Publication:


abstract

BACKGROUND:

Several risk factors have been consistently associated with neural tube defects (NTDs). However, the predictive ability of these risk factors in combination has not been evaluated.

METHODS:

To assess the predictive ability of established risk factors for NTDs, we built predictive models using data from the National Birth Defects Prevention Study, which is a large, population-based study of nonsyndromic birth defects. Cases with spina bifida or anencephaly, or both (n = 1239), and controls (n = 8494) were randomly divided into separate training (75% of cases and controls) and validation (remaining 25%) samples. Multivariable logistic regression models were constructed with the training samples. The predictive ability of these models was evaluated in the validation samples by assessing the area under the receiver operator characteristic curves. An ordinal predictive risk index was also constructed and evaluated. In addition, the ability of classification and regression tree (CART) analysis to identify subgroups of women at increased risk for NTDs in offspring was evaluated.

RESULTS:

The predictive ability of the multivariable models was poor (area under the receiver operating curve: 0.55 for spina bifida only, 0.59 for anencephaly only, and 0.56 for anencephaly and spina bifida combined). The predictive abilities of the ordinal risk indexes and CART models were also low.

CONCLUSION:

Current established risk factors for NTDs are insufficient for population-level prediction of a women's risk for having affected offspring. Identification of genetic risk factors and novel nongenetic risk factors will be critical to establishing models, with good predictive ability, for NTDs.

Copyright © 2012 Wiley Periodicals, Inc.

Related Articles
Anencephaly and spina bifida among Hispanics: maternal, sociodemographic, and acculturation factors in the National Birth Defects Prevention Study.
Birth Defects Res A Clin Mol T...
Anencephaly and spina bifida among Hispanics: maternal, sociodemographic, and acculturation factors in the National Birth Defects Prevention Study.
Canfield MA, Ramadhani TA, Shaw GM, Carmichael SL, Waller DK, Mosley BS, Royle MH, Olney RS, National Birth Defects Prevention Study. Birth Defects Res A Clin Mol Teratol. 2009 Jul; 85(7):637-46.
Review [Maternal age and neural tube defects: evidence for a greater effect in spina bifida than in anencephaly].
Rev Med Chil. 2005
Review [Maternal age and neural tube defects: evidence for a greater effect in spina bifida than in anencephaly].
Vieira AR, Castillo Taucher S. Rev Med Chil. 2005 Jan; 133(1):62-70. Epub 2005 Mar 10.
Prevalence of spina bifida at birth--United States, 1983-1990: a comparison of two surveillance systems.
MMWR CDC Surveill Summ. 1996
Prevalence of spina bifida at birth--United States, 1983-1990: a comparison of two surveillance systems.
Lary JM, Edmonds LD. MMWR CDC Surveill Summ. 1996 Apr 19; 45(2):15-26.
Hispanic origin and neural tube defects in Houston/Harris County, Texas. II. Risk factors.
Am J Epidemiol. 1996
Hispanic origin and neural tube defects in Houston/Harris County, Texas. II. Risk factors.
Canfield MA, Annegers JF, Brender JD, Cooper SP, Greenberg F. Am J Epidemiol. 1996 Jan 1; 143(1):12-24.
Review Mini-review: toward understanding mechanisms of genetic neural tube defects in mice.
Teratology. 1999
Review Mini-review: toward understanding mechanisms of genetic neural tube defects in mice.
Harris MJ, Juriloff DM. Teratology. 1999 Nov; 60(5):292-305.