Abstract Book - 26th ESPU Congress, Joint Meeting with ICCS + SPU + AAP/SOU + AAPU + SFU

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S22-13 (P)
PREVALENCE OF NEURAL TUBE DEFECTS CORRELATES WITH ENVIRONMENTAL
EXPOSURE TO AGRICULTURAL HERBICIDES AND PESTICIDES
Martin KAEFER 1, Catherine PROCTOR2, Rosalia MISSERI3, Catherine HUBERT3, Benjamin WHITTAM3, Konrad
SZYMANSKI 3, Richard RINK3, Mark CAIN 3 and Paul WINCHESTER2
1) Riley Hospital for Children, Pediatric Urology, Indianapolis, USA - 2) Indiana University Medical School, Neonatology,
Indianapolis, USA - 3) Indiana University Medical School, Pediatric Urology, Indianapolis, USA
PURPOSE
Despite a reduction in neural tube defects after folic acid supplementation, the number of new cases remains at 69% of
the pre-folic acid supplementation era. This has prompted us to hypothesize that agricultural pesticide and herbicide
exposure may play a role in the pathogenesis of this disorder.
MATERIAL AND METHODS
After obtaining internal review board approval we retrospectively collected data on all patients from 2000-2013 who
presented with a diagnosis of spina bifida. Charts were reviewed for the variables of patient date of birth, gender, race
and geographic region of birth. To determine prevalence in each region we utilized published statistics of live births for
the same fourteen-year period. Mean kg of agricultural pesticides applied per region were divided in to low, medium and
high terciles. Spina bifida rates/region were calculated by dividing cases by live births for the study period. Spina bifida
rates were analyzed by year, by region and by pesticide use tercile.
RESULTS
A total of 298 patients with neural tube defects were identified in the study period. An overall prevalence of 3 per
10,000 live births was noted. Overall prevalence of neural tube defects correlated directly with the levels of exposure to
herbicides and pesticides. The prevalence for low, moderate and high exposure regions was 2.4, 3.25 and 3.2 (per
10,000 births) respectively. In contrast, fungicide application did not appear to correlate with spina bifida prevalence.
Due to small case numbers (less than 30/year) our study fell just short of reaching statistical significance.
CONCLUSIONS
The prevalence of spina bifida in the post folic acid supplementation era may correlate with the degree of exposure to
agricultural herbicides and pesticides. In contrast, this correlation was not seen with fungicide application. The
relationship between pesticide/herbicide exposure and spina bifida risk must now be verified using larger data sets
which is now being planned.