Sacral Spina Bifida Occulta: A Frequency Analysis of Secular Change

Substantial relaxation of natural selection beginning around 1900 changed the mutation/selec­tion balance of modern genetic material, producing an increase in variable anatomical structures. While multiple structures have been affected, the temporal increase in variations of the sacrum, specifically, ‘Sa­cral Spina Bifida Occulta,’ have been reliably demonstrated on a localised scale. Calculation of largescale frequency has been hindered by the localised nature of these publications, the morphological variability of this variation, and potential pathological associations, which have produced divergent classifications, and conflicting reported rates of occurrence. A systematic review of the reported literature was conducted to provide an objective analysis of Sacral Spina Bifida Occulta frequency from 2500 BCE to the present. This review was designed to compensate for observed inconsistencies in reporting and to ascertain, for the first time, the temporal trajectory of this secular trend. A systematic review of Sacral Spina Bifida Occulta lit­erature was conducted through the strict use of clinical meta-analysis criteria. Publications were retrieved from four databases: PubMed, Embase, the Adelaide University Library database, and Google Scholar. Data were separated into three historical groups, (1 = <1900, 2 = 1900 to 1980 and 3 = >1980), and frequency outcomes compared, to determine temporal rates of occurrence. A total of 39/409 publications were included in the final analysis, representing data for 16,167 sacra, spanning a period of 4,500 years. Statistically significant results were obtained, with total open S1 frequen­cy increasing from 2.34%, (79 to 1900CE), to 4.80%, (1900 to 1980CE) and to 5.43% (>1980CE). These increases were significant at p<0.0001, with Chi-squared analysis. A clear secular increase in the global frequency of Sacral Spina Bifida Occulta has been demonstrated from 1900 to the present. This research provides a novel and adaptable framework for the future assessment of variation distribution, with impor­tant implications for the fields of biological anthropology and bioarchaeology.

Evaluating folic acid supplementation among Japanese pregnant women with dietary intake of folic acid lower than 480 µg per day: results from TMM BirThree Cohort Study

Objective: In Japan, supplementation with 400 µg of folic acid per day is recommended for women who are planning to get pregnant to decrease the risk of their babies getting neural tube defects (NTD). However, the proportion of women who have taken folic acid supplements before conception is low among Japanese pregnant women. In addition, the dietary intake of folic acid has not yet reached the government recommended dietary intake levels (480 µg per day). This study aimed to clarify the prevalence and determinants of adequate folic acid supplements among Japanese pregnant women with dietary folic acid intake lower than 480 µg per day.Methods: This cross-sectional study was a part of the Tohoku Medical Megabank Project Birth and Three-Generation Cohort Study. We collected information on folic acid supplements before conception, sociological/lifestyle characteristics, and food consumption. The primary outcome was the use of folic acid supplements (adequate or inadequate, based on the timing of initiation of folic acid supplements). Multiple logistic regression analysis was used to examine the association between sociological/lifestyle characteristics and the adequate intake of folic acid supplements.Results: Among the 11,562 pregnant women who took lower than 480 µg per day of folic acid from food, the prevalence of adequate users was 18.0%. Pregnant women who reported adequate use of folic acid supplements were more likely to be older and educated; and reported higher household income, and history of fertility treatment. Conversely, they were less likely to be ever or current smokers and multipara.Conclusion: This study found that the prevalence of folic acid supplements use for the prevention of NTD among Japanese pregnant women was still low.

Folic acid deficiency declined substantially after introduction of the mandatory fortification programme in Queensland, Australia: a secondary health data analysis

OBJECTIVE

To investigate the prevalence of folic acid deficiency in Queensland-wide data of routine laboratory measurements, especially in high-risk sub-populations.

DESIGN

Secondary health data analysis.

SETTING

Analysis of routine folic acid tests conducted by Pathology Queensland (AUSLAB).

PARTICIPANTS

Female and male persons aged 0-117 years with routine folic acid testing between 1 January 2004 and 31 December 2015. If repeat tests on the same person were conducted, only the initial test was analysed (n 291 908).

