Using state and provincial surveillance programs to reduce risk of recurrence of neural tube defects in the United States and Canada: A missed opportunity?

Louis AM, Agopian AJ. Scientific impact of the National Birth Defects Prevention Network multistate collaborative publications

BACKGROUND

Given the lack of a national, population-based birth defects surveillance program in the United States, the National Birth Defects Prevention Network (NBDPN) has facilitated important studies on surveillance, research, and prevention of major birth defects. We sought to summarize NBDPN peer-reviewed publications and their impact.

METHODS

We obtained and reviewed a curated list of 49 NBDPN multistate collaborative publications during 2000-2022, as of December 31, 2022. Each publication was reviewed and classified by type (e.g., risk factor association analysis). Key characteristics of study populations and analytic approaches used, along with publication impact (e.g., number of citations), were tabulated.

RESULTS

NBDPN publications focused on prevalence estimates (N = 17), surveillance methods (N = 11), risk factor associations (N = 10), mortality and other outcomes among affected individuals (N = 6), and descriptive epidemiology of various birth defects (N = 5). The most cited publications were those that reported on prevalence estimates for a spectrum of defects and those that assessed changes in neural tube defects (NTD) prevalence following mandatory folic acid fortification in the United States.

CONCLUSIONS

Results from multistate NBDPN publications have provided critical information not available through other sources, including US prevalence estimates of major birth defects, folic acid fortification and NTD prevention, and improved understanding of defect trends and surveillance efforts. Until a national birth defects surveillance program is established in the United States, NBDPN collaborative publications remain an important resource for investigating birth defects and informing decisions related to health services planning of secondary disabilities prevention and care.

Folic acid prescription practice for high-risk prevention of spina bifida at a tertiary care hospital in Addis Ababa, Ethiopia

PURPOSE

Mothers who have had a pregnancy affected by spina bifida are advised to take 4-5 mg/day folic acid pills to prevent recurrence. The folic acid prescription pattern was examined for high-risk mothers whose children received spina bifida surgery in an urban Ethiopian hospital.

METHODS

Data were analyzed from a large Ethiopian urban tertiary care hospital that provided spina bifida care. General practitioners recorded 5 mg/day folic acid prescriptions administered to mothers of infants with spina bifida born between January 2019 and June 2022.

RESULTS

Among 500 baby-mother pairs, 340 (68%) received a 120-day prescription for 5 mg/day folic acid pills. Of these 340 mothers, 331 (97%) received their folic acid prescription at their child's first or second patient encounter. Almost all mothers (94%) had documentation of only one prescription for the study duration. The percentage of mothers receiving at least one prescription varied by the baby's year of birth (2019:75%; 2020:92%; 2021:46%; Jan 2022 -June 2022:79%).

CONCLUSION

This prioritization of spina bifida recurrence prevention demonstrates feasibility for other healthcare centers in low-income countries. Sustained funds to provide women with free folic acid pills can favor high compliance and uptake of this prevention intervention.