Neural tube defects occur in about 8.8 out of every 10,000 babies born in Puerto Rico, according to a 2026 cross-sectional study of 220,138 births from 2015 to 2024. While folic acid fortification has reduced the number of babies born with these serious brain and spine defects, the overall rate hasn’t improved significantly in recent years, suggesting that stronger prevention strategies and better prenatal care access are needed.
Researchers studied neural tube defects (serious birth defects affecting the brain and spine) in Puerto Rico from 2015 to 2024 to see how common they are today. They found that about 8.8 out of every 10,000 babies born had these defects, which is lower than before folic acid was added to food. The study shows that while folic acid fortification has helped reduce babies born with these conditions, the overall rate hasn’t improved much in recent years. According to Gram Research analysis, Puerto Rico needs stronger prevention strategies and better monitoring to continue reducing these preventable birth defects.
Key Statistics
A 2026 cross-sectional study of 220,138 births in Puerto Rico found that neural tube defects occurred in 8.8 per 10,000 live births from 2015 to 2024, with spina bifida and anencephaly accounting for 45.4% and 40.7% of cases respectively.
Among 79 pregnancies with anencephaly diagnosed prenatally in Puerto Rico (2015-2024), 68.4% resulted in pregnancy termination, compared to only 26.1% of 88 spina bifida pregnancies, showing major differences in outcomes based on defect type.
The live-born rate of neural tube defects in Puerto Rico was 3.7 per 10,000 births from 2015 to 2024, significantly lower than the overall surveillance rate of 8.8 per 10,000, reflecting the impact of prenatal diagnosis and pregnancy termination.
A 10-year surveillance study in Puerto Rico found no significant temporal trend in neural tube defect rates from 2015 to 2024, with a rate ratio of 1.01, indicating that rates have remained stable despite folic acid fortification efforts.
The Quick Take
- What they studied: How often neural tube defects (birth defects of the brain and spine) happen in Puerto Rico and whether the rates have changed over the past 10 years
- Who participated: All 220,138 babies born in Puerto Rico from 2015 to 2024, with 194 cases of neural tube defects identified through health surveillance records
- Key finding: About 8.8 out of every 10,000 babies born in Puerto Rico had neural tube defects. The rate hasn’t changed much in recent years, even though folic acid is added to food. However, fewer babies are born with these defects because more pregnancies are being terminated after diagnosis.
- What it means for you: If you’re planning to have a baby in Puerto Rico, taking folic acid supplements before and during pregnancy is still important. The rates suggest that current prevention efforts are working somewhat, but there’s room for improvement through better education and earlier prenatal care.
The Research Details
This was a population-based surveillance study, meaning researchers looked at health records for all babies born in Puerto Rico over a 10-year period (2015 to 2024). They identified every case of neural tube defects, which are serious birth defects that develop early in pregnancy when the brain and spinal cord are forming. The researchers calculated how many babies per 10,000 live births had these defects and looked for patterns over time.
The study used data from Puerto Rico’s official neural tube defect surveillance system and birth records from the Puerto Rico Department of Health. This approach is like taking a complete census of a health problem rather than studying just a sample, which makes the findings very reliable for understanding what’s happening in Puerto Rico specifically.
Researchers also looked at what happened to pregnancies where neural tube defects were detected. They tracked whether babies were born alive or if pregnancies were terminated after diagnosis, and they noted where on the spine the defects occurred when spina bifida was present.
This type of study is important because it gives Puerto Rico specific information about a serious health problem. Neural tube defects are preventable with proper folic acid intake, so understanding current rates helps public health officials decide where to focus prevention efforts. By looking at 10 years of data, researchers can see if things are getting better or worse, which guides future health strategies.
This study is reliable because it tracked all cases in Puerto Rico rather than just a sample, used official government health records, and covered a full 10-year period. The researchers used proper statistical methods to calculate rates and confidence intervals. However, the study depends on accurate reporting to the surveillance system, so some cases might be missed if they weren’t properly documented or reported to health authorities.
What the Results Show
Among all 220,138 babies born in Puerto Rico from 2015 to 2024, researchers found 194 pregnancies affected by neural tube defects. This equals a rate of 8.8 cases per 10,000 live births. The two most common types were spina bifida (a defect where the spine doesn’t close completely), which accounted for 45.4% of cases, and anencephaly (a severe defect where much of the brain and skull doesn’t develop), which accounted for 40.7% of cases.
