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Q&A

Epidemiology

Poster Session 3

(755) Increased prevalence of neural tube defects in industrial area in Northwestern Netherlands in 2020-2021.

Wednesday, February 14, 2024
8:30 AM – 10:00 AM  
Location: Prince George's Exhibit Hall CDE, Lower Atrium Level
Objective:

In the first year of the COVID-19 pandemic, 2020, we perceived an unexpected increase of prenatal diagnosis of neural tube defects (NTDs) in the Northwest region of the Netherlands.

Environmental pollutants and exposure to heavy metals are associated with NTDs. The aim of this study is to evaluate the association of possible risk factors to the unexpected increase of prenatal diagnosis of NTDs in our region.

Study Design:

We performed a retrospective cohort study to examine the prevalence of isolated NTDs in the Northwest region of the Netherlands from 2010-2022. We looked into all possible risk factors for NTDs, including COVID-19. Zipcodes were used to examine exposure to pollution on municipal level. The region was separated into three areas according to levels of pollution: IJmond area (industrial area), Amsterdam (urban area), and all other municipalities. Poisson regression was employed to calculate crude prevalence ratios (PR) and 95% confidence intervals [CI]. PR were described per 10,000 births.

Results:

We diagnosed 203 isolated NTDs between 2010 and 2022 of which 41 cases (20%) were in 2020 and 2021. The PR of NTDs between 2010-2022 was 4.4 (95% CI 3.8, 5.1) per 10,000 births on average. In 2020 and 2021 the PR significantly increased to 5.4 (95%-CI 3.2, 8.5) and 7.5 (95%-CI 4.9-11.0) per 10,000 births, respectively (p=0.005). There was no change in lifestyle, obstetric or social-demographic risk factors such as use of folic-acid supplements, medication e.g.. Areal differences were evident only in 2020-2021 (p=0.001).The PR of NTDs in 2020 and 2021 was the highest in IJmond area with 21.0 (95%-CI 7.6, 45.8) NTDs per 10,000 births. Amsterdam and other municipalities of Northwest Netherlands had lower PRs of 7.3 (95%-CI 4.1, 12.1) and 4.5 (95%-CI 2.7, 6.9) per 10,000 births, respectively.

Conclusion:

There was an increase of NTD prevalence in 2020 and 2021 in the Northwest region of the Netherlands. NTDs were most prevalent in the industrial area (IJmond area), and also increased in the very urban city of Amsterdam. We hypothesize that COVID-19 lockdown measures increased individual exposure of pregnant women to industrial pollution.