{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,12]],"date-time":"2026-09-12T06:16:09Z","timestamp":1789193769151,"version":"build-2803163510"},"reference-count":25,"publisher":"BMJ","issue":"1","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J Epidemiol Community Health"],"published-print":{"date-parts":[[1991,3]]},"abstract":"<jats:p>STUDY OBJECTIVE--The aims were (1) to determine whether in Europe, 1980-86, geographical differences in total prevalence of neural tube defects persist; (2) to examine the stability of total prevalence rates over time; (3) to evaluate the impact of prenatal diagnosis in terms of frequency and timing of termination of pregnancy. DESIGN--Prevalence rates of neural tube defects were determined from case registration data in 20 EUROCAT regional registers of congenital anomalies, 1980-86. The chi 2 test for homogeneity in proportions was used to test whether differences in total prevalence rates were significant between regions or over time. SETTING--Geographically defined populations were used in the Republic of Ireland, United Kingdom, Belgium, The Netherlands, Luxemburg, Denmark, France, Italy, Yugoslavia, and Malta. PATIENTS--The patients were 3113 cases of anencephaly, spina bifida, encephalocele, and iniencephaly. Total cases (livebirths, stillbirths and induced abortions following prenatal diagnosis) were registered in 14 regions. Induced abortions were excluded from registration in six regions. MEASUREMENTS AND MAIN RESULTS--Total prevalence rates (including livebirths, stillbirths and induced abortions) were 24 to 38 per 10,000 in six areas of Ireland and United Kingdom. Average total prevalence rate in eight continental European areas was 11.5 per 10,000. There was a secular decline in total prevalence in Dublin (Republic of Ireland) and Northern Ireland (United Kingdom) and a fluctuation in Glasgow, Liverpool, and South Glamorgan (United Kingdom). Total prevalence in continental Europe was stable over time. There was no significant geographical or secular variation in the spina bifida to anencephaly ratio (1.3). The ratio of encephalocele to other neural tube defects was lower in the British Isles (0.09) than in continental Europe (0.18). The impact of prenatal diagnosis and termination of pregnancy is increasing over time. Terminations were performed 1984-86 in at least 80% of total cases of anencephaly in 6\/11 centres registering induced abortions, and in at least 40% of total cases of spina bifida in four centres. Serum alpha fetoprotein screening in British centres was associated with earlier prenatal diagnosis of spina bifida than ultrasound screening in other centres. CONCLUSIONS--Geographical and secular variation in total prevalence of neural tube defects persists in Europe 1980-86, independent of the practice of prenatal diagnosis. There is considerable regional variation in the impact of prenatal diagnosis in terms of frequency and timing of diagnosis and pregnancy termination linked to different policies and practices of prenatal screening.<\/jats:p>","DOI":"10.1136\/jech.45.1.52","type":"journal-article","created":{"date-parts":[[2008,11,12]],"date-time":"2008-11-12T15:10:54Z","timestamp":1226502654000},"page":"52-58","source":"Crossref","is-referenced-by-count":113,"title":["Prevalence of neural tube defects in 20 regions of Europe and the impact of prenatal diagnosis, 1980-1986. EUROCAT Working Group."],"prefix":"10.1136","volume":"45","member":"239","published-online":{"date-parts":[[1991,3,1]]},"reference":[{"key":"ref_1","article-title":"Epidemiology of anencephalus and spina bifida","author":"Elwood, J.M.; Elwood, J.H.","year":"1980","unstructured":"Elwood JM, Elwood JH. Epidemiology of anencephalus and spina bifida. Oxford: Oxford University Press, 1980."