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Prevention of Neural Tube Defects in Europe: A Public Health Failure
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 t...
Autores principales: | , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Frontiers Media S.A.
2021
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8264257/ https://www.ncbi.nlm.nih.gov/pubmed/34249803 http://dx.doi.org/10.3389/fped.2021.647038 |
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author | 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 |
author_facet | 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 |
author_sort | Morris, Joan K. |
collection | PubMed |
description | 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 μg/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. |
format | Online Article Text |
id | pubmed-8264257 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2021 |
publisher | Frontiers Media S.A. |
record_format | MEDLINE/PubMed |
spelling | pubmed-82642572021-07-09 Prevention of Neural Tube Defects in Europe: A Public Health Failure 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 Front Pediatr Pediatrics 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 μg/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. Frontiers Media S.A. 2021-06-24 /pmc/articles/PMC8264257/ /pubmed/34249803 http://dx.doi.org/10.3389/fped.2021.647038 Text en Copyright © 2021 Morris, Addor, Ballardini, Barisic, Barrachina-Bonet, Braz, Cavero-Carbonell, Den Hond, Garne, Gatt, Haeusler, Khoshnood, Lelong, Kinsner-Ovaskainen, Kiuru-Kuhlefelt, Klungsoyr, Latos-Bielenska, Limb, O'Mahony, Perthus, Pierini, Rankin, Rissmann, Rouget, Sayers, Sipek, Stevens, Tucker, Verellen-Dumoulin, de Walle, Wellesley, Wertelecki and Bermejo-Sanchez. https://creativecommons.org/licenses/by/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms. |
spellingShingle | Pediatrics 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 Prevention of Neural Tube Defects in Europe: A Public Health Failure |
title | Prevention of Neural Tube Defects in Europe: A Public Health Failure |
title_full | Prevention of Neural Tube Defects in Europe: A Public Health Failure |
title_fullStr | Prevention of Neural Tube Defects in Europe: A Public Health Failure |
title_full_unstemmed | Prevention of Neural Tube Defects in Europe: A Public Health Failure |
title_short | Prevention of Neural Tube Defects in Europe: A Public Health Failure |
title_sort | prevention of neural tube defects in europe: a public health failure |
topic | Pediatrics |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8264257/ https://www.ncbi.nlm.nih.gov/pubmed/34249803 http://dx.doi.org/10.3389/fped.2021.647038 |
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