Birth defect and risk factor surveillance in the northern and southwestern Netherlands

Objective: To survey the associations between several risk factors and birth defects, in order to detect potential new teratogens.Methods: Data of the two Dutch European Registration of Congenital Anomalies (EUROCAT) registries collected before January 1, 1998 were used to perform X2 tests for a large number of risk factors and birth defects. Defects caused by chromosomal or monogenic disorders were analyzed separately.Results: Cross- tabulations of 80 groups of birth defects with 303 risk factors were studied. Of these, 126 combinations had a p value under 0.05, and 34 had a p value under 0.001. Of these 34 associations, some are known in the literature, some were found before in the same databases and some were new associations.Conclusions: This is a good method for generating new hypotheses for associations between risk factors and birth defects. It can be a start for new, more in-depth studies of potential teratogens. Copyright (C) 2000 S. Karger AG, Basel.</p

Inadequate folic acid intake around the time of conception, particularly among less highly educated women

Objective. To describe the knowledge and use of folic acid by women in the North of the Netherlands who wish to become pregnant, in relation to their social-economic status. Design. Descriptive. Method. Pregnant women who were attending one of 3 gynaecological and 7 midwifery practices for their first or second pregnancy check-up in October or November 2000 in the provinces Groningen, Friesland and Drenthe were asked to complete a questionnaire about their knowledge, sources of information and use of folic acid. Four hundred and sixty-one of the 473 women were prepared to take part. The highest level of education achieved was used as an indicator of social-economic status. Results. Three hundred and fifty-seven (77%) respondents had heard about folic acid before becoming pregnant, 289 (63%) knew about its protective effect in terms of neural-tube defects, and 151 (33%) knew the full length of the advised period of folic acid intake. Two hundred and sixty-five (61%) respondents had taken folic acid for some part of the advised period and 164 (36%) had taken it for the entire duration of the advised period. More women with a higher education than women with lower levels of education knew about folic acid and had used it. Conclusion. Three quarters of the respondents had heard about folic acid before their pregnancy, and less than half took it during the advised period around the time of conception. Women with a higher education were more likely to follow the advice.</p

Inadequate folic acid intake around the time of conception, particularly among less highly educated women

Objective. To describe the knowledge and use of folic acid by women in the North of the Netherlands who wish to become pregnant, in relation to their social-economic status. Design. Descriptive. Method. Pregnant women who were attending one of 3 gynaecological and 7 midwifery practices for their first or second pregnancy check-up in October or November 2000 in the provinces Groningen, Friesland and Drenthe were asked to complete a questionnaire about their knowledge, sources of information and use of folic acid. Four hundred and sixty-one of the 473 women were prepared to take part. The highest level of education achieved was used as an indicator of social-economic status. Results. Three hundred and fifty-seven (77%) respondents had heard about folic acid before becoming pregnant, 289 (63%) knew about its protective effect in terms of neural-tube defects, and 151 (33%) knew the full length of the advised period of folic acid intake. Two hundred and sixty-five (61%) respondents had taken folic acid for some part of the advised period and 164 (36%) had taken it for the entire duration of the advised period. More women with a higher education than women with lower levels of education knew about folic acid and had used it. Conclusion. Three quarters of the respondents had heard about folic acid before their pregnancy, and less than half took it during the advised period around the time of conception. Women with a higher education were more likely to follow the advice.</p

Inadequate folic acid intake around the time of conception, particularly among less highly educated women

Objective. To describe the knowledge and use of folic acid by women in the North of the Netherlands who wish to become pregnant, in relation to their social-economic status. Design. Descriptive. Method. Pregnant women who were attending one of 3 gynaecological and 7 midwifery practices for their first or second pregnancy check-up in October or November 2000 in the provinces Groningen, Friesland and Drenthe were asked to complete a questionnaire about their knowledge, sources of information and use of folic acid. Four hundred and sixty-one of the 473 women were prepared to take part. The highest level of education achieved was used as an indicator of social-economic status. Results. Three hundred and fifty-seven (77%) respondents had heard about folic acid before becoming pregnant, 289 (63%) knew about its protective effect in terms of neural-tube defects, and 151 (33%) knew the full length of the advised period of folic acid intake. Two hundred and sixty-five (61%) respondents had taken folic acid for some part of the advised period and 164 (36%) had taken it for the entire duration of the advised period. More women with a higher education than women with lower levels of education knew about folic acid and had used it. Conclusion. Three quarters of the respondents had heard about folic acid before their pregnancy, and less than half took it during the advised period around the time of conception. Women with a higher education were more likely to follow the advice.</p

