Current policies have failed to reduce the number of neural tube defects in Europe

Every year, nearly 5,000 pregnancies in Europe are affected by neural tube defects such as spina bifida and anencephaly (malformations of the brain and skull), with serious consequences for the newborn infants. Taking nutritional supplements containing folic acid (or vitamin B9) before and during early pregnancy may considerably reduce the risk, but studies show that only a minority of women do so. A study published today in The British Medical Journal, and coordinated by Babak Khoshnood, Inserm Research Director (Inserm Unit 1153 “Sorbonne Paris Cité Research Center in Epidemiology and Biostatistics”) concludes that there has been no decrease in neural tube defects over a 20-year period. The researchers urge the decision-makers to consider establishing a policy of mandatory folic acid fortification of some staple foods, such as flour or cereals.

The prevalence of neural tube defects in Europe has not decreased in the last 20 years, despite recommendations to women intending to have a child to supplement their folic acid intake, according to a study published in The BMJ today.

The team led by Babak Khoshnood, Inserm Research Director, set itself the goal of evaluating the long-term trends in the number of cases of defective neural tube closure in Europe.

They analysed data on over 11,000 cases of defects from 28 EUROCAT (European Surveillance of Congenital Anomalies) registries, which cover approximately 12.5 million births in 19 countries between 1991 and 2011. Mathematical models were used in order to compare the differences between the registries. They found that the total prevalence of neural tube defects in 2011 was generally comparable to that observed in 1991 (9 per 10,000 births). This was also true for the two main types of defect, anencephaly and spina bifida. Estimates from the models show a 4% annual increase from 1995 to 1999, and a 3% decrease between 1999 and 2003, followed by a stabilisation in the subsequent years.

Trends for spina bifida and anencephaly were comparable, and no substantial decrease was observed for these two defects.

The authors emphasise that this is an observational study, and that no definite explanation as to cause and effect can therefore be drawn from these results. However, they claim that their data make it possible to conclude that “Recommendations, voluntary fortification, or both have not been effective in decreasing the prevalence of neural tube defects.”

There is no plan in Europe to make it mandatory to add folic acid to some staple foods such as flour or cereals, which happens in many countries such as the United States and Canada. Moreover, studies suggest that this approach increases folic acid intake enough to halve the prevalence of neural tube defects, while no serious side effects have been observed to date.

According to the researchers, the conclusions of this new study “should encourage the relevant European authorities to take a closer look at mandatory fortification.”

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Researcher Contact

Babak Khoshnood
Directeur de recherche Inserm
Unité Inserm 1153 "Centre de recherche épidémiologie et statistique Sorbonne Paris Cité"
Équipe de recherche en épidémiologie obstétricale périnatale et pédiatrique (EPOPé),
Tel: 06 70 77 45 12
Email: ononx.xubfuabbq@vafrez.se

Press Contact

cerffr@vafrez.se

Sources

Long term trends in prevalence of neural tube defects in Europe: population based study Babak Khoshnood senior researcher 1, Maria Loane lecturer in public health 2, Hermien de Walle registry leader3, Larraitz Arriola epidemiologist4, Marie-Claude Addor medical geneticist5, Ingeborg Barisic professor 6, Judit Beres senior researcher in genetics 7, Fabrizio Bianchi epidemiologist and registry leader 8, Carlos Dias head of the department of epidemiology 9, Elizabeth Draper professor of perinatal and paediatric epidemiology10, Ester Garne neonatologist and registry leader11, Miriam Gatt consultant in public health 12, Martin Haeusler professor 13, Kari Klungsoyr professor 14, Anna Latos-Bielenska professor15, Catherine Lynch specialist in public health medicine16, Bob McDonnell consultant in public health medicine 17, Vera Nelen director 18, Amanda J Neville registry leader 19, Mary T O’Mahony specialist in public health medicine 20, Annette Queisser-Luft senior physician 21,Judith Rankin professor 22, Anke Rissmann professor of pediatrics 23, Annukka Ritvanen registry leader and chief physician 24, Catherine Rounding acting registry leader 25, Antonin Sipek medical geneticist and neonatologist26, David Tucker CARIS registry manager27, Christine Verellen-Dumoulin professor28, Diana Wellesley consultant in clinical genetics29, Helen Dolk professor of epidemiology and health services research 21 Obstetrical, Perinatal and Pediatric Epidemiology Research Team, Center for Biostatistics and Epidemiology, INSERM U1153, Maternité de Port-Royal, 75014 Paris, France;
2 EUROCAT Central Registry, Centre for Maternal, Fetal and Infant Research, Institute of Nursing Research, University of Ulster, Newtownabbey, UK;
3 EUROCAT Northern Netherlands Registry, University of Groningen, University Medical Center Groningen, Department of Genetics, Groningen, Netherlands;
4 Public Health Division of Gipuzkoa, Instituto BIO-Donostia Basque Government CIBER Epidemiología y Salud Pública - CIBERESP, San Sebatian, Spain;
5 Service de Genetique Medicale Maternite, CHUV, Lausanne, Switzerland;
6 Children’s University Hospital of Zagreb, Clinical Hospital Sisters of Mercy, Zagreb, Croatia;
7 National Institute of Health Development, Department of Hungarian Congenital Abnormality Registry and Surveillance, Budapest, Hungary;
8 CNR Institute of Clinical Physiology and Tuscany Registry of Congenital Defects, “Gabrielle Monasterio” Foundation, Pisa, Italy;
9Instituto Nacionale de Saude Dr. Ricardo Jorge, Lisbon, Portugal;
10Departmentof Health Sciences, University of Leicester, Leicester, UK;
11Hospital Lillebaelt, Kolding, Denmark;
12Department of Health Information and Research,Guardamangia, Malta;
13Medical University of Graz, Graz, Austria;
14Medical Birth Registry of Norway, Norwegian Institute of Public Health and Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway;
15Department of Medical Genetics, University of Medical Sciences, Poznan, Poland;
16Public Health Department, HSE South, Lacken, Kilkenny, Ireland;
17Health Service Executive, Dublin, Ireland;
18Provincial Institute for Hygiene, Antwerp, Belgium;
19Registro IMER - IMER Registry (Emilia Romagna Registry of Birth Defects), Center for Clinical and Epidemiological Research, University of Ferrara, Ferrara, Italy;
20 Department of Public Health, Health Service Executive - South, Ireland;
21Birth Registry Mainz Model, Childrens Hospital, University Medical Center, Johannes Gutenberg-University, Mainz, Germany;
22Institute of Health andSociety, Newcastle University, Newcastle, UK;
23Malformation Monitoring Centre Saxony-Anhalt, Medical Faculty Otto-von-Guericke University,Magdeburg, Germany;
24National Institute for Health and Welfare, Helsinki, Finland;
25National Perinatal Epidemiology Unit, University of Oxford,Oxford, UK;
26National Registry of Congenital Anomalies of the Czech Republic, Department of Medical Genetics, Thomayer University Hospital,Prague, Czech Republic;
27Public Health Wales, Swanseaa, UK;
28Center for Human Genetics, Institut de Recherche Scientifique en Pathologie et en Génétique, Charleroi, Belgium;
29University Hospitals Southampton, Faculty of Medicine and Wessex Clinical Genetics Service, Southampton, UKThe British Medical Journal