RESULTS

Overall the prevalence of folic acid deficiency declined from 7·5 % before (2004-2008) to 1·1 % after mandatory folic acid fortification (2010-2015; P < 0·001) reflecting a relative reduction of 85 %. Levels of erythrocyte folate increased significantly from a median (interquartile range) of 820 (580-1180) nmol/l in 2008 before fortification to 1020 (780-1350) nmol/l in 2010 (P < 0·001) after fortification. The prevalence of folic acid deficiency in the Indigenous population (14 792 samples) declined by 93 % (17·4 v. 1·3 %; P < 0·001); and by 84 % in non-Indigenous residents (7·0 v. 1·1 %; P < 0·001). In a logistic regression model the observed decrease of folic acid deficiency between 2008 and 2010 was found independent of gender, age and ethnicity (ORcrude = 0·20; 95 % CI 0·18, 0·23; P < 0·001; ORadjusted = 0·21; 95 % CI 0·18, 0·23; P < 0·001).

CONCLUSIONS

While voluntary folic acid fortification, introduced in 1995, failed especially in high-risk subgroups, the 2009 mandatory folic acid fortification programme coincided with a substantial decrease of folic acid deficiency in the entire population.

Low proportions of folic acid deficiency after introduction of mandatory folic acid fortification in remote areas of northern Queensland, Australia: a secondary health data analysis

Background: Australia implemented mandatory folic acid fortification of bread-making flour in 2009. Objective: To assess the impact of folic acid fortification in remote vs. regional urban areas and Indigenous vs. non-Indigenous populations in northern Queensland. Methods: Routinely collected data on folic acid measurements in remote areas and two regional urban centres in northern Queensland between 2004 and 2015 were analysed (n = 13,929) dichotomously (folic deficient vs. non-deficient). Results: Overall prevalence of folic acid deficiency was 3.2% (235/7282) in urban centres compared with 7.2% (480/6647) in remote areas (p < 0.001), and 9.3% (393/4240) in the Indigenous population compared with 3.2% (273/8451) in the non-Indigenous population (p < 0.001). Prevalence of folic acid deficiency dropped from 12.2% (n = 481) in 2004-2008 to 1.5% (n = 126) in 2010-2015 (p < 0.001). This translates into a relative risk reduction (RRR) of 88%. RRR was 79% (7.2% vs. 1.5%) in urban centres, 91% (17.3% vs. 1.5%) in remote areas, 92% (20.5% vs. 1.6%) in the Indigenous population and 80% (7.4% vs. 1.5%) in the non-Indigenous population (p < 0.001 for all). Conclusions: Substantial declines of folic acid deficiency to low and comparable proportions in former high-risk populations indicate that mandatory folic acid fortification of flour has had a population-wide benefit in northern Queensland.

Determinants and seasonality of major structural birth defects among newborns delivered at primary and referral hospital of East and West Gojjam zones, Northwest Ethiopia 2017-2018: case-control study

Objective

Although infant mortality because of birth defect has increased in both developed and developing countries, had not got attention like other health issues at national, regional, or local levels. Documenting the risk factors that influence the occurrence of birth defects and its seasonality will help to inform the community and to develop preventive strategies for the country.

Results

Factors associated with higher likelihood of a major structural birth defects included maternal age; neonates born from women living in urban; and in Dega; history of fever during pregnancy; intake of herbal medicine; and drinking alcohol. Counselling for pregnancy preparation and folic acid supplementation was found protective for the likelihood of birth defect.

Nutritional status among women whose pregnancy outcome was afflicted with neural tube defects in Tigray region of Ethiopia

BACKGROUND

Nutritional deficiency in pregnant women is a confirmed cause of neural tube defects (NTDs). Alongside to this background, We sought to determine the nutritional status and level of awareness on the issue of the NTDs as well as folic acid (FA) utilization among women who born infants with NTDs in Tigray region of Ethiopia.

METHOD

A standard interviewer and a food frequency questionnaire was used to obtain information from mothers of cases with neural tube defects (n = 205) and their controls (n = 412). Demographic information, weekly food frequency consumption, information on awareness on the issue of the NTDs as well as folic acid (FA) use was collected.

