title: Long term maintenance of neural tube defects prevention in a high prevalence state.
abstract: OBJECTIVE
  To assess the efficacy of folic acid (FA) supplementation and fortification in preventing neural tube defects (NTDs) in a high prevalence region of the United States.
  
  
  METHODS
  Active and passive surveillance methods were used to identify all fetuses/infants affected with an NTD in South Carolina. Prevalence rates were compared with FA intake to determine the effects of increased intake on NTD occurrence and recurrence.
  
  
  RESULTS
  From 1992 to 2009, 916 NTD cases occurred in South Carolina, with isolated defects comprising 79% of cases. The NTD rate decreased 58% during this period. There was one NTD-affected pregnancy in 418 subsequent pregnancies (0.2%) in mothers with earlier NTD-affected pregnancies who consumed periconceptional FA supplements, and there were 4 NTDs in 66 pregnancies (6.1%) in which the mother did not take FA supplements. FA supplementation increased from 8% to 35% from 1992 to 2007, and knowledge of the protective benefits of FA increased from 8% to 65% in women of childbearing age.
  
  
  CONCLUSIONS
  Increased periconceptional intake of FA appeared to reduce NTDs in a high-prevalence region. The rate of spina bifida and anencephaly in South Carolina is now essentially the same (0.69 cases per 1000 live births and fetal deaths) as the 1998 to 2005 US rate (0.69).
authors.affiliation: Greenwood Genetic Center, Greenwood, SC 29646, USA.
authors.forename: Julianne S
authors.initials: JS
authors.lastname: Collins
authors.forename: Kristy K
authors.initials: KK
authors.lastname: Atkinson
authors.forename: Jane H
authors.initials: JH
authors.lastname: Dean
authors.forename: Robert G
authors.initials: RG
authors.lastname: Best
authors.forename: Roger E
authors.initials: RE
authors.lastname: Stevenson
mesh_terms: D003920:Diabetes Mellitus / Q000453:epidemiology; D016640:Diabetes, Gestational / Q000453:epidemiology; D019587:Dietary Supplements; D005260:Female; D005492:Folic Acid / Q000627:therapeutic use; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007231:Infant, Newborn; D009436:Neural Tube Defects / Q000175:diagnosis / Q000453:epidemiology* / Q000517:prevention & control*; D011247:Pregnancy; D011295:Prenatal Care; D015995:Prevalence; D015397:Program Evaluation; D044469:Racial Groups / Q000706:statistics & numerical data; D013022:South Carolina / Q000453:epidemiology; D016216:Ultrasonography, Prenatal; D014803:Vitamin B Complex / Q000627:therapeutic use
chemical_list: D014803:Vitamin B Complex; D005492:Folic Acid