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Birth Defects Res A Clin Mol Teratol. 2015 Sep;103(9):763-71. doi: 10.1002/bdra.23400. Epub 2015 Jul 14.

Preventable spina bifida and anencephaly in Europe.

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AIAS, Aarhus Institute for Advanced Studies, Aarhus University, Høegh-Guldbergs Gade 6B, Aarhus C, Denmark.
Department of Nutrition and Food Science, Rheinische Friedrich-Wilhelms University, Bonn, Bonn, Germany.
Center for Spina Bifida Research, Prevention and Policy, Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, Georgia.
Chair of the Board of Directors of the University Bonn Medical Center, University Hospital of Bonn, Bonn, Germany.
Winterthur Institute of Health Economics, Zurich University of Applied Sciences, Winterthur, Switzerland.



Promotion of voluntary folic acid supplement use among women of reproductive age has been proven to be ineffective in lowering the risk of neural tube defects in Europe.


Using surveillance data from all births covered by the full member countries of the European Surveillance of Congenital Anomalies (EUROCAT), we estimated the total prevalence of spina bifida and anencephaly per 10,000 births between 2000 and 2010. We also estimated additional lifetime direct medical costs among individuals with spina bifida, compared with those without, in Germany for the year 2009.


During the study period, there were 7478 documented cases of spina bifida and anencephaly among the 9,161,189 births, with an estimated average combined prevalence of 8.16 per 10,000 births (95% confidence interval, 7.98 - 8.35). For the 241 spina bifida-affected live births in 2009 in Germany, the estimated additional lifetime direct medical costs compared with non-spina bifida affected births were €65.5 million. Assuming a 50% reduction in the prevalence if folic acid has been provided to all women before pregnancy, 293 spina bifida cases could have been prevented in Germany in 2009. The estimated lifetime direct medical cost saving for the live births in 2009 was €32.9 million assuming a 50% reduction, or €26.1 million assuming a 40% risk reduction.


Europe has an epidemic of spina bifida and anencephaly compared with countries with mandatory folic acid fortification policy. Primary prevention through mandatory folic acid fortification would considerably reduce the number of affected pregnancies, and associated additional costs.


anencephaly; economic; folic acid; fortification; neural tube defects; pregnancy; prevention; spina bifida

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