Issues‎ > ‎Vol6n1‎ > ‎



Adiba Ismail Ali*

* Department of Pediartrics, School of Medicine, Faculty of Medical Sciences, University of Sulaimani.

Submitted: 11/6/2015; Accepted: 23/4/2016Published: 1/6/2016



Awareness among women about folic acid supplementation during pregnancy showed an increment. Therefore, a difference in the prevalence of Neural Tube Defects happened.


The aim of this study was to identify the prevalence of NTDs in Sulaimani governorate and to make a comparison between the 2 periods before and after folic acid fortification of wheat in Iraq and with improved awareness of mothers.


This observational study was conducted in Sulaimani Maternity Teaching Hospital in two different periods. The first period extending from 1/7/2005 to 31/12/2006, out of 19831 live births, records of neonates with anencephaly, meningocele, meningomyelocele and encephalocele were reviewed. The second period extending from 1/7/2012 to 31/12/2013, out of 26841 live births, a combined record revision and direct interview of mothers who had delivered a newborn with Neural Tube Defects was followed.


Results showed that during the first period of study, out of 19831 Live Births, 52 cases of Neural Tube Defects were encountered making a prevalence rate of 2.6/1000 Live Births. The total number of deliveries during the second period was 26841 Live Births and the number of newborns having Neural Tube Defects was 31, making
a prevalence rate of 1.16/1000 Live Births.


It was found that Neural Tube Defects are common in our area and that fortification of wheat flour with folic acid together with providing folic acid to pregnant mothers at the antenatal clinics had an overall effect in decreasing the prevalence of this defect.


NTD=neural tube defect.


1. Jallo G I. Neural Tube Defects. Emedicine Last updated: Sep 06,2011. Accessed Jan 10 2012

2. Salih M A, Murshid W R, Seidahmed M Z . Epidemiology, prenatal management, and prevention of neural tube defects. Saudi Med J. 2014; 35 (Suppl 1): S15–S28. US National Library of Medicine National Institutes of Health

3. Hamamy H. Epidemiological profile of neural tube defects in Arab countries. Middle East Journal of Medical Genetics. Jan 2014;3(1):1-10.

4. Crider K S, Bailey L B, Berry R J. Folic acid fortification-its history, effect, concerns and future directions. Nutrients. 2011;3(3) 370-384.

5. J Williams J, Mai C T, Mulinare J, Isenburg J, Flood T J, Ethen M, et al. Updated Estimates of Neural Tube Defects Prevented by Mandatory Folic Acid Fortification — United States, 1995–2011.Centers for disease control and prevention. Morbidity and Mortality Weekly Report (MMWR). Weekly, January 16, 2015 / 64(01);15. Accessed on April 12,2013.

6. Morris JK, Wald NJ. Prevalence of neural tube defect pregnancies in England and Wales from 1964 to 2004. J Med Screen. 2007;14(2):55-9. PUBMED US National Library of MedicineNational Institutes of Health

7. Williams LJ, Mai CT, Edmonds LD, Shaw GM, Kirby RS, Hobbs CA, et al. Prevalence of spina bifida and anencephaly during the transition to mandatory folic acid fortification in the United States. Teratology. 2002 Jul;66(1):33-9.

8. Howard Hartman. Centers for Disease Control and Prevention CDC. IMMPACT-International Micronutient Malnutrition Prevention and Control Program. Celebrating 15 years of Healthier Children due to Fortified Flour. last viewed: Nov. 3, 2013. Page last update: Nov. 2011.

9. WHO publications. Recommendations on Wheat and Maize Flour Fortification. Meeting Report: Interim Consensus Statement. WHO/NMH/NHD/MNM/09.1. . Last accessed 0n Jan 10 2013

10. WHO-EM/NUT/259/E. Report on the Joint WHO/Flour Fortification Initiative harmonization workshop for wheat and maize flour fortification, Amman, Jordan 20–22 February,2012. last viewed on Aug 02 2013 

11. UNICEF Press center. Wheat Flour Fortification - a strong step forward in Iraq.  updated:23 Aug. 2006. Last viewed on Jul 05/ 2013

12. Kliegman R M, Stanton B F, St Geme J W, Schor N F. Dysmorphology. In: Richard E. Behrman, Editor. Nelson Textbook of Pediatrics. Edition 20;Canada ELSEVIER 2015. P. 899-906.