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1290","DOI":"10.1016\/S0140-6736(81)91528-2","article-title":"Neural tube defects","volume":"i:","author":"Nevin, N.C.","year":"1981","unstructured":"Nevin NC. Neural tube defects. Lancet 1981; i: 1290-1.","journal-title":"Lancet"},{"key":"ref_3","first-page":"1032","article-title":"19-Year incidence of neural tube defects in area under constant surveillance","volume":"i:","author":"Owens, JR, McAllister; E, Harris; F, West; L.","year":"1981","unstructured":"Owens JR, McAllister E, Harris F, West L. 19-Year incidence of neural tube defects in area under constant surveillance. Lancet 1981; i: 1032-3.","journal-title":"Lancet"},{"issue":"1","key":"ref_4","first-page":"58","article-title":"The apparently declining prevalence of neural tube defect in two counties in South Wales over three decades illustrating the need for continuing action and vigilance","volume":"40","author":"Laurence, K.M.","year":"1985","unstructured":"Laurence KM. The apparently declining prevalence of neural tube defect in two counties in South Wales over three decades illustrating the need for continuing action and vigilance. Z Kinderchir 1985; 40 (suppl 1): 58-60.","journal-title":"Z Kinderchir"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"64","DOI":"10.1016\/S0140-6736(83)91592-1","article-title":"Anencephaly in the Netherlands: a remarkable decline","volume":"i:","author":"Romijn, J.A.; Treffers, P.E.","year":"1983","unstructured":"Romijn JA, Treffers PE. Anencephaly in the Netherlands: a remarkable decline. Lancet 1983; i: 64-5.","journal-title":"Lancet"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"103","DOI":"10.1136\/jech.38.2.103","article-title":"Time trends of spina bifida in Sweden 1947-81","volume":"38","author":"Kallen, B.; Lofkvist, E.","year":"1984","unstructured":"Kallen B, Lofkvist E. Time trends of spina bifida in Sweden 1947-81. J Epidemiol Community Health 1984; 38: 103-7.","journal-title":"J Epidemiol Community Health"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"97","DOI":"10.1007\/BF00279300","article-title":"Epidemiology ofneural tube defects in Germany","volume":"68","author":"Koch, M.; Fuhrmann, W.","year":"1984","unstructured":"Koch M, Fuhrmann W. Epidemiology ofneural tube defects in Germany. Hum Genet 1984; 68: 97-103.","journal-title":"Hum Genet"},{"key":"ref_8","first-page":"89","article-title":"Analysis of the changing birth prevalence ofneural tube defects in Hungary","volume":"33","author":"Czeizel, A.; Karig, G.","year":"1985","unstructured":"Czeizel A, Karig G. Analysis of the changing birth prevalence ofneural tube defects in Hungary. Acta Morphol Hung 1985; 33: 89-99.","journal-title":"Acta Morphol Hung"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"1086","DOI":"10.1136\/adc.60.11.1086","article-title":"Spina bifida-a vanishing nightmare?","volume":"60","author":"Lorber, J.; Ward, A.M.","year":"1985","unstructured":"Lorber J, Ward AM. Spina bifida-a vanishing nightmare? Arch Dis Child 1985; 60: 1086-91.","journal-title":"Arch Dis Child"},{"key":"ref_10","article-title":"Registration of congenital anomalies in EUROCA T centres 1979-1983","author":"Beckers, R.; Borlee-Grimee, I.; Ulrich, M.","year":"1985","unstructured":"Beckers R, Borlee-Grimee I, Ulrich M, et al. In: De Wals P, Weatherall JAC, Lechat MF, eds. Registration of congenital anomalies in EUROCA T centres 1979-1983. Cabay, 1985.","journal-title":"Cabay"},{"key":"ref_11","article-title":"Surveillance ofcongenital anomaliesyears 1980-84. (EUROCAT Report No 2.)","author":"Ayme, S.","year":"1987","unstructured":"Ayme S, Cuschieri A, Tenconi R. In: De Wals P, Lechat MF, eds. Surveillance ofcongenital anomaliesyears 1980-84. (EUROCAT Report No 2.) Brussels: Department of Epidemiology, UCL, 1987."},{"key":"ref_12","first-page":"220","article-title":"The British Paediatric Association. British Paediatric Association Classification of Diseases","year":"1979","unstructured":"The British Paediatric Association. British Paediatric Association Classification of Diseases. London: BPA, 1979: 220."},{"key":"ref_13","article-title":"Statistical methods in medical research","author":"Armitage, P.","year":"1971","unstructured":"Armitage P. Statistical methods in medical research. Oxford: Blackwell Scientific Publications, 1971."