Public health projects for preventing the recurrence of neural tube defects in the United States

Collins, Julianne S.; Canfield, Mark A.; Pearson, Kay; Kirby, Russell S.; Case, Amy P.; Cara, T.; Major, Judy; Mulinare, Joe

doi:10.1002/bdra.20619

Cited by 5 publications

(6 citation statements)

References 12 publications

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“…The results of this study indicate that while there are similarities, these 2 clinical conditions are not synonymous. Limited studies (Coe et al., ; Collins et al., ; Doig et al., ; Frankel et al., ; Oesterheld et al, ; O'Malley et al., ; Snyder et al., ) suggest differences in treatment effectiveness between FASD and ADHD, thus further indicating the need for accurate identification of alcohol‐affected children.…”

Section: Discussionmentioning

confidence: 99%

Further Development of a Neurobehavioral Profile of Fetal Alcohol Spectrum Disorders

Mattson

Roesch

Glass

et al. 2012

Alcoholism Clin & Exp Res

148

122

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Background Heavy prenatal alcohol exposure (AE) results in a broad array of neurobehavioral deficits. Recent research has focused on identification of a neurobehavioral profile or profiles that will improve identification of children affected by AE. The current study aimed to build on our preliminary neurobehavioral profile in order to improve classification accuracy and test the specificity of the resulting profile in an alternate clinical group. Methods A standardized neuropsychological test battery was administered to three groups of children: subjects with AE (n = 209), typically developing controls (CON, n = 185), and subjects with attention-deficit/hyperactivity disorder (ADHD, n = 74). We assessed a large sample from six sites in the U.S. and South Africa, using standardized methodology. Data were analyzed using three latent profile analyses (LPA) including: (1) subjects with FAS and controls, (2) subjects with AE without FAS and controls, (3) subjects with AE (with or without FAS) and subjects with ADHD. Results Classification accuracy was moderate but significant across the three analyses. In analysis 1, overall classification accuracy was 76.1% (77.2% FAS, 75.7% CON). In the second analysis, overall classification accuracy was 71.5% (70.1% AE/Non-FAS, 72.4% CON). In the third analysis, overall classification accuracy was 73.9% (59.8% AE, 75.7% ADHD). Subjects that were misclassified were examined for systematic differences from those that were correctly classified. Conclusion The results of this study indicate that the neuropsychological effects of AE are clinically meaningful and can be used to accurately distinguish alcohol-affected children from both typically developing children and children with ADHD. Further, in combination with other recent studies, these data suggest that approximately 70% of children with heavy prenatal alcohol exposure are neurobehaviorally affected while the remaining 30% are spared these often-devastating consequences, at least those in the domains under study. Refining the neurobehavioral profile will allow improved identification and treatment development for children affected by prenatal alcohol exposure.

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Section: Discussionmentioning

confidence: 99%

Further Development of a Neurobehavioral Profile of Fetal Alcohol Spectrum Disorders

Mattson

Roesch

Glass

et al. 2012

Alcoholism Clin & Exp Res

148

122

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“…However, we feel that our study and others 21 have shown that recurrence prevention is quite effective. Because only approximately one-third of states have or have had NTD recurrence prevention projects, 22 more public health agencies need to provide the funding and personnel to prevent the recurrence of NTDs in this very high risk population.…”

Section: Discussionmentioning

confidence: 99%

Long Term Maintenance of Neural Tube Defects Prevention in a High Prevalence State

Collins

Atkinson

Dean

et al. 2011

The Journal of Pediatrics

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Objective To assess the efficacy of folic acid (FA) supplementation and fortification in preventing neural tube defects (NTDs) in a high prevalence region of the US. Study design Active and passive surveillance methods were used to identify all fetuses/infants affected by an NTD in South Carolina. Prevalence rates were compared with FA intake to determine the effects of increased intake on NTD occurrence and recurrence. Results From 1992–2009, 916 NTD cases occurred in South Carolina with isolated defects comprising 79% of cases. The NTD rate decreased 58% during this period. There was one NTD-affected pregnancy among 418 subsequent pregnancies (0.2%) in mothers with previous NTD-affected pregnancies who consumed periconceptional FA supplements and four NTDs among 66 pregnancies (6.1%) in which the mother did not take FA supplements. Folic acid supplementation increased from 8% to 35% from 1992–2007 and knowledge of the protective benefits of FA increased from 8% to 65% in women of childbearing age. Conclusions Increased periconceptional intake of FA appeared to reduce NTDs in a high prevalence region. The rate of spina bifida and anencephaly in South Carolina is now essentially the same (0.69 cases per 1000 live births and fetal deaths) as the 1998–2005 US rate (0.69).

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“…The failure in closure, which is initiated at multiple sites of the neural tube (O'Rahilly and Müller, 2002), results in a spectrum of cranial and spinal canal defects ranging from anencephaly to very minor vertebral defects either open or closed. Approximately 70% of NTDs are isolated and are presumed to be multifactorial in origin (Aguiar et al, 2003), thereby conferring a 3% recurrence risk for subsequent pregnancies (Collins et al, 2009).…”

Section: Introductionmentioning

confidence: 99%

Chromosomal abnormalities in fetuses with ultrasonographically detected neural tube defects

Kant

Özkan²,

Öner³

et al. 2011

Clinical Dysmorphology

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We analyzed the karyotype of fetuses with ultrasonographically detected neural tube defects (NTDs). In our study, we included a total of 194 fetuses with NTDs. We analyzed the type of NTD, the karyotype, maternal age, fetal gestational age at diagnosis, and fetal sex. Of the 194 fetuses with NTDs, 87 were anencephalic and 107 had other, nonanencephalic, NTDs. A total of 12 fetuses were shown to have chromosomal abnormalities. Three of 87 anencephalic fetuses (3.45%) had chromosomal abnormalities. The sex ratio for anencephalic fetuses was 65.5% : 34.5% for female and male fetuses. Nine of 107 fetuses with other NTDs (8.41%) had chromosomal abnormalities. Seven fetuses had isolated NTDs and a further seven fetuses had additional ultrasonographic anomalies. Two of the latter had abnormal karyotypes. The sex ratio of all other NTD cases was 67.3% : 32.7% for female and male fetuses. The high number of chromosomal abnormalities justifies prenatal karyotyping in all fetuses with ultrasonographically diagnosed NTDs.

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Public health projects for preventing the recurrence of neural tube defects in the United States

Abstract: Only 15 states and Puerto Rico had or were planning NTD recurrence prevention projects. An NTD recurrence prevention project using minimal resources should consist of timely case ascertainment, educational materials, and mechanisms for disseminating these materials.

Cited by 5 publications

References 12 publications

Further Development of a Neurobehavioral Profile of Fetal Alcohol Spectrum Disorders

Further Development of a Neurobehavioral Profile of Fetal Alcohol Spectrum Disorders

Long Term Maintenance of Neural Tube Defects Prevention in a High Prevalence State

Chromosomal abnormalities in fetuses with ultrasonographically detected neural tube defects

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