Morris Joan K, Addor Marie-Claude, Ballardini Elisa, Barisic Ingeborg, Barrachina-Bonet Laia, Braz Paula, Cavero-Carbonell Clara, Den Hond Elly, Garne Ester, Gatt Miriam, Haeusler Martin, Khoshnood Babak, Lelong Nathalie, Kinsner-Ovaskainen Agnieszka, Kiuru-Kuhlefelt Sonja, Klungsoyr Kari, Latos-Bielenska Anna, Limb Elizabeth, O'Mahony Mary T, Perthus Isabelle, Pierini Anna, Rankin Judith, Rissmann Anke, Rouget Florence, Sayers Gerardine, Sipek Antonin, Stevens Sarah, Tucker David, Verellen-Dumoulin Christine, de Walle Hermien E K, Wellesley Diana, Wertelecki Wladimir, Bermejo-Sanchez Eva
Population Health Research Institute, St. George's, University of London, London, United Kingdom.
Department of Woman-Mother-Child, University Hospital Center, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland.
Front Pediatr. 2021 Jun 24;9:647038. doi: 10.3389/fped.2021.647038. eCollection 2021.
Thirty years ago it was demonstrated that folic acid taken before pregnancy and in early pregnancy reduced the risk of a neural tube defect (NTD). Despite Public Health Initiatives across Europe recommending that women take 0.4 mg folic acid before becoming pregnant and during the first trimester, the prevalence of NTD pregnancies has not materially decreased in the EU since 1998, in contrast to the dramatic fall observed in the USA. This study aimed to estimate the number of NTD pregnancies that would have been prevented if flour had been fortified with folic acid in Europe from 1998 as it had been in the USA. The number of NTD pregnancies from 1998 to 2017 that would have been prevented if folic acid fortification had been implemented in the 28 countries who were members of the European Union in 2019 was predicted was predicted using data on NTD prevalence from 35 EUROCAT congenital anomaly registries and literature searches for population serum folate levels and folic acid supplementation. From 1998 to 2017 an estimated 95,213 NTD pregnancies occurred amongst 104 million births in the 28 countries in the EU, a prevalence of 0.92 per 1,000 births. The median serum folate level in Europe over this time period was estimated to be 14.1 μg/L. There is a lack of information about women taking folic acid supplements before becoming pregnant and during the first trimester of pregnancy, with one meta-analysis indicating that around 25% of women did so. An estimated 14,600 NTD pregnancies may have been prevented if the European countries had implemented fortification at the level adopted by the USA in 1998 and 25% of women took folic acid supplements. An estimated 19,500 NTD pregnancies would have been prevented if no women took folic acid supplements. This study suggests that failure to implement mandatory folic acid fortification in the 28 European countries has caused, and continues to cause, neural tube defects to occur in almost 1,000 pregnancies every year.
三十年前有研究表明，在怀孕前及怀孕早期摄入叶酸可降低神经管缺陷（NTD）的风险。尽管欧洲各地的公共卫生倡议都建议女性在怀孕前和孕早期服用0.4毫克叶酸，但自1998年以来，欧盟神经管缺陷妊娠的患病率并未实质性下降，这与美国观察到的大幅下降形成对比。本研究旨在估计，如果欧洲自1998年起像美国那样在面粉中强化叶酸，原本可以预防的神经管缺陷妊娠数量。利用来自35个欧洲先天性异常监测（EUROCAT）登记处的神经管缺陷患病率数据以及关于人群血清叶酸水平和叶酸补充剂的文献检索，预测了如果在2019年欧盟的28个成员国中实施叶酸强化，从1998年到2017年原本可以预防的神经管缺陷妊娠数量。1998年至2017年期间，欧盟28个国家的1.04亿例出生中估计有95213例神经管缺陷妊娠，患病率为每1000例出生0.92例。在此期间欧洲血清叶酸水平的中位数估计为14.1微克/升。缺乏关于女性在怀孕前和孕早期服用叶酸补充剂的信息，一项荟萃分析表明约25%的女性这样做了。如果欧洲国家按照美国1998年采用的水平实施强化且25%的女性服用叶酸补充剂，估计可预防14600例神经管缺陷妊娠。如果没有女性服用叶酸补充剂，估计可预防19500例神经管缺陷妊娠。这项研究表明，28个欧洲国家未实施强制性叶酸强化已导致并将继续导致每年近1000例妊娠出现神经管缺陷。
