Neural tube defects in the Asir Region of Saudi Arabia

The aim of the study was to determine the incidence of neural tube defects (NTD) among admissions at a regional referral hospital in Saudi Arabia, compare trends over several years and note any influence of prenatal folic acid treatment.

For every NTD admission into the newborn unit of Asir Central Hospital, during the period January 1995 through December 1998, data were collected on the infant and mother and input into a programmed form.

During the period, 64 infants were admitted with NTDs, giving an incidence of 0.78/1000 births in the region. The yearly admission frequency (4.5%-8%) was closely the same (average 6.6%) over the 4-year period (P>0.05). The sex incidence was equal and the major lesions were myelomeningocele (70%) and encephalocele (23%). Thoracolumbar (44.4%) and lumbosacral (40%) regions were the most common sites of spina bifida; encephalocele were largely occipital (93%). A majority (87%) of infants with myelomeningocele were hydrocephalic at birth. Fifty percent of the infants were offspring of consanguineous marriage (first and second cousins). Eighty-three percent of the mothers attended antenatal care, but 70% of these reported late (from the 12th week of pregnancy). Only 25% of the 64 mothers were on folate supplementation during the affected pregnancy and no mother received preconceptional folic acid supplementation.

The incidence of NTD in the region appears to be non-declining over the years, a situation which is at variance with experience in Western countries. There is a need to consider an intensive approach to periconceptional folic acid supplementation for Saudi women. Genetic counseling may also be important.