RESULT

The mean age of the mothers of the cases and controls was 26.5 years (range 17-43 years) and 26.05 years (range 18-40 years), respectively. Approximately 92.2% (189/205) of the cases and 90.5% (373/412) control mothers do not know the term folic acid (FA). Notably, all participant mothers (100%) did not understand that NTDs are a serious health problem associated with inadequate intake of FA and none of them used FA prior to conception. Food frequency analysis revealed that except for cereals (p = 0.12) and milk products (p = 0.8), the proportion of the consumed food type within seven days recalls period showed a statistically significant difference (p < 0.05) as compared with controls. The dietary diversity score assessment showed those attained low and high dietary diversity score were a statistically significant difference (p = 0.0003) and (p = 0.0002) respectively) as compared with controls, but the medium dietary diversity score no significant variation was found (p = 0.35).

CONCLUSION

This study has shown none of the study participants do understand that NTDs are a serious health problem associated with inadequate intake of FA. Dietary diversity score was significantly associated with incidence of NTDs. This Ethiopian study also highlighted the need of considering the basic food in future programs of food fortification with folic acid, preconceptional folic acid supplementation and adequate dietary intake counseling. Advance research is required to find out the gene-nutrient and gene environment interactions, as well as particular causative factors associated with NTDs in Ethiopia.

Factors associated with congenital anomalies in Addis Ababa and the Amhara Region, Ethiopia: a case-control study

Background

The early stage of embryo development is extremely vulnerable to various teratogenic factors, leading to congenital anomalies. In Ethiopia, a significant number of babies are born with congenital anomalies, but the risk factors for the anomalies have never been studied. Understanding the specific risk factors for congenital anomalies is very essential to provide health education that aims at creating awareness and establishing preventive strategic plan/s. The main objective of this study was to assess the risk factors associated with congenital anomalies in Addis Ababa and the Amhara Region, Ethiopia.

Methods

A case-control study was conducted from January 1- June 30, 2015. The participants were recruited at the purposively selected hospitals in Addis Ababa and the Amhara Region. A total of 207 cases and 207 controls were included in the study. Cases were neonates, infants, and children 0-11 months of age with external and internal major congenital anomalies diagnosed by pediatricians. Controls were neonates, infants, and children 0-11 months of age without external and internal anomalies. Data on sociodemographic characteristics, exposure to risk factors, and reproductive history were collected by face to face interviews with children’s mothers/caregivers using a structured questionnaire. Binary logistic regression was employed to explore risk factors associated with the occurrence of the problems.

Results

About 87.4% of the children were below 6 months, and 12.6% were between 6 and 11 months. The majority (59.9%) of the children were male, with the M: F sex ratio of 1.49. The mean age of the mothers was 26 years (16-45 years). Unidentified medication use during early pregnancy (AOR = 4.595; 95% CI: 1.868-11.301, P-value = 0.001), maternal alcohol drinking (AOR = 2.394; 95% CI: 1.212-4.726, P-value = 0.012), and exposure to chemicals (AOR = 9.964; 95% CI = 1.238-80.193, P-value = 0.031) were significantly associated with the occurrence of congenital anomalies. Iron folate use (AOR = 0.051; 95% CI: 0.010-0.260, P-value = < 0.001) before and during early pregnancy had a protective effect on congenital anomaly.

Conclusion

Unidentified medication use, alcohol drinking during early pregnancy, and exposure to chemicals had a significant association with the occurrence of congenital anomalies, whereas iron folate use before and during early pregnancy had a protective effect from congenital anomalies.

Awareness, knowledge, and use of folic acid among non-pregnant Korean women of childbearing age

BACKGROUND/OBJECTIVES

Folic acid supplementation before pregnancy is known to reduce the risk of neural tube defects. The purposes of this study were to investigate the awareness, knowledge, and use of folic acid supplements along with their associated factors among non-pregnant Korean women of childbearing age.

SUBJECTS/METHODS

From August 2012 to March 2013, 704 women aged 19-45 years completed a self-administered questionnaire regarding their awareness, knowledge, and use of folic acid as well as questions to identify risk of inadequate folate intake.

