Association of premarital medical check-ups and folic acid knowledge, attitudes, and practices with the occurrence of neural tube defects in Guangxi, China (2009–2023)

Background: Neural tube defects (NTDs) are severe congenital malformations that cause significant foetal mortality and lifelong disability. Preconception folic acid supplementation has been proven effective in reducing the risk of NTDs. In 2009, China launched a national folic acid supplementation programme, which was further strengthened in Guangxi, China, by the implementation of a free premarital medical check-up policy in 2010. In this study, we analysed NTDs incidence trends in Guangxi (2009-2023) to evaluate the impact of these integrated interventions. Methods: We conducted a descriptive epidemiological study utilising surveillance data from Guangxi on premarital medical check-up (PMC) rate, folic acid supplementation rate, compliance rate, awareness rate, and the number of NTDs cases from 2009 to 2023. We used the Cochran-Armitage trend test to assess temporal trends, and Spearman's rank correlation and linear regression analyses to examine associations between PMC rate, folic acid-related indicators, and the NTDs incidence rate. Results: = 365.556, P < 0.001). Spearman correlation analysis showed significant negative correlations between the NTDs incidence rate and the PMC rate (r = -0.986, P < 0.001), folic acid supplementation rate (r = -0.932, P < 0.001), and folic acid awareness rate (r = -0.976, P < 0.001). Linear regression models indicated that increases in the PMC rate (β = -0.063, P < 0.001) and the folic acid supplementation rate (β = -0.090, P < 0.001) were significant predictors of a decrease in the NTDs incidence rate. Conclusions: The findings highlight the pivotal role of premarital medical check-ups and folic acid supplementation in preventing NTDs. The sustained promotion and reinforcement of these public health interventions are essential for further reducing the burden of birth defects and improving population health outcomes. The 'Guangxi model' of integrated premarital and reproductive health services offers valuable insights in this context.