{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,24]],"date-time":"2026-09-24T13:08:16Z","timestamp":1790255296809,"version":"4.1.0"},"reference-count":18,"publisher":"Wiley","issue":"9","license":[{"start":{"date-parts":[[2026,9,21]],"date-time":"2026-09-21T00:00:00Z","timestamp":1789948800000},"content-version":"vor","delay-in-days":20,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,9,1]],"date-time":"2026-09-01T00:00:00Z","timestamp":1788220800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Birth Defects Research"],"published-print":{"date-parts":[[2026,9]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Neural tube defects (NTDs) remain clinically important congenital conditions, but contemporary Puerto Rico\u2013specific epidemiological data in the current folic acid fortification era are limited.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>To describe the epidemiology of NTDs in Puerto Rico from 2015 through 2024, characterize pregnancy outcomes and lesion patterns, evaluate temporal trends, and compare contemporary metrics with prior Puerto Rico reports using directly comparable denominators.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Retrospective population\u2010based cross\u2010sectional surveillance study of NTD\u2010affected pregnancies in Puerto Rico, 2015\u20132024. Case data were obtained from the Puerto Rico NTD surveillance dataset; annual live\u2010birth denominators were obtained from the Puerto Rico Department of Health. Surveillance\u2010based rates per 10,000 live births were calculated with exact Poisson 95% confidence intervals. Temporal trends were evaluated with negative binomial regression. The study was conducted under local institutional and public health data policies as a secondary analysis of de\u2010identified data; institutional review board review was not required.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Among 194 NTD\u2010affected pregnancies and 220,138 live births, the overall surveillance\u2010based rate was 8.8 per 10,000 live births (95% CI 7.6, 10.1). No significant temporal trend was identified (rate ratio 1.01, 95% CI 0.81, 1.26). The live\u2010born NTD rate was 3.7 per 10,000 live births (95% CI 3.0, 4.6). Spina bifida (88; 45.4%) and anencephaly (79; 40.7%) predominated. Termination occurred in 54 of 79 (68.4%) anencephaly pregnancies compared with 23 of 88 (26.1%) spina bifida pregnancies. Lumbosacral lesions were the most common spina bifida level (39; 44.3%).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>The contemporary live\u2010born NTD rate in Puerto Rico is lower than the pre\u2010fortification era estimate, reflecting the influence of prenatal diagnosis and termination. The overall surveillance\u2010based rate remains similar to the earlier post\u2010fortification estimate, with no significant recent decline, supporting the need for strengthened territory\u2010specific surveillance and earlier, coordinated folate\u2010centred prevention strategies.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/bdr2.70110","type":"journal-article","created":{"date-parts":[[2026,9,22]],"date-time":"2026-09-22T04:15:50Z","timestamp":1790050550000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Epidemiology of Neural Tube Defects in Puerto Rico in the Era of Folic Acid Fortification: Population\u2010Based Surveillance, Pregnancy Outcomes, and Lesion Patterns (2015\u20132024)"],"prefix":"10.1002","volume":"118","author":[{"given":"Derick","family":"Rodr\u00edguez\u2010Reyes","sequence":"first","affiliation":[{"name":"Department of Orthopaedic Surgery Ponce Health Sciences University  Ponce Puerto Rico USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-5507-2608","authenticated-orcid":false,"given":"Hiram E.","family":"Luigi\u2010Martinez","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery Ponce Health Sciences University  Ponce Puerto Rico USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-0690-9120","authenticated-orcid":false,"given":"Joseph","family":"Salem\u2010Hern\u00e1ndez","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery Ponce Health Sciences University  Ponce Puerto Rico USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gustavo E.","family":"Ronda\u2010Rodr\u00edguez","sequence":"additional","affiliation":[{"name":"Public Health Program Ponce Health Sciences University  Ponce Puerto Rico USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Samuel","family":"Fern\u00e1ndez","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery Ponce Health Sciences University  Ponce Puerto Rico USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,9,21]]},"reference":[{"key":"e_1_2_11_2_1","first-page":"1","article-title":"Recommendations for the Use of Folic Acid to Reduce the Number of Cases of Spina Bifida and Other Neural Tube Defects","volume":"41","author":"Centers for Disease Control and Prevention","year":"1992","journal-title":"MMWR \u2010 Recommendations and Reports"},{"issue":"1","key":"e_1_2_11_3_1","first-page":"10","article-title":"Prevalence of Neural Tube Defects and Folic Acid Knowledge and Consumption\u2014Puerto Rico, 1996\u20132006","volume":"57","author":"Centers for Disease Control and Prevention","year":"2008","journal-title":"MMWR. Morbidity and Mortality Weekly Report"},{"key":"e_1_2_11_4_1","doi-asserted-by":"publisher","DOI":"10.5888\/pcd18.210035"},{"issue":"31","key":"e_1_2_11_5_1","first-page":"980","article-title":"CDC Grand Rounds: Additional Opportunities to Prevent Neural Tube Defects With Folic Acid Fortification","volume":"59","author":"Cordero A. M.","year":"2010","journal-title":"MMWR. Morbidity and Mortality Weekly Report"},{"issue":"4","key":"e_1_2_11_6_1","first-page":"1","article-title":"Surveillance for Anencephaly and Spina Bifida and the Impact of Prenatal Diagnosis\u2014United States, 1985\u20131994","volume":"44","author":"Cragan J. D.","year":"1995","journal-title":"MMWR. CDC Surveillance Summaries"},{"issue":"2","key":"e_1_2_11_7_1","first-page":"57","article-title":"Neural Tube Defects: A Study in Puerto Rico","volume":"82","author":"Fern\u00e1ndez R.","year":"1990","journal-title":"Bolet\u00edn de la Asociaci\u00f3n M\u00e9dica de Puerto Rico"},{"key":"e_1_2_11_8_1","doi-asserted-by":"publisher","DOI":"10.2105\/AJPH.2011.300135"},{"key":"e_1_2_11_9_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.285.23.2981"},{"key":"e_1_2_11_10_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00381\u2010023\u201005945\u2010w"},{"key":"e_1_2_11_11_1","doi-asserted-by":"publisher","DOI":"10.1016\/0140\u20106736(91)90133\u2010A"},{"key":"e_1_2_11_12_1","unstructured":"Puerto Rico Department of Health.2024.\u201cOffice of Planning and Development Division of Statistics. 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