13. Joó JG, Beke A, Papp C, Tóth-Pál E, Csaba A, Szigeti Z, et al. Neural tube defects in the sample of genetic counselling. Prenat Diagn. 2007 Oct;27(10):912-21.

14.Krista S. Crider, Lynn B. Bailey, Robert J. Berry. Folic Acid Food Fortification—Its History, Effect, Concerns, and Future Directions. Nutrients. 2011 Mar; 3(3): 370–384.Published online 2011 Mar doi: 10.3390/nu3030370

15. Hussain A R, Othman N N, Nabaz Mohammed Mustafa N M . Neural tube defects in Sulaimaniyah, Iraqi Kurdistan: a descriptive study of 50 cases . JSMC.2014; 4(2):105-113.

16. Rashid B R. Risk factors of neural tube defects in Sulaimania Governorate. A thesis Submitted to the scientific council of pediatrics in partial fulfillment for the degree of fellowship of the Iraqi Board for Medical specialization in pediatrics; 2008.

17. Alasfoor D,  Elsayed M K , Mohammed A J. Spina Bifida and Birth Outcome before and after fortification of white flour with iron and folic acid in Oman. East Mediterr Health J. 2010 May;16(5):533-8. PubMed.

18. Choi JH , Yates Z , Veysey M , Heo YR,  Lucock M. Contemporary Issues Surrounding Folic Acid Fortification Initiatives. Prev Nutr Food Sci. 2014 Dec; 19(4): 247–260.Published online 2014 Dec 31. doi:  10.3746/pnf.2014.19.4.247 US National Library of Medicine National Institutes of Health

19. Amarin ZO, Obeidat AZ. Effect of folic acid fortification on the incidence of neural tube defects. Paediatr Perinat Epidemiol. 2010 Jul 1;24(4):349-51. doi: 10.1111/j.1365-3016.2010.01123.x. PubMed

20. Abdurrahman K N.The prevalence of neural tube defects among newborns delivered in Azadi Hospital in Dohuk City, Kurdistan Region, Iraq. DMJ 2007;1(1):42-8.


22. Al-Rabbaty A. Birth defects among neonates admitted to neonatal intensive care unit-Erbil Children and Maternity Hospital. Zanko Med J. 2001;5(Special issue):66–78.

23. Al-Hadithi T S , Al-Diwan J K, Saleh A M,  Shabila N P. Birth defects in Iraq and the plausibility of environmental exposure: A review. Confl Health. 2012;6:3.Published online 2012 Jul 28. doi: 10.1186/1752-1505-6-3

24.Al-Ani ZR, Al-Hiali SJ, Al-Mehimdi SM. Neural tube defects among neonates delivered in Al-Ramadi Maternity and Children’s Hospital, western Iraq. Saudi Med J. 2010 Feb;31(2):163-9.

25. Williams L J, Rasmussen S A, Flores A, Kirby R S, Edmonds LD. Decline in the Prevalence of Spina Bifida and Anencephaly by Race/Ethnicity: 1995–2002. Pediatrics.2005; 116(3): 580 -586 

26. Tootoonchi P. Easily identifiable congenital anomalies:prevalence and risk factors. Acta Medica Iranica 2003;41(1):15-19.

27. Mandýracýoðlu A ,  Ulman Ý ,  Lüleci E,  Ulman C. The incidence and risk factors of neural tube defects in Izmir, Turkey: a nested case-control study. The Turkish Journal of Pediatrics(Turk J Pediatr) 2004; 46: 214-220

28. Tadmouri G O,  Al-Haj Ali S. Anencephaly. Centre for Arab Genomic Studies A Division of Sheikh Hamdan Award for Medical Sciences The Catalogue for Transmission Genetics in Arabs CTGA Database. Genetic Disorders in the Arab World: United Arab Emirates Accessed Mar 2nd 2013.

29. Aqrabawi H E. Incidence of neural tube defects among neonates at King Hussein Medical Centre, Jordan. EMHJ Eastern Mediterranean Health Journal;2005; 11( 4):819-823.

30. Al-Mendalawi M D,  Mahmoud I J , Obed A AR, Al-Ameri L T . Neural Tube Defects in Iraq. KCMJ CME ARTICLES 2013; 9(2): 3-5.