Busby Araceli, Abramsky Lenore, Dolk Helen, Armstrong Ben, Addor Marie-Claude, Anneren Goran, Armstrong Nicola, Baguette Andre, Barisic Ingeborg, Berghold Andrea, Bianca Sebastiano, Braz Paula, Calzolari Elisa, Christiansen Marianne, Cocchi Guido, Daltveit Anne Kjersti, De Walle Hermien, Edwards Grace, Gatt Miriam, Gener Blanca, Gillerot Yves, Gjergja Romana, Goujard Janine, Haeusler Martin, Latos-Bielenska Anna, McDonnell Robert, Neville Amanda, Olars Birgitta, Portillo Isabel, Ritvanen Annukka, Robert-Gnansia Elizabeth, Rösch Christine, Scarano Gioacchino, Steinbicker Volker
London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK.
Reprod Toxicol. 2005 Sep-Oct;20(3):393-402. doi: 10.1016/j.reprotox.2005.03.009.
Each year, more than 4500 pregnancies in the European Union are affected by neural tube defects (NTD). Unambiguous evidence of the effectiveness of periconceptional folic acid in preventing the majority of neural tube defects has been available since 1991. We report on trends in the total prevalence of neural tube defects up to 2002, in the context of a survey in 18 European countries of periconceptional folic acid supplementation (PFAS) policies and their implementation. EUROCAT is a network of population-based registries in Europe collaborating in the epidemiological surveillance of congenital anomalies. Representatives from 18 participating countries provided information about policy, health education campaigns and surveys of PFAS uptake. The yearly total prevalence of neural tube defects including livebirths, stillbirths and terminations of pregnancy was calculated from 1980 to 2002 for 34 registries, with UK and Ireland estimated separately from the rest of Europe. A meta-analysis of changes in NTD total prevalence between 1989-1991 and 2000-2002 according to PFAS policy was undertaken for 24 registries. By 2005, 13 countries had a government recommendation that women planning a pregnancy should take 0.4mg folic acid supplement daily, accompanied in 7 countries by government-led health education initiatives. In the UK and Ireland, countries with PFAS policy, there was a 30% decline in NTD total prevalence (95% CI 16-42%) but it was difficult to distinguish this from the pre-existing strong decline. In other European countries with PFAS policy, there was virtually no decline in NTD total prevalence whether a policy was in place by 1999 (2%, 95% CI 28% reduction to 32% increase) or not (8%, 95% CI 26% reduction to 16% increase). The potential for preventing NTDs by periconceptional folic acid supplementation is still far from being fulfilled in Europe. Only a public health policy including folic acid fortification of staple foods is likely to result in large-scale prevention of NTDs.
欧盟每年有超过4500例妊娠受到神经管缺陷（NTD）的影响。自1991年以来，已有明确证据表明孕前补充叶酸对预防大多数神经管缺陷有效。我们在对18个欧洲国家的孕前叶酸补充（PFAS）政策及其实施情况进行调查的背景下，报告了截至2002年神经管缺陷总患病率的趋势。EUROCAT是欧洲一个基于人群的登记处网络，合作开展先天性异常的流行病学监测。18个参与国的代表提供了有关政策、健康教育活动以及PFAS摄入情况调查的信息。1980年至2002年期间，对34个登记处计算了包括活产、死产和终止妊娠在内的神经管缺陷的年度总患病率，英国和爱尔兰与欧洲其他地区分别估算。对24个登记处进行了一项荟萃分析，根据PFAS政策分析了1989 - 1991年至2000 - 2002年期间NTD总患病率的变化。到2005年，13个国家有政府建议计划怀孕的妇女应每天补充0.4毫克叶酸，7个国家还开展了政府主导的健康教育活动。在有PFAS政策的英国和爱尔兰，NTD总患病率下降了30%（95%置信区间16 - 42%），但很难将其与之前就已存在的大幅下降区分开来。在其他有PFAS政策的欧洲国家，无论1999年是否出台政策，NTD总患病率几乎都没有下降（出台政策的国家下降2%，95%置信区间为下降28%至上升32%；未出台政策的国家上升8%，95%置信区间为下降26%至上升16%）。在欧洲，通过孕前补充叶酸预防NTD的潜力仍远未实现。只有一项包括主食强化叶酸的公共卫生政策才有可能大规模预防NTD。