RESULTS

Approximately 67% of women reported that they had heard of folic acid, and 23.7% had knowledge of both the role of folic acid in preventing birth defects and appropriate time for taking folic acid supplements to prevent birth defects. However, only 9.4% of women took folic acid supplements at the time of the survey. Women aged 19-24 years, unmarried women, and women who had never been pregnant were less likely to be aware and knowledgeable of folic acid or take folic acid supplements. In addition, women at high risk of inadequate folate intake were less likely to take folic acid supplements. In a multivariate analysis, women aged 19-24 years, women with a high school diploma or lower education level, and unmarried women were less likely to be aware and have knowledge of folic acid. The percentage of women taking folic acid supplements was significantly higher among knowledgeable women than among unknowledgeable women.

CONCLUSIONS

These results support our hypothesis that women with knowledge of folic acid are more likely to take folic acid supplements. Therefore, educational programs or campaigns to improve knowledge regarding the importance of folic acid and to promote consumption of folic acid supplements as well as folate-rich foods are needed to target young, less educated, and unmarried women.

Awareness, use and information sources of folic acid supplementation to prevent neural tube defects in pregnant Japanese women

OBJECTIVE

Folic acid supplementation and folate-rich diets are recommended for women of childbearing age worldwide to prevent congenital anomalies. We aimed to determine the current status of folic acid supplementation among pregnant Japanese women and identify means to increase the intake of these supplements.

DESIGN

Cross-sectional study.

SUBJECTS

A total of 1862 pregnant women who consulted the perinatal centre from September 2014 to December 2015 completed a questionnaire concerning knowledge about folic acid, sources of information and the use of folic acid supplements.

SETTING

Osaka Medical Center and Research Institute for Maternal and Child Health (Japan).

RESULTS

In our study population, only 20·5 % of pregnant women took folic acid supplements periconceptionally even though 70·4 % knew about the protective effect of folic acid. A multivariate analysis demonstrated that age ≥35 years (OR=2·80; 95 % CI 1·24, 6·29) and knowledge of the benefits of folic acid (OR=2·64; 95 % CI 1·92, 3·62) were associated with periconceptional folic acid use, and multiparity was negatively associated with such use. Compared with those who took folic acid supplements periconceptionally, women who did not take supplements received information through passive and less interactive media.

CONCLUSIONS

Although folic acid awareness was relatively high among pregnant Japanese women, folic acid supplementation before conception was insufficient. To increase the intake of folic acid supplements in countries in which foods are not fortified with folic acid, an effective public health approach promoting behavioural change is necessary for women of reproductive age.

Awareness and uptake of measures for preventing CNS birth defects among mothers of affected children in a sub-Saharan African neurosurgeon's practice

BACKGROUND

The two main measures used in the reduction of the birth prevalence of CNS birth defects are (i) folic acid, FA, supplementation/food fortification for reproductively active women as the primary one, and (ii) timely screening/intrauterine diagnosis, and possibly termination of the affected pregnancies.

MATERIALS AND METHODS

We performed a cross-sectional survey of the levels of awareness and uptake of these measures in a consecutive cohort of mothers of children with CNS birth defects presenting for neurosurgical treatment in an African clinical practice.

RESULTS

There were 151 cases, 101 of them neural tube defects, NTDs. The level of awareness of the role of FA in prevention of these defects was low, 18.8%, and dietary multivitamin supplementation was ingested by only10.7% of the study subjects. The mothers' obstetric behavior in the index pregnancies was suboptimal: pregnancy registration and commencement of obstetric supplements were at median gestational age of 4 months, and obstetric ultrasonography was obtained infrequently, and in an unregulated milieu. Only 17.8% of these CNS birth defects were diagnosed prenatally, but >80% of the mothers would have liked to have the intrauterine diagnosis, and about 23% might have asked for termination of these pregnancies.

CONCLUSIONS

The levels of awareness and uptake of measures for preventing CNS birth defects among mothers of affected children in this sub-Saharan African women cohort are low. Interestingly, many of the mothers were very favorably disposed to receiving, and acting on, the information about the screen detected CNS birth defects in their fetuses.

An increase in neural tube defect notifications, South Australia, 2009-2010

INTRODUCTION

In South Australia, reporting of live births, stillbirths of at least 20 weeks or 400 g birth weight, termination of pregnancies and congenital anomalies is mandated. We describe the investigation of an increase in notifications of neural tube defects (NTDs) in South Australia in 2009 and 2010 using data from several surveillance systems.