Inadequate folic acid intake around the time of conception, particularly among less highly educated women

Objective. To describe the knowledge and use of folic acid by women in the North of the Netherlands who wish to become pregnant, in relation to their social-economic status. Design. Descriptive. Method. Pregnant women who were attending one of 3 gynaecological and 7 midwifery practices for their first or second pregnancy check-up in October or November 2000 in the provinces Groningen, Friesland and Drenthe were asked to complete a questionnaire about their knowledge, sources of information and use of folic acid. Four hundred and sixty-one of the 473 women were prepared to take part. The highest level of education achieved was used as an indicator of social-economic status. Results. Three hundred and fifty-seven (77%) respondents had heard about folic acid before becoming pregnant, 289 (63%) knew about its protective effect in terms of neural-tube defects, and 151 (33%) knew the full length of the advised period of folic acid intake. Two hundred and sixty-five (61%) respondents had taken folic acid for some part of the advised period and 164 (36%) had taken it for the entire duration of the advised period. More women with a higher education than women with lower levels of education knew about folic acid and had used it. Conclusion. Three quarters of the respondents had heard about folic acid before their pregnancy, and less than half took it during the advised period around the time of conception. Women with a higher education were more likely to follow the advice.</p

Inadequate folic acid intake around the time of conception, particularly among less highly educated women

Objective. To describe the knowledge and use of folic acid by women in the North of the Netherlands who wish to become pregnant, in relation to their social-economic status. Design. Descriptive. Method. Pregnant women who were attending one of 3 gynaecological and 7 midwifery practices for their first or second pregnancy check-up in October or November 2000 in the provinces Groningen, Friesland and Drenthe were asked to complete a questionnaire about their knowledge, sources of information and use of folic acid. Four hundred and sixty-one of the 473 women were prepared to take part. The highest level of education achieved was used as an indicator of social-economic status. Results. Three hundred and fifty-seven (77%) respondents had heard about folic acid before becoming pregnant, 289 (63%) knew about its protective effect in terms of neural-tube defects, and 151 (33%) knew the full length of the advised period of folic acid intake. Two hundred and sixty-five (61%) respondents had taken folic acid for some part of the advised period and 164 (36%) had taken it for the entire duration of the advised period. More women with a higher education than women with lower levels of education knew about folic acid and had used it. Conclusion. Three quarters of the respondents had heard about folic acid before their pregnancy, and less than half took it during the advised period around the time of conception. Women with a higher education were more likely to follow the advice.</p

Inadequate folic acid intake around the time of conception, particularly among less highly educated women

Objective. To describe the knowledge and use of folic acid by women in the North of the Netherlands who wish to become pregnant, in relation to their social-economic status. Design. Descriptive. Method. Pregnant women who were attending one of 3 gynaecological and 7 midwifery practices for their first or second pregnancy check-up in October or November 2000 in the provinces Groningen, Friesland and Drenthe were asked to complete a questionnaire about their knowledge, sources of information and use of folic acid. Four hundred and sixty-one of the 473 women were prepared to take part. The highest level of education achieved was used as an indicator of social-economic status. Results. Three hundred and fifty-seven (77%) respondents had heard about folic acid before becoming pregnant, 289 (63%) knew about its protective effect in terms of neural-tube defects, and 151 (33%) knew the full length of the advised period of folic acid intake. Two hundred and sixty-five (61%) respondents had taken folic acid for some part of the advised period and 164 (36%) had taken it for the entire duration of the advised period. More women with a higher education than women with lower levels of education knew about folic acid and had used it. Conclusion. Three quarters of the respondents had heard about folic acid before their pregnancy, and less than half took it during the advised period around the time of conception. Women with a higher education were more likely to follow the advice.</p

