6th EUROCAT European Synposium
Sicily, Italy, 1 June 2001
Primary Prevention of NTD by Periconceptional Folic Acid
Research Development and Issues in the Prevention of Neural Tube Defects by Periconceptional Folic Acid
A Comparison of Policies for the Prevention of Neural Tube Defects in Europe
Periconceptional Folic Acid Supplementation in Norway, 1999-2000
Trends in Knowledge and Use of Folic Acid in the Five Year Period 1996-2000
Prevalence of Neural Tube Defects in Bulgaria
Insufficient Folic Acid Intake in The Netherlands: What About the Future?
Epidemiology, Prevention and Treatment of Oral Clefts
Developments in the Treatment of Oral Clefts and Other Craniofacial Anomalies in Europe
Gene Environment Interaction in Orofacial Clefts
Epidemiology of Oral Clefts in Europe
Investigating the High Rate of Cleft Palate in Finland
Impact of Prenatal Diagnosis
Evaluation of the Use of Oltrasound Soft Markers for Prenatal Screening
Operational Protocols After Diagnosis by Soft Markers
Prenatal Screening for Down Syndrome in Europe
Evaluation of Prenatal Diagnosis of Congenital Heart Diseases
Sex Chromosome Anomalies: How Likely are they to be Pastnatally Diagnosed and How is the Prenatal
Diagnosis First Communicated to Parents?
Prenatal Ultrasound Detection of Abdominal Wall Defects: Associated Malformations, Chromosomal
Abnormalities and Perinatal Outcome
Important of Ultrasonography in the Prenatal Screening for Trisomy 21 in the Parisian Population 1998-99
One Year Follow-Up Study of Antenatally Diagnosis Dilated Renal Pelves Between 5 and 9.9mm Within
Merseyside and Cheshire
In Memory of Zachery Johnson
Congenital Anomalies in Ireland
Other Issues in Prevention
Risk of Chromosomal Congenital Anomalies in Relation to Residence Near Hazardous Waste Landfill Sites in
Europe
Parental Occupation in Agriculture and Risk of Hypospadias: A Multicentre Case-Control Study in Italy
Congenital Anomalies: Experience of a Regional Registry for Heart Defects 1980-1994 (Italy)
Folic Acid Antagonists (Trimethoprim-Sulfonamides and Sulfonamides) During Pregnency and the Risk of
Orofacial Clefts
Comparison of Clinical Findings and Echocardiographic Examinations of Newborns with Trisomy 21: Analysis of
32,589 Newborns of the Mainz Congenital Birth Defect Monitoring System
Cluster of Birth Defects in an Industrial Area of Sicily
Prenatal Diagnosis of Congenital Heart Disease: Epidemiologic and Clinical Impact
Research Developmnents and Issues in the Prevention of Neural Tube Defects by Periconceptional Folic Acid
PN Kirke
It has been known since the early 1990's that folic acid taken periconceptionally prevents up to 70% of neural tube defects (NTDs). Although women's knowledge about the protective effect of folic acid has increased considerably during the past decade, studies in Europe and North American show that most pregnant women do not take folic acid periconceptionally. This reseach underlines the importance of implementing comprehensive and sustained health promotion campaigns to increase awarenes of the benefits of folic acid in preventing NTDs. The population subgroups in greatest need of this information are known: supplementation rates are low in young, poorly educated, unsupported and socially disadvantaged mothers. Unplanned pregnany is the strongest predictive factor for non-supplementation emphasising the urgency of considering food fortification as a complemtary public health intervention. Approximately half of the estimated 4,000 babies born with NTDs every year in the Eruopean Union could be prevented if public health programmes were in place to ensure that all pregnant wmen received sufficient folic acid around conception.
The ultimate measure of the effectiveness of periconceptional folic acid supplementation is a reduction in the population prevaence at birth of NTDs and it is somewhat surprising that the substantial increase in the reported use of periconceptional folic acid in England in recent years has not been accompanied by a clear cut reduction in the population prevalence. The reported increase of 29% in the use of folic acid supplementation before pregnancy in England from 1.8% in 1993 to 30.6% in 1997 (Wild J et al, 1997) would be expected to result in a fall in the NTD prevalence at birth rate of approximately 14% and some (but not all) recent reports are consistent with this estimate.
The main emphasis in current NTD research is on identifying genetic risk factors with particular emphasis on folate-related genes but now also branching out to examine other genes. It is hoped that the discovery of new genetic risk factors might reveal important gene-environment interactions which could result in better interventions for primary prevention.
A Comparison of Policies for the Prevention of Neural Tube Defects in Europe
J Goujard
Following research findings on the prevention of neural tube defects (NTD) by periconceptional folic acid in the years 1980-1992, from the first non-randomised studies in the UK to the MRC and Hungarian controlled trials, recommendations for a possible primary preventive strategy of these defects were developed in several European countries between 1992 (UK) and 2000 (France). These recommendations were first promulgated either by government agencies or by professional organisations in the fields of medicine or nutrition. Rare are now countries in Europe without a governmental ("official") policy regarding folic acid for NTD prevention.
In the 9 European countries we surveyed (England and Wales, Finland, France, Hungary, Ireland, Italy, Norway, The Netherlands, Portugal), the taget population is, for the most part, women planning a pregnancy, and the target period is from one month before expected conception through the first two months of pregnancy. Such recommendations, however, would not benefit the high proportion of unplanned pregnancies that occur in many European countries. In Portugal, the recommendation is that child-bearing women should be informed of the advantages of folic acid supplementation. In France, in 2000, the Ministry of Health and the French Committee of Health Education produced a booklet that encourages childbearing women to improve their nutrition, in particular their dietary folic intake.
Generally, the recommendation for prevention of recurrence is daily use of a supplement containing 4mg of folic acid during the periconceptional period. For the prevention of first occurrence, the current advice is the use of folid acid tablets with most commonly a daily dose of 0.4mg, and an increase of dietary folate intake.
The possibility of mandatory enrichment of cereal flours with folic acid, such as done in USA, is raised in England and Wales, In some countries, limited types of food fortified with folic acid, mainly breakfast cereals, are available. In Hungary, the initital production of fortified bread began in August 1998.
In some countries the issuance of recommendations was followed by public awareness campaigns and surveys to assess the effectiveness of and compliance with the recommendations. In some countries such as Ireland and the Netherlands, these efforts were directed at high risk subgroups of women (such as those of low socioeconomic class).
Each point will be approached.
Periconceptional Folic Acid Supplmentation in Norway 1999-2000
LM Irgens
Objectives
In Norway, the recommendations issued to the public on periconceptional folic acid supplementation have been conflicting; while the National Board on Nutrition has reocmmended periconceptional use of 0.4mg folate in general and 4mg to prevent recurence, the Inspectorate of Health has considered Norwegian nutrition in general to be adequate, through recommending specific items such as liver and vegetables. On the other hand, the message from professionals, through the media, has been unanimously pro supplementation. Thus, in Norway, the interest attached to the use of periconceptional folic acid supplementation in general, has a special background, and there is a particular need of an assessment.