TY - JOUR
T1 - Preventing neural tube defects in Europe
T2 - A missed opportunity
AU - Busby, Araceli
AU - Armstrong, Ben
AU - Dolk, Helen
AU - Armstrong, Nicola
AU - Haeusler, Martin
AU - Berghold, Andrea
AU - Gillerot, Yves
AU - Baguette, Andre
AU - Gjergja, Romana
AU - Barisic, Ingeborg
AU - Christiansen, Marianne
AU - Goujard, Janine
AU - Steinbicker, Volker
AU - Rösch, Christine
AU - McDonnell, Robert
AU - Scarano, Gioacchino
AU - Calzolari, Elisa
AU - Neville, Amanda
AU - Cocchi, Guido
AU - Bianca, Sebastiano
AU - Gatt, Miriam
AU - Walle, Hermien De
AU - Braz, Paula
AU - Latos-Bielenska, Anna
AU - Gener, Blance
AU - Portillo, Isabel
AU - Addor, Marie Claude
AU - Abramsky, Lenore
AU - Ritvanen, Annukka
AU - Robert-Gnansia, Elisabeth
AU - Daltveit, Anne Kjersti
AU - Aneren, Goran
AU - Olars, Birgitta
AU - Edwards, Grace
N1 - Funding Information:
Eurocat is supported by the EU Commission Public Health Directorate Public Health Programme.
PY - 2005/9
Y1 - 2005/9
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 0.4 mg 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.
AB - 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 0.4 mg 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.
KW - EUROCAT
KW - Folate
KW - Folic acid supplementation
KW - Folic acid supplementation policy
KW - Neural tube defects
KW - Surveillance of congenital anomalies
UR - http://www.scopus.com/inward/record.url?scp=21744443422&partnerID=8YFLogxK
U2 - 10.1016/j.reprotox.2005.03.009
DO - 10.1016/j.reprotox.2005.03.009
M3 - Article
C2 - 15927445
AN - SCOPUS:21744443422
SN - 0890-6238
VL - 20
SP - 393
EP - 402
JO - Reproductive Toxicology
JF - Reproductive Toxicology
IS - 3
ER -
