{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,17]],"date-time":"2026-10-17T22:35:41Z","timestamp":1792276541301,"version":"4.4.0"},"reference-count":51,"publisher":"Wiley","issue":"9","license":[{"start":{"date-parts":[[2015,7,14]],"date-time":"2015-07-14T00:00:00Z","timestamp":1436832000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Birth Defects Research"],"published-print":{"date-parts":[[2015,9]]},"abstract":"<jats:sec><jats:title>BACKGROUND<\/jats:title><jats:p>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.<\/jats:p><\/jats:sec><jats:sec><jats:title>METHODS<\/jats:title><jats:p>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.<\/jats:p><\/jats:sec><jats:sec><jats:title>RESULTS<\/jats:title><jats:p>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 \u2013 8.35). For the 241 spina bifida\u2010affected live births in 2009 in Germany, the estimated additional lifetime direct medical costs compared with non\u2010spina bifida affected births were \u20ac65.5 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 \u20ac32.9 million assuming a 50% reduction, or \u20ac26.1 million assuming a 40% risk reduction.<\/jats:p><\/jats:sec><jats:sec><jats:title>CONCLUSION<\/jats:title><jats:p>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. Birth Defects Research (Part A) 103:763\u2013771, 2015. \u00a9 2015 Wiley Periodicals, Inc.<\/jats:p><\/jats:sec>","DOI":"10.1002\/bdra.23400","type":"journal-article","created":{"date-parts":[[2015,7,14]],"date-time":"2015-07-14T20:47:19Z","timestamp":1436906839000},"page":"763-771","source":"Crossref","is-referenced-by-count":30,"title":["Preventable spina bifida and anencephaly in Europe"],"prefix":"10.1002","volume":"103","author":[{"given":"Rima","family":"Obeid","sequence":"first","affiliation":[{"name":"AIAS, Aarhus Institute for Advanced Studies, Aarhus University H\u00f8egh\u2010Guldbergs Gade 6B Aarhus C Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Klaus","family":"Pietrzik","sequence":"additional","affiliation":[{"name":"Department of Nutrition and Food Science Rheinische Friedrich\u2010Wilhelms University Bonn Bonn Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"suffix":"Jr.","given":"Godfrey P.","family":"Oakley","sequence":"additional","affiliation":[{"name":"Center for Spina Bifida Research Prevention and Policy Department of Epidemiology Emory University Rollins School of Public Health  Atlanta Georgia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vijaya","family":"Kancherla","sequence":"additional","affiliation":[{"name":"Center for Spina Bifida Research Prevention and Policy Department of Epidemiology Emory University Rollins School of Public Health  Atlanta Georgia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wolfgang","family":"Holzgreve","sequence":"additional","affiliation":[{"name":"Chair of the Board of Directors of the University Bonn Medical Center, University Hospital of Bonn Bonn Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Simon","family":"Wieser","sequence":"additional","affiliation":[{"name":"Winterthur Institute of Health Economics Zurich University of Applied Sciences Winterthur Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2015,7,14]]},"reference":[{"key":"e_1_2_6_2_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-277X.2011.01216.x"},{"key":"e_1_2_6_3_1","doi-asserted-by":"publisher","DOI":"10.1155\/2012\/470656"},{"key":"e_1_2_6_4_1","doi-asserted-by":"crossref","first-page":"S22","DOI":"10.1177\/15648265100311S103","article-title":"Fortification of flour with folic acid","volume":"31","author":"Berry RJ","year":"2010","journal-title":"Food Nutr Bull"},{"key":"e_1_2_6_5_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0089354"},{"key":"e_1_2_6_6_1","doi-asserted-by":"publisher","DOI":"10.2147\/IJWH.S40149"},{"key":"e_1_2_6_7_1","doi-asserted-by":"publisher","DOI":"10.1093\/ije\/dyq028"},{"key":"e_1_2_6_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.puhe.2013.12.001"},{"key":"e_1_2_6_9_1","doi-asserted-by":"publisher","DOI":"10.1024\/0300-9831.79.2.61"},{"key":"e_1_2_6_10_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.reprotox.2005.03.009"},{"key":"e_1_2_6_11_1","first-page":"980","article-title":"CDC Grand Rounds: additional opportunities to prevent neural tube defects with folic acid fortification","volume":"59","author":"CDC","year":"2010","journal-title":"MMWR Morb Mortal Wkly Rep"},{"key":"e_1_2_6_12_1","doi-asserted-by":"publisher","DOI":"10.1017\/S0007114514002906"},{"key":"e_1_2_6_13_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.g4554"},{"key":"e_1_2_6_14_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM199212243272602"},{"key":"e_1_2_6_15_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(97)07247-4"},{"issue":"10","key":"e_1_2_6_16_1","first-page":"CD007950","article-title":"Effects and safety of periconceptional folate supplementation for preventing birth defects","author":"De\u2010Regil LM","year":"2010","journal-title":"Cochrane Database Syst Rev"},{"key":"e_1_2_6_17_1","doi-asserted-by":"publisher","DOI":"10.1002\/bdra.20485"},{"key":"e_1_2_6_18_1","unstructured":"EUROCAT. 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