Hebrew University School of Medicine, Jerusalem, Israel.
Hebrew University School of Medicine, Jerusalem, Israel; Clalit Health Services, Jerusalem District, Israel.
Prev Med. 2020 Oct;139:106064. doi: 10.1016/j.ypmed.2020.106064. Epub 2020 Mar 24.
Neural tube defects (NTDs) are common and disabling congenital malformations that remain a public health challenge despite prevention efforts. In 2000, The Israeli Ministry of Health published recommendations on daily folic acid (FA) supplementation for women of reproductive age and established a national NTD registry. This study aims to evaluate the long-term impact of the FA supplementation policy on NTD rates in Israel and the need for further intervention. In this descriptive report, we present the rate of NTD-affected pregnancies recorded in the registry between 2000 and 2012, their subtype (anencephaly, spina bifida or other), outcome (live birth, stillbirth or pregnancy termination), ethnic group (Jewish, Bedouin and non-Bedouin Muslim) and years of maternal education. The final analysis included 2374 NTD cases reported between 2000 and 2012, compared with 1,668,073 live births. During this period NTD rates decreased from 20.3 to 11.2 cases per 10,000 live births, a 45% reduction. Reductions were seen in rates of spina bifida, anencephaly and encephalocele. NTD rates decreased in all pregnancy outcomes and in all ethnic groups, though rates among Bedouins remain high. Women with higher levels of education tended to have lower NTD rates, and were more prone to choose termination of an affected pregnancy. Following the institution of FA supplementation in Israel, a substantial reduction was seen in NTD rates. Nonetheless, Israeli NTD rates remain higher than in other developed countries. FA interventions should continue to be vigorously implemented, especially in vulnerable populations. The global success of mandatory fortification of grain strongly advocates its consideration in Israel.
神经管缺陷（NTDs）是常见的致残性先天性畸形，尽管采取了预防措施，但仍是公共卫生的挑战。2000 年，以色列卫生部发布了关于育龄妇女每日叶酸（FA）补充的建议，并建立了国家 NTD 登记处。本研究旨在评估 FA 补充政策对以色列 NTD 发生率的长期影响以及是否需要进一步干预。在本描述性报告中，我们介绍了登记处记录的 2000 年至 2012 年间 NTD 受影响妊娠的发生率、其亚型（无脑畸形、脊柱裂或其他）、结局（活产、死产或妊娠终止）、族裔（犹太、贝都因和非贝都因穆斯林）和母亲受教育年限。最终分析包括 2000 年至 2012 年间报告的 2374 例 NTD 病例，与 1668073 例活产儿相比。在此期间，NTD 发生率从每 10000 例活产儿 20.3 例降至 11.2 例，降低了 45%。脊柱裂、无脑畸形和脑膨出的发生率有所下降。所有妊娠结局和所有族裔群体的 NTD 发生率均有所下降，但贝都因人的发生率仍较高。教育程度较高的妇女 NTD 发生率较低，更倾向于选择终止受影响的妊娠。在以色列实施 FA 补充后，NTD 发生率显著下降。尽管如此，以色列的 NTD 发生率仍高于其他发达国家。FA 干预措施应继续大力实施，特别是在弱势群体中。全球强制谷物强化的成功强烈支持在以色列考虑这一措施。
