title: Preventing neural tube defects in Europe: a missed opportunity.
abstract: 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.
authors.affiliation: London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK. araceli.busby@lshtm.ac.uk
authors.forename: Araceli
authors.initials: A
authors.lastname: Busby
authors.forename: Lenore
authors.initials: L
authors.lastname: Abramsky
authors.forename: Helen
authors.initials: H
authors.lastname: Dolk
authors.forename: Ben
authors.initials: B
authors.lastname: Armstrong
authors.forename: Marie-Claude
authors.initials: MC
authors.lastname: Addor
authors.forename: Goran
authors.initials: G
authors.lastname: Anneren
authors.forename: Nicola
authors.initials: N
authors.lastname: Armstrong
authors.forename: Andre
authors.initials: A
authors.lastname: Baguette
authors.forename: Ingeborg
authors.initials: I
authors.lastname: Barisic
authors.forename: Andrea
authors.initials: A
authors.lastname: Berghold
authors.forename: Sebastiano
authors.initials: S
authors.lastname: Bianca
authors.forename: Paula
authors.initials: P
authors.lastname: Braz
authors.forename: Elisa
authors.initials: E
authors.lastname: Calzolari
authors.forename: Marianne
authors.initials: M
authors.lastname: Christiansen
authors.forename: Guido
authors.initials: G
authors.lastname: Cocchi
authors.forename: Anne Kjersti
authors.initials: AK
authors.lastname: Daltveit
authors.forename: Hermien
authors.initials: H
authors.lastname: De Walle
authors.forename: Grace
authors.initials: G
authors.lastname: Edwards
authors.forename: Miriam
authors.initials: M
authors.lastname: Gatt
authors.forename: Blanca
authors.initials: B
authors.lastname: Gener
authors.forename: Yves
authors.initials: Y
authors.lastname: Gillerot
authors.forename: Romana
authors.initials: R
authors.lastname: Gjergja
authors.forename: Janine
authors.initials: J
authors.lastname: Goujard
authors.forename: Martin
authors.initials: M
authors.lastname: Haeusler
authors.forename: Anna
authors.initials: A
authors.lastname: Latos-Bielenska
authors.forename: Robert
authors.initials: R
authors.lastname: McDonnell
authors.forename: Amanda
authors.initials: A
authors.lastname: Neville
authors.forename: Birgitta
authors.initials: B
authors.lastname: Olars
authors.forename: Isabel
authors.initials: I
authors.lastname: Portillo
authors.forename: Annukka
authors.initials: A
authors.lastname: Ritvanen
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Robert-Gnansia
authors.forename: Christine
authors.initials: C
authors.lastname: Rösch
authors.forename: Gioacchino
authors.initials: G
authors.lastname: Scarano
authors.forename: Volker
authors.initials: V
authors.lastname: Steinbicker
mesh_terms: 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
chemical_list: D005492:Folic Acid