Utilize este identificador para referenciar este registo: http://hdl.handle.net/10400.18/3396
Título: Long term trends in prevalence of neural tube defects in Europe: population based study
Autor: Khoshnood, Babak
Loane, Maria
Walle, Hermien de
Arriola, Larraitz
Addor, Marie-Claude
Barisic, Ingeborg
Beres, Judit
Bianchi, Fabrizio
Dias, Carlos Matias
Draper, Elizabeth
Garne, Ester
Gatt, Miriam
Haeusler, Martin
Klungsoyr, Kari
Latos-Bielenska, Anna
Lynch, Catherine
McDonnell, Bob
Nelen, Vera
Neville, Amanda J.
O’Mahony, Mary T.
Queisser-Luft, Annette
Rankin, Judith
Rissmann, Anke
Ritvanen, Annukka
Rounding, Catherine
Sipek, Antonin
Tucker, David
Verellen-Dumoulin, Christine
Wellesley, Diana
Dolk, Helen
Palavras-chave: Neural Tube Defect
Folic Acid
Congenital Anomalies
Prenatal Diagnosis
Prevention and Control
Fetal Death
Dietary Supplements
European Surveillance of Congenital Anomalies
Nacional Registry of Congenital Anomalies
Estados de Saúde e de Doença
Determinantes da Saúde e da Doença
Data: 14-Out-2015
Editora: BMJ Publishing Group
Citação: BMJ. 2015 Nov 24;351:h5949. doi: 10.1136/bmj.h5949
Resumo: Study question: What are the long term trends in the total (live births, fetal deaths, and terminations of pregnancy for fetal anomaly) and live birth prevalence of neural tube defects (NTD) in Europe, where many countries have issued recommendations for folic acid supplementation but a policy for mandatory folic acid fortification of food does not exist? Methods: This was a population based, observational study using data on 11 353 cases of NTD not associated with chromosomal anomalies, including 4162 cases of anencephaly and 5776 cases of spina bifida from 28 EUROCAT (European Surveillance of Congenital Anomalies) registries covering approximately 12.5 million births in 19 countries between 1991 and 2011. The main outcome measures were total and live birth prevalence of NTD, as well as anencephaly and spina bifida, with time trends analysed using random effects Poisson regression models to account for heterogeneities across registries and splines to model non-linear time trends. Summary answer and limitations: Overall, the pooled total prevalence of NTD during the study period was 9.1 per 10 000 births. Prevalence of NTD fluctuated slightly but without an obvious downward trend, with the final estimate of the pooled total prevalence of NTD in 2011 similar to that in 1991. Estimates from Poisson models that took registry heterogeneities into account showed an annual increase of 4% (prevalence ratio 1.04, 95% confidence interval 1.01 to 1.07) in 1995-99 and a decrease of 3% per year in 1999-2003 (0.97, 0.95 to 0.99), with stable rates thereafter. The trend patterns for anencephaly and spina bifida were similar, but neither anomaly decreased substantially over time. The live birth prevalence of NTD generally decreased, especially for anencephaly. Registration problems or other data artefacts cannot be excluded as a partial explanation of the observed trends (or lack thereof) in the prevalence of NTD. What this study adds: In the absence of mandatory fortification, the prevalence of NTD has not decreased in Europe despite longstanding recommendations aimed at promoting peri-conceptional folic acid supplementation and existence of voluntary folic acid fortification.
Descrição: Comment in: Mills JL, Dimopoulos A. Folic acid fortification for Europe? BMJ. 2015 Nov 24;351:h6198. doi: 10.1136/bmj.h6198.
Peer review: yes
URI: http://hdl.handle.net/10400.18/3396
DOI: 10.1136/bmj.h5949
ISSN: 0959-8138
Versão do Editor: http://www.bmj.com/content/351/bmj.h5949.long
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