METHODS

NTD trend data from 1966 to 2010 were reviewed. Comparisons of pregnancies affected by an NTD in 2009 and 2010 were made with pregnancies affected by an NTD in the period 2003-2008 and with all pregnancies in 2009 and 2010. Statistical analysis was undertaken using Poisson regression, χ(2) or Fisher's exact tests.

RESULTS

The prevalence of NTD-affected pregnancies was 1.95 per 1000 births (39 cases) in 2010 and 1.91 per 1000 births in 2009 (38 cases), the highest annual rates since 1991. Case series comparisons indicated women with NTD-affected pregnancies in 2009 and 2010 were less likely to be Caucasian compared with women who had NTD-affected pregnancies in the period 2003-2008. Women born in the Middle East and African region (n = 7) were significantly more likely to have NTD-affected pregnancies in the years 2009 and 2010 (relative risk: 3.03; 95% confidence interval: 1.39-6.62) compared with women born in the Oceania region.

DISCUSSION

The increased notifications of NTDs can only be partially explained by the increase in numbers of women from the Middle East and African region, with no other contributory causes revealed. This analysis highlighted areas where prevention efforts should be strengthened and surveillance data improved.

Histone modification mapping in human brain reveals aberrant expression of histone H3 lysine 79 dimethylation in neural tube defects

Neural tube defects (NTDs) are severe, common birth defects that result from failure of neural tube closure, but their pathological mechanisms are not yet fully understood. Histone modifications have an important role in gene regulation during fetal development. We therefore hypothesized that the human NTDs may be partly caused by an imbalance in metabolism, perhaps caused by nutritional deficiencies, that leads to aberrant histone modifications. Here, we report a screen of fetal brain histone modifications using 2D nano-LC strong cation exchange reverse phase (SCX/RP) MS/MS and the identification of 61 unique post-translational modification sites on histones H1, H2a, H2b, H3, and H4. Of these, 38 sites are novel (not already found in the Uniprot database). Furthermore, we compared the histone modification patterns between normal brains and NTD brains special of which maternal folate levels were lower than of normal control. The results showed that histone H3 lysine 79 dimethylation (H3K79me2) and a novel identified site, H2bK5 monomethylation (H2bK5me1), were completely absent in individuals with NTDs. Follow-up Western blotting validated the decreased H3K79me2 expression in brains with NTDs, but the amplified samples experiments displayed that decreased H3K79me2 expression was not suitable for all samples with NTDs. Furthermore, folate-free treated mouse embryonic stem cells induced the decreased H3K79me2 level. Subsequently, our ChIP results in normal fetal brain tissues showed that H3K79me2 binds to SUFU, RARA and ITGA3 which induce NTDs phenotype after knockout in mice, and in NTDs brain tissues the bindings of H3K79me2 to these three genes were significantly altered. Taken together, our study indicated that low folate treatment might attenuate H3K79 dimethylation, further affect its regulate activation on target genes, some of which are NTDs-resulting associated, lastly interrupt early embryo developing. Our study increases the understanding of normal fetal brain histone modifications and provides a platform for investigating histone modifications in neural disease and also has an insight into a potential role of aberrant histone modification in etiology of NTDs.

Maternal factors associated with heavy periconceptional alcohol intake and drinking following pregnancy recognition: a post-partum survey of New Zealand women

INTRODUCTION AND AIMS

Alcohol consumption during pregnancy places the foetus at risk of Foetal Alcohol Spectrum Disorders. Little is known about the current prevalence and patterns of alcohol consumption before and following pregnancy recognition in New Zealand.

DESIGN AND METHODS

A retrospective survey of 723 post-partum women resident in maternity wards located across New Zealand was conducted using a self-administered questionnaire. Maternal sociodemographic and obstetric characteristics and alcohol intake before and after pregnancy recognition were assessed.

