Despite efforts in the 1990s to prevent the occurrence of neural tube defects (NTDs) with periconceptional folic acid, compliance by the public and health care providers has not been impressive. Surveys conducted in the late 1990s suggest improvement, but behavior change has fallen short of targeted objectives. However, it is possible, as suggested in NHANES 1999 data, that red cell folate levels are increasing dramatically (following 1998 mandated fortification of grain products at 140mcg/100 grams) and this is encouraging, as the ultimate endpoint is to decrease the incidence and associated mortality from NTDs. Unfortunately, there is currently no national birth defects monitoring program in the United States and approximately one-third of states have no birth defects monitoring program in place. It has been estimated that only about 14% of birth defects are captured using birth certificate data. While also limited, the US death certificate provides data on causes of infant deaths, including NTDs (which explain about 7% of infant deaths due to birth defects annually) and thereby provide a gauge for fatal NTDs. The results of analyses of infant deaths due to NTDs (anencephaly, iniencephaly, spina bifida, encephalocele) from linked birth infant death files from National Center for Health Statistics for the combined years 1995-1997 will be presented with respect to differences by state, maternal age, education, race, ethnicity, plurality, gestational age, birthweight, and age of infant death. Implications of these findings for evaluation of public health campaigns and opportunities and challenges for improving the system will be presented.
Learning Objectives: At the conclusion of the session, the participant will be able to: 1. Understand the variation in infant mortality due to neural tube defects within the United States. 2. Identify the current limitations in sources of data to evaluate folic acid public health campaigns and identify potential opportunties for improvement.
Keywords: Birth Defects, Infant Mortality
Presenting author's disclosure statement:
Organization/institution whose products or services will be discussed: None
Disclosure not received
Relationship: Not Received.