Prevention of Neural Tube Defects in Europe: A Public Health Failure
2021
Morris, Joan K. | Addor, Marie-Claude | Ballardini, Elisa | Barisic, Ingeborg | Barrachina-Bonet, Laia | Braz, Paula | Cavero-Carbonell, Clara | den Hond, Elly | Garne, Ester | Gatt, Miriam | Haeusler, Martin | Khoshnood, Babak | Lelong, Nathalie | Kinsner-Ovaskainen, Agnieszka | Kiuru-Kuhlefelt, Sonja | Klungsoyr, Kari | Latos-Bielenska, Anna | Limb, Elizabeth | O'Mahony, Mary T. | Perthus, Isabelle | Pierini, Anna | Rankin, Judith | Rissmann, Anke | Rouget, Florence | Sayers, Gerardine | Sipek, Antonin | Stevens, Sarah | Tucker, David | Verellen-Dumoulin, Christine | de Walle, Hermien E. K. | Wellesley, Diana | Wertelecki, Wladimir | Bermejo-Sanchez, Eva | St George's, University of London | Centre Hospitalier Universitaire Vaudois = Lausanne University Hospital [Lausanne] (CHUV) | Università degli Studi di Ferrara = University of Ferrara (UniFE) | University of Zagreb | Biomedical Research Institute [Valencia, Spain] (INCLIVA) | Instituto Nacional de Saùde Dr Ricardo Jorge [Portugal] (INSA) | Provincial Institute of Hygiene [Antwerp, Belgium] (PIH) | Lillebaelt Hospital [Kolding, Denmark] (LH) | Directorate for Health Information and Research [Pietà, Malta] (DHIR) | Medical University of Graz = Medizinische Universität Graz | Obstetrical, Perinatal and Pediatric Epidemiology | Épidémiologie Obstétricale, Périnatale et Pédiatrique (EPOPé [CRESS - U1153 / UMR_A 1125]) ; Centre for Research in Epidemiology and Statistics | Centre de Recherche Épidémiologie et Statistiques (CRESS (U1153 / UMR_A 1125)) ; Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Paris Cité (UPCité)-Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement (INRAE)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Paris Cité (UPCité)-Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement (INRAE) | European Commission - Joint Research Centre [Ispra] (JRC) | Finnish Institute for Health and Welfare (FIHW) | University of Bergen (UiB) | Norwegian Institute of Public Health [Oslo] (NIPH) | St. Finbarr's Hospital [Cork, Ireland] (StFH) | CHU Estaing [Clermont-Ferrand] ; CHU Clermont-Ferrand | Institute of Clinical Physiology (IFC) ; National Research Council of Italy | Consiglio Nazionale delle Ricerche (CNR) | Newcastle University [Newcastle] | Otto-von-Guericke-Universität Magdeburg = Otto-von-Guericke University [Magdeburg] (OVGU) | Institut de recherche en santé, environnement et travail (Irset) ; Université d'Angers (UA)-Université de Rennes (UR)-École des Hautes Études en Santé Publique [EHESP] (EHESP)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Structure Fédérative de Recherche en Biologie et Santé de Rennes (Biosit : Biologie - Santé - Innovation Technologique) | Health Intelligence Ltd. | First Faculty of Medicine Charles University | Public Health England [London] | Singleton Hospital | Centre de Génétique Humaine [Charleroi, Belgium] (Institut de Pathologie et de Génétique) ; Institut de Pathologie et de Génétique, Charleroi | University of Groningen [Groningen] | Princess Anne Hospital [Southampton, UK] (PAH) ; University of Southampton | OMNI-Net Ukraine Programs [Rivne, Ukraine] | Instituto de Salud Carlos III [Madrid] (ISCIII)
International audience
Afficher plus [+] Moins [-]anglais. Objective: Thirty years ago it was demonstrated that folic acid taken before pregnancy and in early pregnancy reduced the risk of a neural tube defect (NTD). Despite Public Health Initiatives across Europe recommending that women take 0.4 mg folic acid before becoming pregnant and during the first trimester, the prevalence of NTD pregnancies has not materially decreased in the EU since 1998, in contrast to the dramatic fall observed in the USA. This study aimed to estimate the number of NTD pregnancies that would have been prevented if flour had been fortified with folic acid in Europe from 1998 as it had been in the USA.Design and Setting: The number of NTD pregnancies from 1998 to 2017 that would have been prevented if folic acid fortification had been implemented in the 28 countries who were members of the European Union in 2019 was predicted was predicted using data on NTD prevalence from 35 EUROCAT congenital anomaly registries and literature searches for population serum folate levels and folic acid supplementation.Results: From 1998 to 2017 an estimated 95,213 NTD pregnancies occurred amongst 104 million births in the 28 countries in the EU, a prevalence of 0.92 per 1,000 births. The median serum folate level in Europe over this time period was estimated to be 14.1 mu g/L. There is a lack of information about women taking folic acid supplements before becoming pregnant and during the first trimester of pregnancy, with one meta-analysis indicating that around 25% of women did so. An estimated 14,600 NTD pregnancies may have been prevented if the European countries had implemented fortification at the level adopted by the USA in 1998 and 25% of women took folic acid supplements. An estimated 19,500 NTD pregnancies would have been prevented if no women took folic acid supplements.Conclusions: This study suggests that failure to implement mandatory folic acid fortification in the 28 European countries has caused, and continues to cause, neural tube defects to occur in almost 1,000 pregnancies every year.
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