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Long term trends in prevalence of neural tube defects in Europe: population based study

2015-10-14Journal article Open access
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dc.contributor.authorKhoshnood, Babak
dc.contributor.authorLoane, Maria
dc.contributor.authorWalle, Hermien de
dc.contributor.authorArriola, Larraitz
dc.contributor.authorAddor, Marie-Claude
dc.contributor.authorBarisic, Ingeborg
dc.contributor.authorBeres, Judit
dc.contributor.authorBianchi, Fabrizio
dc.contributor.authorDias, Carlos Matias
dc.contributor.authorDraper, Elizabeth
dc.contributor.authorGarne, Ester
dc.contributor.authorGatt, Miriam
dc.contributor.authorHaeusler, Martin
dc.contributor.authorKlungsoyr, Kari
dc.contributor.authorLatos-Bielenska, Anna
dc.contributor.authorLynch, Catherine
dc.contributor.authorMcDonnell, Bob
dc.contributor.authorNelen, Vera
dc.contributor.authorNeville, Amanda J.
dc.contributor.authorO’Mahony, Mary T.
dc.contributor.authorQueisser-Luft, Annette
dc.contributor.authorRankin, Judith
dc.contributor.authorRissmann, Anke
dc.contributor.authorRitvanen, Annukka
dc.contributor.authorRounding, Catherine
dc.contributor.authorSipek, Antonin
dc.contributor.authorTucker, David
dc.contributor.authorVerellen-Dumoulin, Christine
dc.contributor.authorWellesley, Diana
dc.contributor.authorDolk, Helen
dc.date.accessioned2016-02-17T18:06:47Z
dc.date.available2016-02-17T18:06:47Z
dc.date.issued2015-10-14
dc.descriptionComment in: Mills JL, Dimopoulos A. Folic acid fortification for Europe? BMJ. 2015 Nov 24;351:h6198. doi: 10.1136/bmj.h6198.
dc.description.abstractStudy 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.pt_PT
dc.description.sponsorshipThe study was funded by the European Public Health Commission, EUROCAT Joint Action 2011-2013. HD and ML received support from the European Commission DG Sanco during the conduct of this study.pt_PT
dc.identifier.citationBMJ. 2015 Nov 24;351:h5949. doi: 10.1136/bmj.h5949pt_PT
dc.identifier.doi10.1136/bmj.h5949pt_PT
dc.identifier.issn0959-8138
dc.identifier.urihttp://hdl.handle.net/10400.18/3396
dc.language.isoengpt_PT
dc.peerreviewedyespt_PT
dc.publisherBMJ Publishing Grouppt_PT
dc.relation.publisherversionhttp://www.bmj.com/content/351/bmj.h5949.longpt_PT
dc.subjectNeural Tube Defectpt_PT
dc.subjectFolic Acidpt_PT
dc.subjectTrendspt_PT
dc.subjectPrevalencept_PT
dc.subjectCongenital Anomaliespt_PT
dc.subjectPrenatal Diagnosis
dc.subjectPrevention and Control
dc.subjectFetal Death
dc.subjectDietary Supplements
dc.subjectPregnancy
dc.subjectEurope
dc.subjectPortugal
dc.subjectEuropean Surveillance of Congenital Anomalies
dc.subjectNacional Registry of Congenital Anomalies
dc.subjectEUROCAT
dc.subjectRENAC
dc.subjectEstados de Saúde e de Doença
dc.subjectDeterminantes da Saúde e da Doença
dc.titleLong term trends in prevalence of neural tube defects in Europe: population based studypt_PT
dc.typejournal article
dspace.entity.typePublication
oaire.citation.endPage6pt_PT
oaire.citation.startPage1pt_PT
oaire.citation.titleBritish Medical Journalpt_PT
oaire.citation.volume351pt_PT
rcaap.rightsopenAccesspt_PT
rcaap.typearticlept_PT

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