Preventing neural tube defects in Europe: a missed opportunity.
Each year, more than 4500 pregnancies in the European Union are affected by neural tube defects (NTD). Unambiguous evidence of the effectiveness of periconceptional folic acid in preventing the majority of neural tube defects has been available since 1991. We report on trends in the total prevalence of neural tube defects up to 2002, in the context of a survey in 18 European countries of periconceptional folic acid supplementation (PFAS) policies and their implementation. EUROCAT is a network of population-based registries in Europe collaborating in the epidemiological surveillance of congenital anomalies. Representatives from 18 participating countries provided information about policy, health education campaigns and surveys of PFAS uptake. The yearly total prevalence of neural tube defects including livebirths, stillbirths and terminations of pregnancy was calculated from 1980 to 2002 for 34 registries, with UK and Ireland estimated separately from the rest of Europe. A meta-analysis of changes in NTD total prevalence between 1989-1991 and 2000-2002 according to PFAS policy was undertaken for 24 registries. By 2005, 13 countries had a government recommendation that women planning a pregnancy should take 0.4mg folic acid supplement daily, accompanied in 7 countries by government-led health education initiatives. In the UK and Ireland, countries with PFAS policy, there was a 30% decline in NTD total prevalence (95% CI 16-42%) but it was difficult to distinguish this from the pre-existing strong decline. In other European countries with PFAS policy, there was virtually no decline in NTD total prevalence whether a policy was in place by 1999 (2%, 95% CI 28% reduction to 32% increase) or not (8%, 95% CI 26% reduction to 16% increase). The potential for preventing NTDs by periconceptional folic acid supplementation is still far from being fulfilled in Europe. Only a public health policy including folic acid fortification of staple foods is likely to result in large-scale prevention of NTDs.
Busby
Araceli
A
London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK. araceli.busby@lshtm.ac.uk
Abramsky
Lenore
L
Dolk
Helen
H
Armstrong
Ben
B
Addor
Marie-Claude
MC
Anneren
Goran
G
Armstrong
Nicola
N
Baguette
Andre
A
Barisic
Ingeborg
I
Berghold
Andrea
A
Bianca
Sebastiano
S
Braz
Paula
P
Calzolari
Elisa
E
Christiansen
Marianne
M
Cocchi
Guido
G
Daltveit
Anne Kjersti
AK
De Walle
Hermien
H
Edwards
Grace
G
Gatt
Miriam
M
Gener
Blanca
B
Gillerot
Yves
Y
Gjergja
Romana
R
Goujard
Janine
J
Haeusler
Martin
M
Latos-Bielenska
Anna
A
McDonnell
Robert
R
Neville
Amanda
A
Olars
Birgitta
B
Portillo
Isabel
I
Ritvanen
Annukka
A
Robert-Gnansia
Elizabeth
E
Rösch
Christine
C
Scarano
Gioacchino
G
Steinbicker
Volker
V
D000328:Adult; D005060:Europe / Q000453:epidemiology; D005260:Female; D005492:Folic Acid / Q000627:therapeutic use*; D005527:Food, Fortified; D006801:Humans; D009436:Neural Tube Defects / Q000453:epidemiology* / Q000517:prevention & control*; D011247:Pregnancy; D011295:Prenatal Care; D015995:Prevalence; D011634:Public Health
D005492:Folic Acid