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Prevention of Neural Tube Defects in Europe: A Public Health Failure

Joan K. Morris 1, * Marie-Claude Addor 2 Elisa Ballardini 3 Ingeborg Barisic 4 Laia Barrachina-Bonet 5 Paula Braz 6 Clara Cavero-Carbonell 5 Elly den Hond 7 Ester Garne 8 Miriam Gatt 9 Martin Haeusler 10 Babak Khoshnood 11 Nathalie Lelong 11 Agnieszka Kinsner-Ovaskainen 12 Sonja Kiuru-Kuhlefelt 13 Kari Klungsoyr 14, 15 Anna Latos-Bielenska 12 Elizabeth Limb 1 Mary T. O'Mahony 16 Isabelle Perthus 17 Anna Pierini 18 Judith Rankin 19 Anke Rissmann 20 Florence Rouget 21 Gerardine Sayers 22 Antonin Sipek 23 Sarah Stevens 24 David Tucker 25 Christine Verellen-Dumoulin 26 Hermien E. K. de Walle 27 Diana Wellesley 28 Wladimir Wertelecki 29 Eva Bermejo-Sanchez 30 
* Corresponding author
11 CRESS - U1153 - Equipe 1 : EPOPé - Épidémiologie Obstétricale, Périnatale et Pédiatrique
CRESS (U1153 / UMR_A_1125 / UMR_S_1153) - Centre de Recherche Épidémiologie et Statistique Sorbonne Paris Cité
Abstract : 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 mu g/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.
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Submitted on : Friday, May 6, 2022 - 3:10:21 PM
Last modification on : Monday, May 30, 2022 - 5:36:02 PM

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Joan K. Morris, Marie-Claude Addor, Elisa Ballardini, Ingeborg Barisic, Laia Barrachina-Bonet, et al.. Prevention of Neural Tube Defects in Europe: A Public Health Failure. Frontiers in Pediatrics, Frontiers, 2021, 9, pp.647038. ⟨10.3389/fped.2021.647038⟩. ⟨hal-03341170⟩

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