Therapeutic drug use during pregnancy:A comparison in four European countries

A drug utilization study was performed using data of the OECM study on Occupational Exposures and Congenital Malformations, which was conducted in six European Registries of Congenital Anomalies (two in France, two in Italy, one in Great Britain, and one in The Netherlands): the mothers were interviewed after delivery for exposures during pregnancy, including use of therapeutic drugs. The analysis of drug use considered only the 1134 control mothers of healthy newborns, and focused on the first trimester of pregnancy: 36.2% of the interviewed mothers used at least one drug (excluding vitamins and minerals) during the first trimester. This rate varied from 22.5% in Glasgow to 50.3% and 44.2% in the French centers. Anti-infectives were the most frequent drugs (12.3% of mothers), then antinauseants (10.6%), and treatments for threatened abortion (5.5%). Important variations between countries were observed, reflecting different medical attitudes towards drug use during pregnancy.</p

Epidemiology of prenatal diagnosis and selective termination of pregnancy because of foetal neural tube defects in the Netherlands in comparison with other European countries

Objective. To describe the epidemiological impact of prenatal diagnosis and selective abortion on the frequency of neural tube defects (NTD) in the period 1980-1992 in the Northern Netherlands in comparison with data from other European regions. Design. Descriptive. Setting. 17 'European registration of congenital anomalies' (EUROCAT) registrations, localized in 10 European countries. Method. Data were collected actively and retrospectively from multiple sources fed by voluntary registration of congenital anomalies in live births, stillbirths and pregnancies terminated because of congenital anomalies. Results. In Europe the total birth prevalence of NTD in the period 1980-1992 ranged from 5.3 per 10,000 in Switzerland to 29.0 per 10,000 in Glasgow, a difference of a factor 5.5. In live births the difference was ninefold: ranging from 2,0 per 10,000 in Paris to 18.8 per 10,000 in Dublin. The Netherlands had a conspicuously high prevalence among live births, higher than in other regions in continental Europe. For spina bifida the live birth prevalence both in other continental regions and in Glasgow was also lower than in the Netherlands. In Glasgow serum alpha-foetoprotein screening apparently led to frequent early prenatal diagnosis of NTD and to frequent termination of pregnancy. In Paris the use of ultrasound screening appears to lead to frequent later prenatal diagnosis, as well as frequent termination of pregnancy. Conclusion. In the Netherlands the impact of prenatal diagnosis and selective abortion is limited, so that primary prevention (periconceptional use of folic acid) is more important than in some other European countries.</p

Epidemiology of prenatal diagnosis and selective termination of pregnancy because of foetal neural tube defects in the Netherlands in comparison with other European countries

Objective. To describe the epidemiological impact of prenatal diagnosis and selective abortion on the frequency of neural tube defects (NTD) in the period 1980-1992 in the Northern Netherlands in comparison with data from other European regions. Design. Descriptive. Setting. 17 'European registration of congenital anomalies' (EUROCAT) registrations, localized in 10 European countries. Method. Data were collected actively and retrospectively from multiple sources fed by voluntary registration of congenital anomalies in live births, stillbirths and pregnancies terminated because of congenital anomalies. Results. In Europe the total birth prevalence of NTD in the period 1980-1992 ranged from 5.3 per 10,000 in Switzerland to 29.0 per 10,000 in Glasgow, a difference of a factor 5.5. In live births the difference was ninefold: ranging from 2,0 per 10,000 in Paris to 18.8 per 10,000 in Dublin. The Netherlands had a conspicuously high prevalence among live births, higher than in other regions in continental Europe. For spina bifida the live birth prevalence both in other continental regions and in Glasgow was also lower than in the Netherlands. In Glasgow serum alpha-foetoprotein screening apparently led to frequent early prenatal diagnosis of NTD and to frequent termination of pregnancy. In Paris the use of ultrasound screening appears to lead to frequent later prenatal diagnosis, as well as frequent termination of pregnancy. Conclusion. In the Netherlands the impact of prenatal diagnosis and selective abortion is limited, so that primary prevention (periconceptional use of folic acid) is more important than in some other European countries.</p