Prevention Program for Reducing Risk for Neural Tube Defects --
South Carolina, 1992-1994
Neural tube defects (NTDs) are common and serious
malformations that originate early in pregnancy. In the United
States, approximately 4000 pregnancies each year are affected by
the two most common NTDs (spina bifida and anencephaly), and an
estimated 2500 infants are born with NTDs. Based on a Public Health
Service (PHS) recommendation published in September 1992, at least
one half of NTDs could be prevented if all women capable of
becoming pregnant consumed 0.4 mg of folic acid daily during the
periconceptional period (1). Women who have previously had an
NTD-affected pregnancy would especially benefit from folic acid
supplements (2). In 1992, with support from a CDC cooperative
agreement, the South Carolina Department of Disabilities and
Special Needs implemented a prevention program to reduce the
incidence of folic acid-preventable NTDs in the pregnancies of
women with prior NTD-affected pregnancies. This report describes
surveillance findings resulting from this program during 1992-1994.
In October 1992, the NTD prevention program initiated a pilot
surveillance system to monitor the occurrence of NTDs in the
Piedmont Region of the state (1990 population: 1.1 million). Data
about NTD cases were collected from hospital medical records, vital
records, and prenatal diagnoses procedure records. In October 1993,
the surveillance system was expanded statewide (1990 population:
3.5 million). During October 1992-September 1994, the surveillance
system identified 105 NTD cases and 72,493 live-born infants,
representing a rate of 14.5 cases per 10,000 resident live-born
infants.
Of the 105 women identified as having had NTD-affected
pregnancies, 71 participated in a personal interview about use of
folic acid-containing supplements during the periconceptional
period (i.e., 1 month before conception through the third month of
pregnancy). Overall, six (8%) of the 71 women reported using a
folic acid-containing multivitamin supplement during the
periconceptional period, including four (7%) of the 54 women who
had a last menstrual period after the PHS recommendation was
issued, and two (12%) of the 17 women who had a last menstrual
period before the PHS recommendation was issued.
Reported by: RE Stevenson, MD, JH Dean, WP Allen, MD, Greenwood
Genetic Center, Greenwood; M Kelly, South Carolina Dept of
Disabilities and Special Needs, Columbia. Birth Defects and Genetic
Diseases Br, Div of Birth Defects and Developmental Disabilities,
National Center for Environmental Health, CDC.
Editorial Note
Editorial Note: During 1980-1990, an estimated 18,000 infants were
born in the United States with spina bifida; by 1990, approximately
5000 (28%) of these children had died. Annual medical and surgical
costs in the United States for all persons with spina bifida exceed
$200 million. For each person with typical severe spina bifida, the
estimated lifetime direct and indirect costs are $250,000 (3).
In 1992, PHS estimated that, if all women capable of becoming
pregnant adhered to the recommendation to consume 0.4 mg of folic
acid per day, the number of cases of spina bifida and anencephaly
would be reduced by 50%. Consumption of a vitamin supplement
containing the prescribed amount of folic acid is one method to
ensure receipt of the proper dosage of folic acid. In 1992, an
estimated 20% of all U.S. women were consuming a multivitamin
containing 0.4 mg of folic acid (4). However, the findings in this
report indicate that, among women with NTD-affected pregnancies in
South Carolina who had conceived after issuance of the PHS
recommendation, only 7% had consumed 0.4 mg of folic acid during
the periconceptional period. In addition, among a sample of 60
women in South Carolina who had given birth to infants without NTDs
during October 1992-September 1994, seven (12%) reported using
folic acid-containing vitamin supplements during the
periconceptional period (Greenwood Genetic Center, Greenwood, South
Carolina, unpublished data, 1994). These findings suggest that
overall use of folic acid-containing supplements in South Carolina
is lower than the 1992 PHS estimate of use among the total
population of U.S. women (4).
The findings in this report underscore the need for increased
efforts in South Carolina to 1) publicize the benefits and promote
the use of increased folic acid consumption during the
periconceptional period, 2) encourage women of childbearing age to
increase their folic acid consumption, and 3) ensure that all women
have the opportunity to increase their consumption of folic acid.
Since promulgation of the 1992 PHS recommendation, public and
private health-care and advocacy organizations in South Carolina
have initiated information and education campaigns to promote
consumption of folic acid among women of childbearing age. In
addition, educational programs have been designed and implemented
to communicate information about the protective benefits of folic
acid to health professionals, public school educators, and the
public.
References
CDC. Recommendations for the use of folic acid to reduce the
number of cases of spina bifida and other neural tube defects. MMWR
1992;41(no. RR-14).
MRC Vitamin Study Research Group. Prevention of neural tube
defects: results of the Medical Research Council Vitamin Study.
Lancet 1991;338:131-7.
CDC. Economic burden of spina bifida -- United States,
1980-1990.
MMWR 1989;38:264-7.
Moss AJ, Levy AS, Kim I, et al. Use of vitamin and mineral
supplements in the United States: current users, types of products,
and nutrients. Hyattsville, Maryland: US Department of Health and
Human Services, Public Health Service, CDC, NCHS, 1989. (Advance
data no. 174).
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