Are the recommendations on the prevention of neural tube defects working?

• Published in: European journal of medical genetics Vol. 49; no. 6; pp. 461 - 465
• Main Authors: Stoll, C., Alembik, Y., Dott, B.
• Format: Journal Article
• Language: English
• Published: Amsterdam Elsevier Masson SAS 01-11-2006; Elsevier
• Subjects: Anencephaly; Anencephaly - epidemiology; Anencephaly - prevention & control; Biological and medical sciences; Female; Folic acid; Folic Acid - administration & dosage; France - epidemiology; General aspects. Genetic counseling; Health Policy; Humans; Infant, Newborn; Male; Malformations of the nervous system; Medical genetics; Medical sciences; Neural tube defects; Neural Tube Defects - epidemiology; Neural Tube Defects - prevention & control; Neurology; Preconception Care; Pregnancy; Prenatal Care; Primary prevention; Spina bifida; Spinal Dysraphism - epidemiology; Spinal Dysraphism - prevention & control; France; Anencephaly; Spina bifida; Primary prevention; Neural tube defects; Folic acid; Human; Nervous system diseases; Diseases of the osteoarticular system; Spine disease; Congenital disease; Neural tube defect; Recommendation; Cerebral disorder; Prevention; Malformation; Central nervous system disease; Genetics
• ISSN: 1769-7212; 1878-0849
• DOI: 10.1016/j.ejmg.2006.06.001

Many studies showed that reduction by an estimated 80% or more of neural tube defects (NTD) by consumption of folic acid from before conception is achievable. The objectives of this study were to evaluate the effectiveness of recommendations on folic acid aimed at reducing the occurrence of NTD in our region. Cases of NTD were ascertained among liveborn infants, stillbirths, and terminations of pregnancy. Incidences and trends in rates of NTD before and after 1992 (the year of the first recommendations) and before and after 1995 (the year of local recommendations) were obtained. The results showed that the issuing of recommendations on folic acid was followed by no detectable improvement in the trends of incidence of NTD. The rates of NTD per 10,000 were before 1992 9.07, from 1993 to 1995 8.14, and after 1995 10.62, respectively. The incidence rate ratios (IRRs) were not different from 1.00. In conclusion new cases preventable by folic acid continue to accumulate. Recommendations alone did not influence trends in NTD in our country up to 11 years after the confirmation of the effectiveness of folic acid in clinical trials. New strategies are needed.