Risk factors for the occurrence of spina bifida (a case-control study) and the prevalence rate of spina bifida in Japan.
BACKGROUND
The Japanese government recommended in 2000 that women planning pregnancy should take 400 μg of folic acid daily to decrease the risk of having an infant with spina bifida. We aimed to identify risk factors for the occurrence of spina bifida and to evaluate how the prevalence rate has altered over the past 3 decades.


METHODS
Subjects comprised 360 women who gave birth to spina bifida-affected offspring and 2333 women who gave birth to offspring without spina bifida between 2001 and 2012. A self-administered questionnaire was used to collect data, which were analyzed by multiple logistic regression models. The prevalence rate of spina bifida was obtained through data provided by international and domestic organizations.


RESULTS
Four variables were significantly associated with the increased risk of having newborns afflicted with spina bifida: not taking folic acid supplements (odds ratios [OR], 2.50; 95% confidence interval [CI], 1.72-3.64), presence of spina bifida patients within third-degree relatives (OR, 4.26; 95% CI, 1.12-16.19), taking anti-epileptic drugs without folic acid (OR, 20·20; 95% CI, 2.06-198.17), and low birth weight in the newborns ≤ 2500 g (OR, 4.21; 95% CI, 3.18-5.59). The prevalence rate of spina bifida has remained 5 to 6 per 10,000 total births and has not shown any decreasing trend over the past 11 years.


CONCLUSIONS
Four risk factors were identified among Japanese women. Because recommendations and information have not decreased the occurrence of spina bifida, the Japanese government should implement mandatory food fortification.
Department of Urology, Tsushima Rehabilitation Hospital, Tsushima, Japan.
Atsuo
A
Kondo
Nobuhito
N
Morota
Satoshi
S
Ihara
Takeshi
T
Saisu
Katsumi
K
Inoue
Shoko
S
Shimokawa
Hiroya
H
Fujimaki
Keisuke
K
Matsuo
Yoichi
Y
Shimosuka
Tomoyuki
T
Watanabe
D000927:Anticonvulsants / Q000009:adverse effects; D016022:Case-Control Studies; D005260:Female; D005492:Folic Acid / Q000627:therapeutic use*; D006801:Humans; D007230:Infant, Low Birth Weight; D007564:Japan / Q000453:epidemiology; D016015:Logistic Models; D016017:Odds Ratio; D010375:Pedigree; D011247:Pregnancy; D015995:Prevalence; D012307:Risk Factors; D016135:Spinal Dysraphism / Q000453:epidemiology* / Q000517:prevention & control*; D011795:Surveys and Questionnaires
D000927:Anticonvulsants; D005492:Folic Acid
case-control study; folic acid; prevalence; risk factors; spina bifida; supplements