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Prevention of neural tube defects in the UK: a missed opportunity

Prevention of neural tube defects in the UK: a missed opportunity
Prevention of neural tube defects in the UK: a missed opportunity
Objective: In 1991, the Medical Research Council (MRC) Vitamin Study demonstrated that folic acid taken before pregnancy and in early pregnancy reduced the risk of a neural tube defect (NTD). We aimed to estimate the number of NTD pregnancies that would have been prevented if flour had been fortified with folic acid in the UK from 1998 as it had been in the USA.

Design: Estimates of NTD prevalence, the preventive effect of folic acid and the proportion of women taking folic acid supplements before pregnancy were used to predict the number of NTD pregnancies that would have been prevented if folic acid fortification had been implemented.

Setting: Eight congenital anomaly registers in England and Wales.

Main outcome measures: The prevalence of pregnancies with an NTD in the UK and the number of these pregnancies that would have been prevented if folic acid fortification had been implemented.

Results: From 1991 to 2012, the prevalence of NTD pregnancies was 1.28 (95% CI 1.24 to 1.31) per 1000 total births (19% live births, 81% terminations and 0.5% stillbirths and fetal deaths ?20?weeks’ gestation). If the USA levels of folic acid fortification from 1998 onwards had been adopted in the UK, an estimated 2014 fewer NTD pregnancies would have occurred.

Conclusions; Failure to implement folic acid fortification in the UK has caused, and continues to cause, avoidable terminations of pregnancy, stillbirths, neonatal deaths and permanent serious disability in surviving children.
0003-9888
604-607
Morris, J.K.
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Rankin, J.
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Draper, E.S.
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Kurinczuk, J.J.
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Springett, A.
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Tucker, D.
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Wellesley, D.
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Wreyford, B.
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Wald, N.J.
ab02141b-306d-4d4f-8986-59274565dafb
Morris, J.K.
dee25358-4e3f-4013-8f80-e98623187aa1
Rankin, J.
f46fdd1f-6006-4a21-ace2-b4d8d8c85c20
Draper, E.S.
7e6dcaba-f171-475b-b361-43e7476e5a52
Kurinczuk, J.J.
91b13da7-28c3-459c-be95-43105d0d0247
Springett, A.
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Tucker, D.
5365973c-3503-4bfc-9436-75f571c8c06b
Wellesley, D.
17cbd6c1-0efb-4df1-ae05-64a44987c9c0
Wreyford, B.
90ee6f80-8d3e-4e39-91f9-9fe7a1e4166e
Wald, N.J.
ab02141b-306d-4d4f-8986-59274565dafb

Morris, J.K., Rankin, J., Draper, E.S., Kurinczuk, J.J., Springett, A., Tucker, D., Wellesley, D., Wreyford, B. and Wald, N.J. (2016) Prevention of neural tube defects in the UK: a missed opportunity. Archives of Disease in Childhood, 101 (7), 604-607. (doi:10.1136/archdischild-2015-309226).

Record type: Article

Abstract

Objective: In 1991, the Medical Research Council (MRC) Vitamin Study demonstrated that folic acid taken before pregnancy and in early pregnancy reduced the risk of a neural tube defect (NTD). We aimed to estimate the number of NTD pregnancies that would have been prevented if flour had been fortified with folic acid in the UK from 1998 as it had been in the USA.

Design: Estimates of NTD prevalence, the preventive effect of folic acid and the proportion of women taking folic acid supplements before pregnancy were used to predict the number of NTD pregnancies that would have been prevented if folic acid fortification had been implemented.

Setting: Eight congenital anomaly registers in England and Wales.

Main outcome measures: The prevalence of pregnancies with an NTD in the UK and the number of these pregnancies that would have been prevented if folic acid fortification had been implemented.

Results: From 1991 to 2012, the prevalence of NTD pregnancies was 1.28 (95% CI 1.24 to 1.31) per 1000 total births (19% live births, 81% terminations and 0.5% stillbirths and fetal deaths ?20?weeks’ gestation). If the USA levels of folic acid fortification from 1998 onwards had been adopted in the UK, an estimated 2014 fewer NTD pregnancies would have occurred.

Conclusions; Failure to implement folic acid fortification in the UK has caused, and continues to cause, avoidable terminations of pregnancy, stillbirths, neonatal deaths and permanent serious disability in surviving children.

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Accepted/In Press date: 17 October 2015
e-pub ahead of print date: 17 December 2015
Published date: July 2016
Organisations: Human Development & Health

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Local EPrints ID: 385271
URI: http://eprints.soton.ac.uk/id/eprint/385271
ISSN: 0003-9888
PURE UUID: 041cfa2f-ce39-4cc5-a3f2-a09831c8943f

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Date deposited: 18 Jan 2016 14:19
Last modified: 16 Dec 2019 20:09

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Contributors

Author: J.K. Morris
Author: J. Rankin
Author: E.S. Draper
Author: J.J. Kurinczuk
Author: A. Springett
Author: D. Tucker
Author: D. Wellesley
Author: B. Wreyford
Author: N.J. Wald

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