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"9","DOI":"10.1136\/jmg.13.1.9","article-title":"Congenital malformations ofthe central nervous system in spontaneous abortions","volume":"13","author":"Creasy, M.F.; Alberman, E.D.","year":"1976","unstructured":"Creasy MF, Alberman ED. Congenital malformations ofthe central nervous system in spontaneous abortions. Jf Med Genet 1976; 13: 9-16.","journal-title":"Jf Med Genet"},{"key":"ref_15","first-page":"343","article-title":"Spina bifida in Ireland","volume":"63","author":"Coffey, V.P.","year":"1970","unstructured":"Coffey VP. Spina bifida in Ireland. J Irish Med Assoc 1970; 63: 343-8.","journal-title":"J Irish Med Assoc"},{"key":"ref_16","first-page":"135","article-title":"Perinatal mortality survey for County Galway","volume":"57","author":"F, Cahalane S.; JD, Kennedy; B, McNicholl; E, O.'Dwyer","year":"1965","unstructured":"Cahalane S F, Kennedy JD, McNicholl B, O'Dwyer E. Perinatal mortality survey for County Galway. J Irish Med Assoc 1965; 57: 135-41.","journal-title":"J Irish Med Assoc"},{"key":"ref_17","first-page":"32","article-title":"Congenital malformations ofthe central nervous system among Glasgow births 1964-68","author":"Wilson, T.S.","year":"4):","unstructured":"Wilson TS. Congenital malformations ofthe central nervous system among Glasgow births 1964-68. Health Bull 28 (4): 32-8."},{"key":"ref_18","first-page":"177","article-title":"Changes in the incidence of anencephalus","volume":"21","author":"Leck, I.; Rogers, S.C.","year":"1967","unstructured":"Leck I, Rogers SC. Changes in the incidence of anencephalus. Br J Prev Soc Med 1967; 21: 177-80.","journal-title":"Br J Prev Soc Med"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"171","DOI":"10.1093\/ije\/2.2.171","article-title":"Epidemics of anencephalus and spina bifida in Ireland since 1900","volume":"2","author":"Elwood, J.H.","year":"1973","unstructured":"Elwood JH. Epidemics of anencephalus and spina bifida in Ireland since 1900. Int J Epidemiol 1973; 2: 171-5.","journal-title":"Int J Epidemiol"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"346","DOI":"10.1007\/BF02950032","article-title":"Secular trends in the incidence of major malformations of the central nervous system reported from three Dublin Maternity Hospitals 1900-1965","volume":"142","author":"Elwood, J.H.","year":"1973","unstructured":"Elwood JH. Secular trends in the incidence of major malformations of the central nervous system reported from three Dublin Maternity Hospitals 1900-1965. Irish J Med Sci 1973; 142: 346-57.","journal-title":"Irish J Med Sci"},{"key":"ref_21","first-page":"336","volume":"16","author":"Frezal, J.; Kelley, J.; Guillemot, M.L.; Lamy, M.","year":"1964","unstructured":"Frezal J, Kelley J, Guillemot ML, Lamy M. Anencephaly in France. Am J Hum Genet 1964; 16: 336-50.","journal-title":"Anencephaly in France. Am J Hum Genet"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"393","DOI":"10.1002\/pd.1970090604","article-title":"Prenatal screening and diagnosis of neural tube defects in England and Wales in 1985","volume":"9","author":"Cuckle, H.S.; Wald, W.J.; Cuckle, P.M.","year":"1989","unstructured":"Cuckle HS, Wald WJ, Cuckle PM. Prenatal screening and diagnosis of neural tube defects in England and Wales in 1985. Prenat Diagn 1989; 9: 393-400.","journal-title":"Prenat Diagn"},{"key":"ref_23","first-page":"328","article-title":"Prenatal diagnosis of anencephaly in Glasgow, 1974-1984 (abstract)","volume":"2","author":"Hamilton, F.M.W.; Richardson, P.; Sinclair, T.; Womersely, J.","year":"1986","unstructured":"Hamilton FMW, Richardson P, Sinclair T, Womersely J. Prenatal diagnosis of anencephaly in Glasgow, 1974-1984 (abstract). Eur Jf Epidemiol 1986; 2: 328.","journal-title":"Eur Jf Epidemiol"},{"key":"ref_24","first-page":"123","article-title":"Diagnostique antenatal des affectations du systeme nerveux central: resultats preliminaires d'une serie multicentrique Europeenne de 350 cas","volume":"2","author":"Evrard, P.; M-Cl, Belpaire; Boog, G.","year":"1984","unstructured":"Evrard P, Belpaire M-Cl, Boog G, et al. Diagnostique antenatal des affectations du systeme nerveux central: resultats preliminaires d'une serie multicentrique Europeenne de 350 cas. J Fr Echographie 1984; 2: 123-6.","journal-title":"J Fr Echographie"},{"key":"ref_25","first-page":"197","article-title":"Sensibilite de l'echographie obstetricale dans le diagnostic antenatal des anomalies foetales majeures","volume":"37","author":"Macquart-Moulin, G.; Julian, C.; Chapel, F.; Ayme, S.","year":"1989","unstructured":"Macquart-Moulin G, Julian C, Chapel F, Ayme S. 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