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

• Published in: Archives of disease in childhood 2016-07, Vol.101 (7), p.604-607
• Main Authors: Morris, JK, Rankin, J, Draper, ES, Kurinczuk, JJ, Springett, A, Tucker, D, Wellesley, D, Wreyford, B, Wald, NJ
• Format: Article
• Language: English
• Subjects: Abnormalities; Abortion, Induced - statistics & numerical data; Acids; Birth defects; Births; Child Health; Congenital Impairments; England - epidemiology; Female; Flour - analysis; Folic acid; Folic Acid - administration & dosage; Food, Fortified; Humans; Infant, Newborn; Medical research; Neural tube; Neural tube defects; Neural Tube Defects - epidemiology; Neural Tube Defects - prevention & control; Original; Pediatrics; Preconception Care - methods; Pregnancy; Pregnancy complications; Pregnancy, Complications of; Prenatal Care - methods; Prevalence; Prevention; Registries; Risk reduction; Spina bifida; Surveillance; Vitamin B; Wales - epidemiology; Womens health
• ISSN: 0003-9888; 1468-2044
• DOI: 10.1136/archdischild-2015-309226

ObjectiveIn 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.DesignEstimates 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.SettingEight congenital anomaly registers in England and Wales.Main outcome measuresThe 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.ResultsFrom 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.ConclusionsFailure 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.