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Prevenção primária dos Defeitos do Tubo Neural: quantos casos poderiam ter sido prevenidos entre 2004 e 2017 através da adesão à recomendação oficial?
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Advisor(s)
Abstract(s)
Os defeitos do tubo neural (DTN) que ocorrem quando não se verifica
o encerramento desta estrutura até ao 28º dia de vida fetal, podem ser
alvo de uma medida de prevenção primária através da suplementação
com ácido fólico, se iniciada antes da gravidez e até ao final do 1º
trimestre, a qual tem o potencial para reduzir o risco daquelas anomalias
em cerca de 70%. Em Por tugal, a Circular Normativa 02/DSMIA emitida
pela DGS, recomenda esta suplementação desde 1998. O presente
estudo descreve a epidemiologia da toma de ácido fólico em Por tugal e
estima o numero de casos de DTN que seriam prevenidos caso o início
do suplemento tivesse começado antes da gravidez. Foi realizado um
estudo transversal com dados do Registo Nacional de Anomalias Congénitas
(RENAC) entre 2004 e 2017. A evolução temporal da frequência
anual do início da toma de ácido fólico foi analisada através do teste de
Cochran-Armitage para proporções. O número de casos preveníveis foi
estimado considerando a fração de prevenção de 70% e o número de
casos de DTN registados no RENAC que ocorreram em gravidezes sem
a correta suplementação por ácido fólico. Em média, o início da suplementação
pré-concepcional foi referido por 13,8% das mulheres, tendo
sido notificados 538 casos de DTN. Estima-se uma prevenção de 202
casos de DTN se as mulheres tivessem iniciado a toma de ácido fólico
antes da gravidez. A prevenção primária dos DTN deve ser encorajada
através de medidas que promovam a suplementação por acido fólico.
Neural tube defects (NTD) occur when the neural tube does not close properly until the 28th day of foetal life. These bir th defects have a primar y prevention measure available if folic acid supplementation star ts before pregnancy and stay until the end of the 1st trimester of pregnancy, resulting in an estimated 70% of NTD that can be prevented. Por tugal joined this recommendation since 1998 (Circular Normativa 02 / DSMIA). The aim of this study is to describe when folic acid intake was star ted and estimate the number of cases that would have be prevented if folic acid intake had star ted before pregnancy. A cross-sectional study was per formed using data from the National Registr y of Congenital Anomalies (RENAC) between 2004 and 2017. The temporal evolution of the beginning of folic acid intake was analysed with Cochran-Armitage test for propor tions. The propor tion of preventable cases was estimated considering the 70% prevention fraction and the number of NTD cases registered in RENAC that occurred in pregnancies without the recommended folic acid supplementation. On average, 13.8% of women repor ted star ted folic acid before pregnancy and 538 cases of NTD were repor ted. If all women had star ted folic acid before pregnancy, an estimated 202 cases could have been prevented. Primar y prevention of NTDs should be encouraged with measures that promote folic acid supplementation.
Neural tube defects (NTD) occur when the neural tube does not close properly until the 28th day of foetal life. These bir th defects have a primar y prevention measure available if folic acid supplementation star ts before pregnancy and stay until the end of the 1st trimester of pregnancy, resulting in an estimated 70% of NTD that can be prevented. Por tugal joined this recommendation since 1998 (Circular Normativa 02 / DSMIA). The aim of this study is to describe when folic acid intake was star ted and estimate the number of cases that would have be prevented if folic acid intake had star ted before pregnancy. A cross-sectional study was per formed using data from the National Registr y of Congenital Anomalies (RENAC) between 2004 and 2017. The temporal evolution of the beginning of folic acid intake was analysed with Cochran-Armitage test for propor tions. The propor tion of preventable cases was estimated considering the 70% prevention fraction and the number of NTD cases registered in RENAC that occurred in pregnancies without the recommended folic acid supplementation. On average, 13.8% of women repor ted star ted folic acid before pregnancy and 538 cases of NTD were repor ted. If all women had star ted folic acid before pregnancy, an estimated 202 cases could have been prevented. Primar y prevention of NTDs should be encouraged with measures that promote folic acid supplementation.
Description
Keywords
Defeitos do Tubo Neural DTN Anomalias Congénitas Registo Nacional de Anomalias Congénitas RENAC Registos Epidemiológicos Acido Fólico Gravidez Prevenção Primária Portugal
Pedagogical Context
Citation
Boletim Epidemiológico Observações. 2019;8(Supl 11):77-79
Publisher
Instituto Nacional de Saúde Doutor Ricardo Jorge, IP