RESULTS

Of the 968 women invited to participate, 78% agreed. Eighty-two percent of women reported consuming alcohol prior to pregnancy and 20% reported typically consuming >4 New Zealand standard drinks per occasion. Overall, 34% of women reported drinking at some time during pregnancy. Twelve percent of pregnancies were at high risk of heavy alcohol exposure in early gestation. In fully adjusted analysis, pregnancies most at risk were those of indigenous Māori women, Pacific women, smokers and drug users. Almost one-quarter (24%) of drinkers continued to drink following pregnancy recognition, and in fully adjusted analysis, continuing to drink was positively associated with frequency of alcohol consumption before pregnancy (P < 0.001 for linear trend).

DISCUSSION AND CONCLUSIONS

To reduce the burden of alcohol-related harm to the foetus, these findings suggest that New Zealand alcohol policy should be focused not only on promoting total abstinence when planning a pregnancy and when pregnant, but also on reducing 'binge drinking' culture and the frequent consumption of lower levels of alcohol.

Awareness of spina bifida and periconceptional use of folic acid among pregnant women in a developing economy

BACKGROUND

Folate deficiency in pregnant women is a recognized cause of spina bifida. We sought to establish the level of awareness of spina bifida as well as the use of folate supplementation among pregnant women in a developing economy.

METHOD

Interviewer-administered questionnaires were used to obtain information from 200 to 20 randomly selected pregnant women attending antenatal clinics at the authors' institution. Demographic information and information on parity, folic acid use and knowledge on spina bifida including its cause, prevention and treatment were obtained. Data analyses were done using Epi Info version 6.

RESULTS

The mean age of the women was 30.3 years (range 17-52 years). Sixty-six of the women (30.0 %) were primigravida. Most of the respondents [208 (94.5 %)] have attained, at least, secondary level of education. The average gestational age at antenatal clinic booking was 20.7 weeks (range 4-38 weeks), while the average gestational age at commencement of folic acid use was 18.5 weeks (range 4-38 weeks). None of them used folic acid in the preconception period. Knowledge about spina bifida is poor and a significant number [103 (46.8 %)] have superstitious belief about its aetiology. Only 56 (25.5 %) of the respondents are aware that folic acid use prevents its occurrence; however, 194 (88.2 %) are willing to receive periconceptional folate supplementation.

CONCLUSION

There is paucity of knowledge about spina bifida among Nigerian pregnant women despite their high level of formal education. We advocate an aggressive public health campaign to enlighten the women about spina bifida and encourage periconceptional folate supplementation.

Periconceptional bread intakes indicate New Zealand's proposed mandatory folic acid fortification program may be outdated: results from a postpartum survey

Background

In September 2009, a folic acid fortification mandate (135 μg/100 g bread) was to be implemented in New Zealand. However, due to political and manufacturer objection, fortification was deferred until May 2012. Based on estimates of bread consumption derived from a 1997 nationally representative survey, this program was intended to deliver a mean additional intake of 140 μg folic acid/d to women of childbearing age. Little is known about current bread consumption patterns in this target group. The aim of this study was to assess bread consumption among women prior to and during pregnancy with the intent to estimate periconceptional folic acid intakes that would be derived from bread if mandatory fortification were implemented as currently proposed.

Methods

A retrospective survey of 723 postpartum women in hospitals and birthing centres across New Zealand was conducted using a self-administered questionnaire on bread intake prior to and during pregnancy and maternal socio-demographic and obstetric characteristics.

Results

Median bread intake before conception (2 slices/d) was below that of previous data upon which the current fortification proposal was modeled (3-4 slices/d). If mandatory fortification is implemented as proposed, only 31% (95% CI = 24%-37%) of childbearing-age women would attain an additional folic acid intake of ≥ 140 μg/d, with a mean of 119 μg/d (95% CI = 107 μg/d-130 μg/d). Based on these data, a fortification level of 160 μg/100 g bread is required to achieve the targeted mean of 140 μg folic acid/d. Nonetheless, under the current proposal additional folic acid intakes would be greatest among the least advantaged segments of the target population: Pacific and indigenous Māori ethnic groups; those with increased parity, lower income and education; younger and single mothers; and women with unplanned pregnancies. Subgroups predicted to derive less than adequate folic acid intakes from the proposed policy were women of Asian descent and those with a postgraduate education.

