Key Findings: Investigation of a Cluster of Neural Tube Defects — Central Washington, 2010–2013
Morbidity and Mortality Weekly Report
In a brief article published in this week’s Morbidity and Mortality Weekly Report, researchers from CDC assisted the Washington State Department of Health to investigate pregnancies affected by major birth defects of the brain and spine called neural tube defects (NTDs) in a three-county area of central Washington. From January 2010 to January 2013, this area of Washington had four times as many pregnancies affected by anencephaly, an NTD, than were expected based on the most recent U.S. estimates. To look for potential causes, researchers compared women who had a pregnancy affected by an NTD and those who did not have a pregnancy affected by a birth defect. Researchers did not find differences between the groups. You can read the article here.
Main Findings from this Study
- Researchers identified 27 pregnancies affected by a neural tube defect (NTD) from January 2010 through January 2013 in a three-county area of central Washington.
- The birth prevalence in the area was higher than national estimates1 for anencephaly but lower for spina bifida (see figure to right).
- Researchers compared factors such as age, race/ethnicity, height and weight, job, smoking, underlying health problems, prenatal vitamin and folic acid use, and private well water use, between women who had a pregnancy affected by an NTD and those who did not have a pregnancy affected by a birth defect, but lived in the same three counties and attended the same prenatal clinics. Researchers found no differences in these factors between the groups.
- The Washington State Department of Health plans to continue monitoring the occurrence of neural tube defects in this region.
About this Study
- CDC assisted researchers from the Washington State Department of Health on a study of pregnancies affected by NTDs.
- Researchers looked at records of pregnancies in three counties in central Washington from January 2010 to January 2013.
- Researchers reviewed area hospital records, vital statistics reports, and medical office records to identify women with pregnancies affected by an NTD. Researchers also reviewed information from a comparison group of women attending the same health clinics with pregnancies not affected by a birth defect.
Getting the recommended amount of folic acid (a particular vitamin) each day decreases the risk of having a baby with a neural tube defect. CDC urges all women who are capable of getting pregnant to get at least 400 mcg of folic acid every day. It is especially important that women are getting this amount of folic acid one month before becoming pregnant to help prevent neural tube defects. Women can get folic acid in these easy ways:
- Take a vitamin containing folic acid every day.
- Eat a bowl of breakfast cereal every day that has 100% of the daily value of folic acid.
CDC activities: Neural Tube Defects
CDC is working to address neural tube defects with the following activities:
- Tracking: CDC funds and coordinates the Metropolitan Atlanta Congenital Defects Program (MACDP). CDC also funds 14 population-based state tracking programs. Birth defects tracking systems are vital to help us find out where and when birth defects, like anencephaly and spina bifida, occur and whom they affect.
- Research: CDC funds a large study of birth defects called the National Birth Defects Prevention Study. This study is working to identify risks for birth defects, including neural tube defects.
- Prevention efforts: Compared to non-Hispanic white and black women, Hispanic, or Latina, women have the highest rate of having a child affected by neural tube defects.2 This could be because they have lower blood folate levels and are less likely to take vitamins containing folic acid.3-7 CDC recently released a report that showed that fortifying corn masa flour with folic acid could increase the intake of folic acid among some groups of Hispanic women in the United States, specifically Mexican American women and those with less acculturation.8
For more information about this study, please visit:
For more information about speaking with a genetics professional in Washington State, please visit:
Washington State Department of Health recommends nitrate testing annually if you have a private well on your property. For more information, please visit:
For more information about having a healthy pregnancy, please visit:
For more information about birth defects, please visit http://www.cdc.gov/birthdefects.
For more information about anencephaly, please visit http://www.cdc.gov/ncbddd/birthdefects/anencephaly.html
For more information about folic acid, please visit http://www.cdc.gov/folicacid.
Key Findings Reference
CDC. Investigation of a Cluster of Neural Tube Defects — Central Washington, 2010–2013. MMWR Morb Mort Wkly Rep. 2013 Sept 5;62(35):728.
- Parker SE, Mai CT, Canfield MA, et al. Updated national birth prevalence estimates for selected birth defects in the United States, 2004–2006. Birth Defects Res A Clin Mol Teratol. 2010;88:1008–16.
- Boulet SL, Yang Q, Mai C, et al. Trends in the postfortification prevalence of spina bifida and anencephaly in the United States. Birth Defects Res A Clin Mol Teratol. 2008;82(7):527-32.
- CDC. Racial/ethnic differences in the birth prevalence of spina bifida – United States, 1995-2005. MMWR Morb Mortal Wkly Rep. 2009;57(53):1409-13.
- CDC. Folate status in women of childbearing age, by race/ethnicity – United States, 1999-2000. MMWR Morb Mortal Wkly Rep. 2002;51(36):808-10.
- CDC. Are women with recent live births aware of the benefits of folic acid? MMWR Morb Mortal Wkly Rep. 2001;50(RR06):3-14.
- Pfeiffer CM, Hughes JP, Lacher DA, et al. Estimation of trends in serum and RBC folate in the U.S. population from pre- to postfortification using assay-adjusted data from the NHANES 1988-2010. J Nutr. 2012;142(5):886-93.
- Hamner HC, Mulinare J, Cogswell ME, et al. Predicted contribution of folic acid fortification of corn masa flour to the usual folic acid intake for the US population: National Health and Nutrition Examination Survey 2001-2004. Am J Clin Nutr. 2009;89(1):305-15.
- Hamner HC, Tinker SC, Flores AL, Mulinare J, Weakland AP, and Dowling NF. Modelling fortification of corn masa flour with folic acid and the potential impact on Mexican-American women with lower acculturation. Public Health Nutr. 2013;16(5):912-21.