title: Using state and provincial surveillance programs to reduce risk of recurrence of neural tube defects in the United States and Canada: A missed opportunity?
abstract: BACKGROUND
  Once a woman has had a fetus or infant affected with a neural tube defect (NTD), the risk of recurrence is approximately 3%. This risk can be significantly reduced by folic acid supplement consumption during the periconceptional period; however, this requires women at risk to be adequately informed about the appropriate dosage and timing of supplement intake before planning another pregnancy. As birth defects surveillance programs are tasked with identifying and documenting NTD-affected pregnancies and births, they are in a unique position to support recurrence prevention activities.
  
  
  METHODS
  In 2015, we surveyed state and provincial birth defects surveillance programs to assess their NTD recurrence prevention activities. The online survey was sent to programs in 52 United States (U.S.) jurisdictions and all 13 provinces and territories in Canada. Findings were compared with a similar survey conducted in 2005 among U.S. programs.
  
  
  RESULTS
  In 2015, of the 44 U.S. and Canadian surveillance programs that responded, only 9 programs (7 U.S. and 2 Canadian) reported currently having activities specifically directed toward preventing NTD recurrence. Compared with a 2005 survey of U.S. programs, the number of U.S. programs working on NTD recurrence prevention decreased by almost 50% (from 13 to 7 programs).
  
  
  CONCLUSIONS
  The number of birth defects surveillance programs with NTD recurrence prevention activities has decreased over the past decade due to a range of barriers, most notably a lack of resources. However, while some recurrence prevention activities require part-time staff, other activities could be accomplished using minimal resources. Birth Defects Research (Part A) 106:875-880, 2016.© 2016 Wiley Periodicals, Inc.
authors.affiliation: Arizona Birth Defects Monitoring Program, Phoenix, Arizona.
authors.forename: Timothy J
authors.initials: TJ
authors.lastname: Flood
authors.affiliation: National Center on Birth Defects and Developmental Disabilities, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia.
authors.forename: Chelsea M
authors.initials: CM
authors.lastname: Rienks
authors.affiliation: National Center on Birth Defects and Developmental Disabilities, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia.
authors.forename: Alina L
authors.initials: AL
authors.lastname: Flores
authors.affiliation: National Center on Birth Defects and Developmental Disabilities, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia.
authors.forename: Cara T
authors.initials: CT
authors.lastname: Mai
authors.affiliation: Birth Defects Monitoring and Analysis, Minnesota Department of Health, St. Paul, Minnesota.
authors.forename: Barbara K
authors.initials: BK
authors.lastname: Frohnert
authors.affiliation: College of Public Health, University of South Florida, Tampa, Florida.
authors.forename: Rachel E
authors.initials: RE
authors.lastname: Rutkowski
authors.affiliation: Department of Biochemistry and Medical Genetics, University of Manitoba, Winnipeg, Manitoba, Canada.
authors.forename: Jane A
authors.initials: JA
authors.lastname: Evans
authors.affiliation: College of Public Health, University of South Florida, Tampa, Florida.
authors.forename: Russell S
authors.initials: RS
authors.lastname: Kirby
mesh_terms: D002170:Canada / Q000453:epidemiology; D062665:Epidemiological Monitoring; D005260:Female; D006801:Humans; D008297:Male; D009313:National Health Programs; D009436:Neural Tube Defects / Q000453:epidemiology*; D012307:Risk Factors; D014481:United States / Q000453:epidemiology
keywords: anencephaly; folic acid; neural tube defect; prevention; recurrence; spina bifida