Abstract
BACKGROUND: Birth defects are an important cause of fetal and neonatal mortality and represent a major global public health concern. Shenzhen has implemented several prevention and control programs in recent years. However, the effectiveness in reducing mortality among affected children has not been systematically evaluated. OBJECTIVE: To assess the impact of birth defect prevention and control programs on mortality among children with birth defects in Shenzhen from 2012 to 2023, and to provide evidence for program evaluation and maternal-child health policy development. METHODS: All registered cases of children with birth defects in Shenzhen between 2012 and 2023 were included. The study period was divided into three phases according to program implementation: Phase I (2012-2017), Phase II (2018-2021), and Phase III (2022-2023). Mortality outcomes included early fetal death, late fetal death, and early neonatal death. Trends were analyzed using the Cochran-Armitage test with Bonferroni-adjusted pairwise comparisons. Multivariable logistic regression adjusted for confounders and subgroup analyses were conducted by maternal household registration status (local vs. non-local). RESULTS: From Phase I to Phase III, early fetal mortality increased (26.1% vs. 29.7% vs. 33.4%), whereas late fetal mortality (5.7% vs. 4.1% vs. 3.6%) and early neonatal mortality (1.0% vs. 0.5% vs. 0.3%) declined significantly(P < 0.001 for trends). Logistic regression showed lower risks of late fetal and early neonatal death in Phases II and III compared with Phase I, with greater reductions among children of non-local mothers. CONCLUSION: Birth defect prevention and control programs in Shenzhen were associated with reduced late fetal and early neonatal mortality, especially in non-local populations, Providing evidence to guide maternal-child health policy.