Conclusions

This study provides insight on the ability of a fortification policy to benefit the groups at highest risk of poor folate intakes in a population. However, bread consumption among the target group of childbearing women appears to have declined since the data used in previous dietary modeling were collected. Thus, it seems prudent to re-model dietary folic acid intakes based on more recent national survey data prior to the implementation of a mandatory folic acid fortification policy.

Cross-sectional pregnancy survey on fertility trends and pregnancy knowledge in Singapore

AIM

Desire for children is a pertinent national health concern for Singapore due to the falling pregnancy rate. There is an urgent need to conduct a pregnancy survey for our local population to look into our local women's desire for pregnancy and family size, as well as their knowledge of the need for pregnancy supplements, fertility and pregnancy risks with the advanced age of mothers.

MATERIAL AND METHODS

A cross-sectional survey was mailed to 300 women in a random sample of the female population in the South West region of Singapore.

RESULTS

Three hundred women were invited to participate in our survey. Two hundred and sixty eight women (89.3%) responded. The mean age was 30.7 years (range 16-60). 41.8% were married. One in five women (21.8%) in the reproductive age group (below age 40) did not intend to have children. 70.5% of the women with tertiary education wanted children, compared to 56.4% of women with below-secondary education. Most of the respondents were aware of the risks of pregnancy with increasing maternal age, as well as the importance of folic acid, iron and calcium supplements in pregnancy.

CONCLUSION

The present study helps clinicians and policymakers gain an insight into pregnancy issues in Singapore. This is important in formulating population policies and public education programs.

Folic acid awareness and intake among women in areas with high prevalence of neural tube defects in China: a cross-sectional study

Objective

To measure folic acid awareness and intake rates among women of childbearing age in certain areas of China with a high prevalence of neural tube defects (NTD).

Design

A cross-sectional survey was carried out utilising a nineteen-item questionnaire enquiring into individual women's knowledge of, attitude towards and practice of folic acid supplementation.

Setting

A total of 293 low-income counties in six provinces of China.

Subjects

Women aged 19–44 years from six provinces with a high prevalence of NTD recruited from June to August 2008.

Results

Among 33 025 participants, 57 % had heard of folic acid but only 15 % knew all of the core information. The intake rate was 12 %; only 8 % took the recommended dose and only 4 % of non-pregnant women took folic acid. Some women did not take folic acid because they did not know that they should take it (49 %) or they had misconceptions about it (24 %). According to logistic regression analysis, rural residence was a risk factor for folic acid awareness. Ethnicity, educational level, average annual income per person and pregnancy were the influencing factors of folic acid awareness and folic acid intake.

Conclusions

Although more than half of the respondents had heard of folic acid, the intake rate was still very low in areas with a high prevalence of NTD. Thus, more efforts are needed to increase folic acid awareness and intake among women of reproductive age in these areas.

Prevalence of neural tube defects in Australia prior to mandatory fortification of bread-making flour with folic acid

OBJECTIVE

To establish baseline prevalence of neural tube defects (NTDs) prior to mandatory folic acid fortification in Australia.

METHOD

Retrospective population based study. Data from the Australian Congenital Anomalies Monitoring System, for 1998-2005 were used to calculate birth prevalence including live/stillbirths of at least 20 weeks gestation or 400 g birthweight. Total prevalence and trends of NTD including terminations of pregnancy (TOPs) before 20 weeks were established using data from South Australia, Victoria and Western Australia because of the incomplete ascertainment in other states.

RESULTS

The birth prevalence of NTDs from 1998-2005, was 5/10,000 births. The total prevalence including TOPs was 13/10,000 births. A 26% declining trend in total prevalence was seen from 1992-2005, but the main decline occurred prior to 1998. Women who were Indigenous, socially disadvantaged, young, living in remote areas and had multiple gestations were more likely to give birth to babies with NTDs.

CONCLUSION

The prevalence of NTD has been stable since 1998. Reporting of the birth prevalence alone underestimates the actual prevalence of NTD.

IMPLICATIONS

From a public health perspective, future monitoring of NTD following implementation of fortification of bread-making flour with folic acid should include a mixed methods approach; reporting birth prevalence on national data and total prevalence on tri-state data.