[Prevalence of neural tube defects in Asturias (Spain): impact of prenatal diagnosis]

[Evolution of the frequency of congenital defects in newborn infants and fetuses from terminations of pregnancy after prenatal diagnosis in the period 1982-2009]

BACKGROUND AND OBJECTIVE

The study of congenital defects (CD) must include termination of pregnancy (TOP) for CD and evaluate risk factors that modify their frequency.

PATIENTS AND METHODS

Consecutive series of 517 newborn and 202 TOP with CD among 38,191 childbirths, between 1982-2009 years.

RESULTS

The mean frequency for newborns with CD is 13.54‰ and for newborn and TOP with CD is 18.73‰. Single CD are 61.12% in newborns and 52.17% in TOP. The 18.37% of CD in newborn and 40.58% of TOP are syndromic. Mean gestational age for TOP is 17.92 weeks. Overall frequency of anencephaly is 2.62‰ for newborns and 6.77 for 10,000 for newborns and TOP. Spina bifida is 3.14 for 10,000 newborns and 5.99 for 10,000 newborns and TOP. Overall frequency of Down syndrome (DS) is 10.74 for 10,000 newborns and 22.14 for 10,000 newborns and TOP. The percentage of foreign mothers was 35.9% in 2009 and the mean maternal age significantly increased in this period.

CONCLUSION

We observe a significant decrease of CD in newborns but not in their conception. We have not detected primary prevention for neural tube defects. The decrease in DS in newborns is not statistically relevant but ethnic diversity and maternal aging may be modifying the frequency. The 53% of CD were TOP in the period 2007-2009. It is mandatory a complete study for CD in TOP in order to offer serious reproductive counselling.

[Folic acid intake from diet and supplements in a population of pregnant women in Valencia, Spain]

BACKGROUND AND OBJECTIVES

We examined the dietary intake and the use of supplements of folic acid (FA) in a cohort of pregnant women. We also explored the factors associated with non-compliance of both the recommended intake (RI) of 600 μg/day and the supplement use of 400 μg/day provided to prevent neural tube defects (NTD).

PATIENTS AND METHODS

We studied 782 pregnant women from the INMA-Valencia cohort. The dietary intake was estimated using a food frequency questionnaire in two periods of pregnancy; from preconception to the second month and from the 3rd to the 7th month. Information on supplement use was also collected which allowed us to estimate the total FA intake (diet+supplements). We explored factors associated with non-compliance of the recommendations by logistic regression.

RESULTS

The periconceptional mean daily FA intake was 304 μg/day. FA supplements were taken by 19.2, 30.2 and 66.2% of women in preconception, first and second month of pregnancy, respectively. Among women using supplements in periconception, 30% exceeded the tolerable upper intake level (UL) of 1.000 μg/day. Non-compliance with RI was more common among women of foreign origin, of low educational level, who smoked, with unplanned pregnancy, who did not visit a private gynaecologist, who had had children or without previous medical illness.

CONCLUSIONS

Diet by itself is not sufficient to reach RI for FA during pregnancy and many women initiate supplement use after the recommended period and inadequately. The youngest women, with lowest educational attainment and unplanned pregnancies are more likely not to comply.