Malformations of Central Nervous System and Softness of Local Water Supplies

Lowe, Charles U.; Roberts, Colin; Lloyd, S

doi:10.1136/bmj.2.5758.357

Cited by 46 publications

(15 citation statements)

References 21 publications

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“…This was shown to be significantly correlated with the softness of the local water supply in accord with studies in the British Isles (Fedrick, 1970b;Lowe, Roberts, and Lloyd, 1971;Verstege, 1971). Nevertheless he also found curious secular patterns, the incidence falling dramatically during the period 1951-68 in the rural areas but rising in the previously low incidence area of Zeeland.…”

Section: Discussionsupporting

confidence: 82%

Anencephalus in Scotland 1961-72.

Fedrick¹

1976

Journal of Epidemiology & Community Health

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. Data relating to the incidence of anencephalus for the 12-year period were abstracted from the Statistical Reviews of the Registrar General for Scotland. It was shown that considerable geographical variation is still apparent with the highlands having, in general, the lower incidences. In comparison with the earlier study of Edwards (1958), there were some changes: the incidence in the areas to the west had increased and that in those to the east decreased. During the 12-year period there was an overall decline in the incidence of the lesion; this was most marked in births to women under 20 years, and to those of social classes III, IV, and V. The decline was least apparent for births to women of high social class and the unmarried. It was shown that there was little seasonal variation in the time of delivery, but that even when the trend had been taken into account the yearly fluctuation was significantly different from that expected, with an excess of cases in 1961. Edwards (1958 published a detailed analysis of stillbirths and infant deaths associated with malformations of the central nervous system in Scotland.The purpose of the present paper is to repeat Edwards's original analyses, but for a later period and only for the malformation anencephalus. The study of the other two lesions would be of limited value since his case ascertainment was confined to those infants stillborn or dying during infancy, and a considerable and probably variable proportion of cases of both spina bifida and hydrocephalus survive this period. MATERIAL AND METHODSAll data pertaining to anencephalus, whether as a cause of stillbirth or of infant death, were abstracted from the Annual Reports of the Registrar General for Scotland together with the corresponding figures for the whole population of live and stillbirths. Incidences were calculated in the normal way and presented as rates per 1000 total births. RESULTSOut of 1 162 939 total births which were delivered during the 12-year period, 3246 were stated to be anencephalics giving a rate of 2 79. Of these 295 (9 1 %) were registered as livebirths. REGIONAL VARIATIONOne of the main findings in Edwards's paper (Edwards, 1958) was a marked variation in incidence within Scotland, with highest rates in the lowlands and lowest rates in the highlands.Using the 12-year data on stillbirths with anencephalus ( Fig. 1), it can be seen that again there is considerable variation within counties. The highest incidences were found in the south of the country especially in the belt from the Clyde to the Firth of Forth. Seven (21 %) of the 33 counties, had incidences that were significantly different (at the 5 % level) from the remainder of Scotland (Aberdeen, Caithness, Midlothian, Perth, and Zetland being significantly lower, Lanark and Stirling higher).

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Section: Discussionsupporting

confidence: 82%

Anencephalus in Scotland 1961-72.

Fedrick¹

1976

Journal of Epidemiology & Community Health

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“…The area surveyed was exactly as that defined by Lowe et al (1971) from which data for the incidence of neural tube malformations were taken. For direct comparison purposes the same division into 48 local authority areas was also maintained.…”

Section: Methodsmentioning

confidence: 99%

“…However, with particular reference to South Wales, Lowe, Roberts, and Lloyd (1971), dividing the region into 48 local authority areas, reported a negative correlation between the incidence of CNS malformations and the total hardness of the related water supply. An analytical epidemiological study was made of the problem and such a study forms the basis of this report.…”

mentioning

confidence: 98%

Trace elements in water and congenital malformations of the central nervous system in South Wales.

Morton¹,

Elwood²,

Abernethy³

1976

Journal of Epidemiology & Community Health

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Morton, M. S., Elwood, P. C., and Abemethy, M. (1976 examined. Significant correlations for four trace elements were observed. Of these, Al was positively correlated while for the remaining three-Ca, Ba, and Cu-negative associations were found. Regression analysis of the data suggested that the relationships between Ba and Cu with CNS malformation rates were more important than those of Al and Ca.

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“…In south Wales the prevalence at birth of malformations of the central nervous system was negatively correlated with hardness of local water supplies 5. It was thought that a causal water factor was unlikely as confounding by socioeconomic conditions could not be excluded.…”

mentioning

confidence: 99%

Involvement of deprivation and environmental lead in neural tube defects: a matched case-control study

Bound

Harvey²,

Francis³

et al. 1997

Archives of Disease in Childhood

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Objective-To analyse the prevalence of neural tube defects in small geographical areas and seek to explain any spatial variations with reference to environmental lead and deprivation. Setting-The Fylde of Lancashire in the north west of England. Design-Cases were ascertained as part of a prospective survey of major congenital malformations in babies born in the Fylde to residents there between 1957 and 1981. A matched case-control analysis used infants with cardiovascular system, alimentary tract, and urinary system malformations as controls. Conditional logistic regression was used to assess the eVects of more than 10 µg/l lead in drinking water and the Townsend deprivation score. Results-The prevalence of neural tube defects in 1957-73 was higher in Blackpool, Fleetwood, and North Fylde, whereas the three control groups showed no significant spatial variation. In 1957-81 mothers living in electoral wards with either a higher proportion of houses with more than 10 µg/l lead in the water or a higher deprivation score had a greater risk of having a baby with a neural tube defect. For spina bifida and cranium bifidum alone, this was also true. For anencephaly, deprivation was less important although the eVect of lead was still seen. In some neural tube defects, lead may act independently of other possible factors associated with deprivation. It seemed unlikely that lead levels changed significantly during the survey. The percentage of houses with 10 µg/l or more of lead in the water in 1984-5 was similar to that found in Great Britain 10 years previously. Conclusion-There is evidence to suggest that lead is one cause of neural tube defects, especially anencephaly. This could link the known preventive actions of hard water and folic acid. Calcium is a toxicological antagonist of lead. One cause of a deficiency of folic acid is impaired absorption secondary to zinc deficiency, which may be produced or exacerbated by lead.

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Malformations of Central Nervous System and Softness of Local Water Supplies

Cited by 46 publications

References 21 publications

Anencephalus in Scotland 1961-72.

Anencephalus in Scotland 1961-72.

Trace elements in water and congenital malformations of the central nervous system in South Wales.

Involvement of deprivation and environmental lead in neural tube defects: a matched case-control study

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