Neural tube defects: Is a decreasing prevalence associated with a decrease in severity?

Objective: Severe neural tube defects (NTDs) tend to occur with disproportionate frequency in areas of high prevalence. The objective of our study was to determine the birth prevalence of NTDs during a 25-year period at a single institution based in an area of high prevalence for NTDs and to investigate if a decreasing prevalence resulted in a change in the type of NTDs. Study design: All cases of NTD affected births born at the Coombe Women's Hospital during the interval 1975-1999 were reviewed. There were 171,260 births at the Coombe Women's Hospital between 1975 and 1999. During this interval, there were 522 NTD affected births. Results: From 1975 until 1999 the prevalence of NTDs significantly decreased (P < 0.0001). This transition from high to low prevalence was associated with a significant decrease in severe forms of NTDs (P < 0.0001). This decreasing trend in rate and severity of NTD affected births was most dramatic prior to either food fortification or periconceptual folic acid supplementation. Conclusions: Our transition from high to low prevalence for NTDs has been associated with a significant decrease in severe forms of NTDs.