Neural tube defects, maternal cohorts, and age: a pointer to aetiology

The effects of maternal year of birth and age on the declining prevalence of neural tube defects after 1972-3 were examined using 403 cases ascertained in a prospective study in the Fylde of Lancashire during 1957-89. Matched case-control data were analysed using conditional logistic regression analysis. The risk of an anencephalic baby was significantly greater for older mothers, but changes in the maternal age distribution in the population did not appear to be relevant to the recent decline in prevalence. Antenatal diagnosis and termination of pregnancy was the major cause. Mothers born before 1950 were at significantly greater risk of producing a baby with spina bifida or cranium bifidum. We suggest that abandonment of mercury as a therapeutic agent for infants in the early 1950s is a possible factor in the current decline of these malformations.