Preventable spina bifida and anencephaly in Europe

BACKGROUND Promotion of voluntary folic acid supplement use among women of reproductive age has been proven to be ineffective in lowering the risk of neural tube defects in Europe. METHODS Using surveillance data from all births covered by the full member countries of the European Surveillance of Co...

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Published in:Birth defects research. A Clinical and molecular teratology 2015-09, Vol.103 (9), p.763-771
Main Authors: Obeid, Rima, Pietrzik, Klaus, Oakley Jr, Godfrey P., Kancherla, Vijaya, Holzgreve, Wolfgang, Wieser, Simon
Format: Article
Language:English
Subjects:
anencephaly
Anencephaly - epidemiology
Anencephaly - prevention & control
Dietary Supplements
economic
Ethnic Groups
Europe
European Continental Ancestry Group
Female
folic acid
Folic Acid - administration & dosage
Food, Fortified
fortification
Humans
Live Birth - epidemiology
neural tube defects
Pregnancy
Prevalence
prevention
spina bifida
Spinal Dysraphism - epidemiology
Spinal Dysraphism - prevention & control
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Summary:BACKGROUND Promotion of voluntary folic acid supplement use among women of reproductive age has been proven to be ineffective in lowering the risk of neural tube defects in Europe. METHODS Using surveillance data from all births covered by the full member countries of the European Surveillance of Congenital Anomalies (EUROCAT), we estimated the total prevalence of spina bifida and anencephaly per 10,000 births between 2000 and 2010. We also estimated additional lifetime direct medical costs among individuals with spina bifida, compared with those without, in Germany for the year 2009. RESULTS During the study period, there were 7478 documented cases of spina bifida and anencephaly among the 9,161,189 births, with an estimated average combined prevalence of 8.16 per 10,000 births (95% confidence interval, 7.98 – 8.35). For the 241 spina bifida‐affected live births in 2009 in Germany, the estimated additional lifetime direct medical costs compared with non‐spina bifida affected births were €65.5 million. Assuming a 50% reduction in the prevalence if folic acid has been provided to all women before pregnancy, 293 spina bifida cases could have been prevented in Germany in 2009. The estimated lifetime direct medical cost saving for the live births in 2009 was €32.9 million assuming a 50% reduction, or €26.1 million assuming a 40% risk reduction. CONCLUSION Europe has an epidemic of spina bifida and anencephaly compared with countries with mandatory folic acid fortification policy. Primary prevention through mandatory folic acid fortification would considerably reduce the number of affected pregnancies, and associated additional costs. Birth Defects Research (Part A) 103:763–771, 2015. © 2015 Wiley Periodicals, Inc.
ISSN:1542-0752
1542-0760
DOI:10.1002/bdra.23400