Preventing neural tube defects in Europe: A missed opportunity

Araceli Busby, Ben Armstrong, Helen Dolk, Nicola Armstrong, Martin Haeusler, Andrea Berghold, Yves Gillerot, Andre Baguette, Romana Gjergja, Ingeborg Barisic, Marianne Christiansen, Janine Goujard, Volker Steinbicker, Christine Rösch, Robert McDonnell, Gioacchino Scarano, Elisa Calzolari, Amanda Neville, Guido Cocchi, Sebastiano BiancaMiriam Gatt, Hermien De Walle, Paula Braz, Anna Latos-Bielenska, Blance Gener, Isabel Portillo, Marie Claude Addor, Lenore Abramsky, Annukka Ritvanen, Elisabeth Robert-Gnansia, Anne Kjersti Daltveit, Goran Aneren, Birgitta Olars, Grace Edwards

Research output: Contribution to journalArticlepeer-review

111 Citations (Scopus)


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.

Original languageEnglish
Pages (from-to)393-402
Number of pages10
JournalReproductive Toxicology
Issue number3
Publication statusPublished - Sept 2005
Externally publishedYes


  • Folate
  • Folic acid supplementation
  • Folic acid supplementation policy
  • Neural tube defects
  • Surveillance of congenital anomalies


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