Child's Nervous System

, Volume 27, Issue 11, pp 1951–1955

Decreased incidence of myelomeningocele at birth: effect of folic acid recommendations or prenatal diagnostics?

  • Dorte Clemmensen
  • Mathias Thygesen
  • Mikkel Mylius Rasmussen
  • Morten Fenger-Grøn
  • Olav B. Petersen
  • Claus Mosdal
Original Paper

DOI: 10.1007/s00381-011-1473-2

Cite this article as:
Clemmensen, D., Thygesen, M., Rasmussen, M.M. et al. Childs Nerv Syst (2011) 27: 1951. doi:10.1007/s00381-011-1473-2

Abstract

Purpose

In Denmark, prevention to reduce the spina bifida birth rate has focused on two areas: folic acid supplementation (1997) and changes in the national ultrasonography screening programme (2004). Myelomeningocele (MMC) is the most severe malformation among the spina bifidas. Taking into consideration the potential negative effect of high-dose folic acid consumption, we found a need to look into the effectiveness of these two strategies in our complete MMC population.

Methods

All spina bifida patients born in the western part of Denmark are differentiated into proper subgroups based on MR imaging, giving us a unique chance to study a true MMC population. The total number of the group of MMC children since 1983 is 121. One hundred and eight (89%) parents answered a questionnaire.

Results

Following the changes in the prenatal ultrasonography screening programme in 2004, a significant decline of 60% live birth MMC per year was noted, incidence rate ratio (IRR) = 40% (22–73%), p = 0.3%. We found no change in MMC birth rate after introduction of folic acid supplementation, IRR = 121% (81–181%), p = 36%.

Conclusion

Our findings demonstrate no effect of folic acid recommendation due to lack of compliance among women of reproductive age in Denmark. However, we found an improved early detection rate of prenatal MMC by high-quality ultrasonography. Subsequent early termination of pregnancy has led to a significant reduction of birth rate of babies with MMC.

Keywords

Myelomeningocele Screening programme Ultrasonography Folic acid Recommendations 

Copyright information

© Springer-Verlag 2011

Authors and Affiliations

  • Dorte Clemmensen
    • 1
  • Mathias Thygesen
    • 1
  • Mikkel Mylius Rasmussen
    • 1
    • 2
  • Morten Fenger-Grøn
    • 3
    • 4
  • Olav B. Petersen
    • 5
  • Claus Mosdal
    • 1
  1. 1.The Spinal Cord Research Centre, Department of NeurosurgeryAarhus University HospitalAarhus CDenmark
  2. 2.Department of Neurosurgery, Aalborg HospitalAarhus University HospitalAarhusDenmark
  3. 3.Department of Clinical EpidemiologyAarhus University HospitalAarhusDenmark
  4. 4.Research Unit for General PracticeAarhus UniversityAarhusDenmark
  5. 5.Fetal Medicine Unit, Department of Obstetrics and GynecologyAarhus University HospitalAarhusDenmark

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