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Preventing neural tube defects in Europe: a missed opportunity.
Reprod Toxicol. 2005 Sep-Oct; 20(3):393-402.RT

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+Show Affiliations

London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK. araceli.busby@lshtm.ac.ukNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Multicenter Study
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

15927445

Citation

Busby, Araceli, et al. "Preventing Neural Tube Defects in Europe: a Missed Opportunity." Reproductive Toxicology (Elmsford, N.Y.), vol. 20, no. 3, 2005, pp. 393-402.
Busby A, Abramsky L, Dolk H, et al. Preventing neural tube defects in Europe: a missed opportunity. Reprod Toxicol. 2005;20(3):393-402.
Busby, A., Abramsky, L., Dolk, H., Armstrong, B., Addor, M. C., Anneren, G., Armstrong, N., Baguette, A., Barisic, I., Berghold, A., Bianca, S., Braz, P., Calzolari, E., Christiansen, M., Cocchi, G., Daltveit, A. K., De Walle, H., Edwards, G., Gatt, M., ... Steinbicker, V. (2005). Preventing neural tube defects in Europe: a missed opportunity. Reproductive Toxicology (Elmsford, N.Y.), 20(3), 393-402.
Busby A, et al. Preventing Neural Tube Defects in Europe: a Missed Opportunity. Reprod Toxicol. 2005 Sep-Oct;20(3):393-402. PubMed PMID: 15927445.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Preventing neural tube defects in Europe: a missed opportunity. AU - Busby,Araceli, AU - Abramsky,Lenore, AU - Dolk,Helen, AU - Armstrong,Ben, AU - Addor,Marie-Claude, AU - Anneren,Goran, AU - Armstrong,Nicola, AU - Baguette,Andre, AU - Barisic,Ingeborg, AU - Berghold,Andrea, AU - Bianca,Sebastiano, AU - Braz,Paula, AU - Calzolari,Elisa, AU - Christiansen,Marianne, AU - Cocchi,Guido, AU - Daltveit,Anne Kjersti, AU - De Walle,Hermien, AU - Edwards,Grace, AU - Gatt,Miriam, AU - Gener,Blanca, AU - Gillerot,Yves, AU - Gjergja,Romana, AU - Goujard,Janine, AU - Haeusler,Martin, AU - Latos-Bielenska,Anna, AU - McDonnell,Robert, AU - Neville,Amanda, AU - Olars,Birgitta, AU - Portillo,Isabel, AU - Ritvanen,Annukka, AU - Robert-Gnansia,Elizabeth, AU - Rösch,Christine, AU - Scarano,Gioacchino, AU - Steinbicker,Volker, PY - 2005/02/28/received PY - 2005/03/23/revised PY - 2005/03/25/accepted PY - 2005/6/2/pubmed PY - 2005/9/28/medline PY - 2005/6/2/entrez SP - 393 EP - 402 JF - Reproductive toxicology (Elmsford, N.Y.) JO - Reprod. Toxicol. VL - 20 IS - 3 N2 - 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. SN - 0890-6238 UR - https://www.unboundmedicine.com/medline/citation/15927445/Preventing_neural_tube_defects_in_Europe:_a_missed_opportunity_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0890-6238(05)00090-0 DB - PRIME DP - Unbound Medicine ER -