 years in a row. In fact, most of the birth defects can be solved by the treatment of the day after tomorrow, and some can slowly grow well after birth, such as a small lack of room or room defect, as long as regular follow-up can be carried out, no intervention is required, only parents need to be more careful in the process of raising.
Including our pediatric cardiothoracic surgery department is also developing very fast, whether it is Shanghai Children's Medical Center or our Fudan Pediatric Hospital, we can master the techniques of various operations of congenital heart disease. Including some kidney problems, such as hydronephrosis, etc., these can be solved by pediatric surgery, so it is not that once the defect is found, the pregnancy must be terminated. Parents should follow the doctor's assessment and give you a comprehensive recommendation, which is very important.
You have been deeply involved in the field of obstetrics and gynecology for many years, what good experience and good advice do you have for the prevention and control of birth defects?
We hope that based on these two platforms of the hospital, we can strengthen the public's popularization of health knowledge, and we must not pay attention to it, but not be overly anxious and worried. In addition, if some families have a bad maternal history, or others in the family have some birth defects, we believe that we should start from before marriage and pregnancy, and do carrier screening for both husband and wife. If there is a problem with the screening, we now have a good means, such as by doing three generations of IVF, through artificial methods, to avoid the successful implantation of embryos carrying pathogenic genes, which are the highlights of development in recent years.
In addition, we have more screening methods during pregnancy, which can be screened early. I want to emphasize that hopefully all these couples who are trying to conceive, including those who are pregnant, don't get nervous. Now every hospital attaches great importance to the prevention and control of defects.
Children are the future of the motherland, minkang is the national health, reduce the incidence of birth defects, the key lies in prevention. With the introduction of the three-child policy, factors such as elderly mothers have brought new challenges to improving the quality of the population. It is a long way to go to strengthen the publicity and education on the prevention and treatment of birth defects, and to guide people from all walks of life and the whole life cycle to pay more attention to participating in and supporting the prevention and treatment of birth defects and the promotion of maternal and child health.
We believe that the establishment of the Shanghai Birth Defects Preventive Health Care Center will bring us more perfect and better life-cycle health services, and provide Shanghai experience for further reducing the incidence of birth defects.