Proportion of neural tube defects attributable to known risk factors^†

A. J. Agopian¹,
Sarah C. Tinker²,
Philip J. Lupo¹,
Mark A. Canfield³,
Laura E. Mitchell,^1,*,
and the National Birth Defects Prevention Study

Article first published online: 27 NOV 2012

DOI: 10.1002/bdra.23100

Issue

Birth Defects Research Part A: Clinical and Molecular Teratology

Volume 97, Issue 1, pages 42–46, January 2013

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How to Cite Author Information Publication History Funding Information

How to Cite

Agopian, A. J., Tinker, S. C., Lupo, P. J., Canfield, M. A., Mitchell,, L. E. and and the National Birth Defects Prevention Study (2013), Proportion of neural tube defects attributable to known risk factors. Birth Defects Research Part A: Clinical and Molecular Teratology, 97: 42–46. doi: 10.1002/bdra.23100

Author Information

¹Human Genetics Center, Division of Epidemiology, Human Genetics and Environmental Sciences, University of Texas School of Public Health, Houston, Texas
²National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia
³Birth Defects Epidemiology and Surveillance Branch, Texas Department of State Health Services, Austin, Texas

Email: Laura E. Mitchell, (laura.e.mitchell@uth.tmc.edu)

^*University of Texas School of Public Health 1200 Herman Pressler Dr., Houston, TX 77030

^†
The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention.

Publication History

Issue published online: 10 JAN 2013
Article first published online: 27 NOV 2012
Manuscript Accepted: 16 OCT 2012
Manuscript Revised: 15 OCT 2012
Manuscript Received: 31 AUG 2012

Funded by

Texas Center for Birth Defects Research and Prevention, under a cooperative agreement (#5U01DD000494-03) from the Centers for Disease Control and Prevention with the Texas Department of State Health Services

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Keywords:

spina bifida;
neural tube;
anencephaly;
congenital abnormalities;
attributable fraction

Abstract

BACKGROUND

Recognized risk factors for neural tube defects (NTDs) poorly predict population-level NTD risk. However, the proportion of NTDs that can be attributed to these risk factors is uncertain.

METHODS

To determine the proportion of NTD cases that is attributable to known or suspected risk factors (i.e., female infant sex, family history of NTDs, and maternal Hispanic ethnicity, obesity, pregestational diabetes, gestational diabetes, low dietary folate intake, lack of folic acid supplementation, anticonvulsant use, and hot tub or sauna use), we estimated the adjusted population attributable fraction (aAF) for each factor, using the method of Eide and Geffler and data from the National Birth Defects Prevention Study.

RESULTS

Our analyses of these data indicate that the proportion of cases of spina bifida and anencephaly that can be attributed to known risk factors is 28% and 44%, respectively. For spina bifida, the factor with the greatest attributable fraction was maternal obesity (aAF, 10%), whereas for anencephaly it was Hispanic ethnicity (aAF, 15%).

CONCLUSION

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