Preventing neural tube defects in Europe: A missed opportunity

Busby, Araceli; Armstrong, Ben; Dolk, Helen; Armstrong, Nicola C.; Haeusler, Martin; Berghold, Andrea; Gillerot, Y.; Baguette, A; Gjerga, R; Barisic,; Christiansen, Morten H.; Goujard, J; Steinbicker,; Rösch, Christine; McDonnell, Robert; Scarano, Gioacchino; Calzolari, Elisa; Neville, Amanda J.; Cocchi, Guido; Bianca, Sebastiano; Gatt, Miriam; Walle, de Hermien; Braz, Paula; Latos‐Bieleńska, Anna; Gener, Blanca; Portillo, Isabel; Mc, Addor; Abramsky, Lenore; Ritvanen, Annukka; Robert-Gnansia, Élisabeth; Daltveit, AK; Aneren, G; Olars, B; Edwards, Giles

doi:10.1016/j.reprotox.2005.03.009

Cited by 108 publications

(72 citation statements)

References 39 publications

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“…Results have been mixed, with reductions reported in some areas but not others. [19][20][21] Reductions in neural tube defects at the population level have also been difficult to document, 22 even though the benefits of folic acid for neural tube defects have been proved in clinical trials. 1 The inherent difficulties of detecting population level changes in rare diseases may contribute to this inconclusive evidence.…”

Section: Contribution Of Other Vitaminsmentioning

confidence: 99%

Folic Acid Supplements and Risk of Facial Clefts: National Population Based Case-Control Study

Wilcox

Lie

Solvoll

et al. 2007

Obstetrical &Amp; Gynecological Survey

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Section: Contribution Of Other Vitaminsmentioning

confidence: 99%

Folic Acid Supplements and Risk of Facial Clefts: National Population Based Case-Control Study

Wilcox

Lie

Solvoll

et al. 2007

Obstetrical &Amp; Gynecological Survey

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“…Most of the EU countries have a public health strategy similar to the one followed in Hungary, regarding the primary prevention of NTDs [32]. However, the Canadian experience and our current study proved that public education campaigns would not be effective alone in achieving optimal preconceptional folic acid intake for the majority of women [33].…”

Section: Discussionmentioning

confidence: 64%

“…However, the Canadian experience and our current study proved that public education campaigns would not be effective alone in achieving optimal preconceptional folic acid intake for the majority of women [33]. The "Canadian like" public health strategy, based on food fortification with folic acid, defined that all women in their childbearing age who increased their dietary intake of folic acid effectively, consequently decreased the frequency of NTDs [18,19,[32][33][34]. Based on a more than five year long experience, it is worth considering changing not only the Hungarian, but the EU public health strategy about folic acid intake by pregnant woman to prevent and/or reduce the number of NTDs.…”

Section: Discussionmentioning

confidence: 88%

Improper Supplementation Habits of Folic Acid Intake by Hungarian Pregnant Women: Improper Recommendations

Ponyi

Hauser

Müller

et al. 2008

Journal of the American College of Nutrition

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Background: Neural tube defects (NTDs) are some of the most common congenital anomalies. Proper folic acid supplementation is a dominant risk factor, which has been shown to decrease the incidence of NTDs. In Canada, the incidence of neuroblastoma has presented a considerable decrease of 60% as a result of enrichment cereal grain flours with synthetic folic acid. The aim of this study was to investigate the effect of folic acid intake by pregnant women on the incidence of NTDs and neuroblastoma.Methods: Regular folic acid intake has been recommended to pregnant women in Hungary since the eighties of the last century by health visitors eventually raking effect as an official protocol which had been released in 1997. During 2001During , 2002During and 2003, folic acid intake habits of pregnant women were evaluated by health visitors, proving to be successful in collecting data from 95.06% of the pregnant women. The incidence of NTDs has been registered by the Hungarian National Centre of Epidemiology, Department of Human Genetics and Teratology. The Pediatric Cancer Registry provided the incidence of neuroblastoma in children.Results: Consistent findings revealed a regular intake of supplementary folic acid products by 68.71% of the pregnant women. Out of these, 93.13% of pregnant women who were taking folic acid, started the supplementation after their 7 weeks of pregnancies, a time designated as the completion period of the development of the neural tube. The dose of folic acid supplementation was evaluated as less than 5 mg/day in 84.75% of the pregnant women. In Hungary, the incidence of NTDs has remained constant, while the incidence of neuroblastoma has shown constant slight increase in spite of the introduction of folic acid supplementation in 1997.Conclusions: Based on our experience, folic acid supplementation was initiated after the recognition of pregnancy and its application in a dose of lower than 5 mg/day neither decreased the incidence of NTDs nor did it have an effect on the neuroblastoma incidence. It is implicated that proper folic acid supplementation, which is started from the conception, can be achieved only with the enrichment of cereal grain flours.

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“…Food fortification policies in Europe have been delayed due to difficulty in determining the effective dose and concerns about safety. This helps explain the disparity in reduction of NTDs in Europe when compared to the USA and Canada [24]. An Irish study carried out in the late nineties indicated effectiveness and safety at a dose between 100µg and 200µg [25].…”

Section: Food Fortificationmentioning

confidence: 99%