When researchers looked at whether the rate changed over the 10-year period, they found no significant trend. The rate stayed relatively stable, neither improving nor worsening. This is important because it suggests that recent efforts to prevent these defects haven’t led to additional improvements beyond what folic acid fortification already achieved.
The study revealed an important difference in pregnancy outcomes between the two main types of defects. When anencephaly was diagnosed prenatally (before birth), 68.4% of pregnancies were terminated. In contrast, when spina bifida was diagnosed, only 26.1% of pregnancies were terminated. This means more babies with spina bifida are born alive, while fewer babies with anencephaly are born alive.
Among babies born with spina bifida, the most common location was the lumbosacral region (lower back), occurring in 44.3% of cases. This location typically results in less severe disability than defects higher up the spine.
The live-born rate (babies actually born with these defects) was 3.7 per 10,000 live births, which is notably lower than the overall surveillance rate of 8.8 per 10,000. This difference exists because many pregnancies with detected neural tube defects are terminated before birth. The data shows that prenatal diagnosis and the option to terminate pregnancies are significantly reducing the number of babies born with these conditions. Other findings included the specific patterns of where spina bifida occurs on the spine, with lumbosacral lesions being most common, followed by thoracic (mid-back) and cervical (neck) locations.
The current live-born rate of 3.7 per 10,000 is lower than estimates from before folic acid fortification was implemented, showing that this public health intervention has been effective. The overall surveillance-based rate of 8.8 per 10,000 is similar to rates reported in earlier studies after fortification began, suggesting that the benefit of folic acid fortification has plateaued. The lack of recent decline indicates that Puerto Rico hasn’t made additional progress beyond the initial benefits of adding folic acid to the food supply.
This study relies on data reported to the surveillance system, so some cases might be missed if they weren’t properly documented or reported. The study doesn’t include information about individual folic acid intake or other risk factors that might affect whether someone has a baby with a neural tube defect. Additionally, the study can’t determine why rates haven’t improved recently, only that they haven’t. The research is specific to Puerto Rico, so findings may not apply to other populations with different genetics, nutrition, or healthcare systems.
The Bottom Line
Women of childbearing age in Puerto Rico should take folic acid supplements (400 micrograms daily) before trying to become pregnant and continue through the first trimester. This recommendation has strong evidence support. Healthcare providers should ensure that prenatal care includes early ultrasound screening to detect neural tube defects. Public health efforts should focus on improving awareness of folic acid’s importance and ensuring access to prenatal care, particularly in underserved communities.
Women planning to become pregnant or who could become pregnant should care about this research. Healthcare providers in Puerto Rico should use this data to guide prevention counseling. Public health officials should consider these findings when planning territory-specific prevention programs. Families with a history of neural tube defects should pay special attention, as they have higher risk.
Folic acid works best when taken before pregnancy and during the early weeks of pregnancy when the neural tube is forming (the first 28 days). You should start taking folic acid supplements at least one month before trying to become pregnant. The benefits of folic acid fortification in reducing neural tube defects have been observed over years and decades, not weeks or months.
Frequently Asked Questions
How common are neural tube defects in Puerto Rico today?
Neural tube defects occur in approximately 8.8 out of every 10,000 babies born in Puerto Rico. The live-born rate is lower at 3.7 per 10,000 because many pregnancies with detected defects are terminated before birth.
Has folic acid fortification reduced neural tube defects in Puerto Rico?
Yes, folic acid fortification has reduced the number of babies born with neural tube defects compared to before fortification began. However, the overall rate hasn’t improved significantly in the past 10 years, suggesting additional prevention strategies are needed.
What should women do to prevent neural tube defects?
Women planning pregnancy should take 400 micrograms of folic acid daily starting at least one month before trying to conceive and continue through the first trimester. Eating fortified cereals, bread, and grains also helps ensure adequate folic acid intake.
What are the most common types of neural tube defects?
Spina bifida (incomplete closure of the spine) and anencephaly (underdeveloped brain and skull) are the most common, accounting for 45.4% and 40.7% of cases respectively in Puerto Rico.
Why do some pregnancies with neural tube defects result in termination?
Prenatal ultrasound screening can detect neural tube defects early in pregnancy. When detected, some families choose to terminate the pregnancy, particularly for anencephaly, which is incompatible with life. This choice is available to families in Puerto Rico.
Want to Apply This Research?
- Track daily folic acid supplement intake (400 micrograms) for women of childbearing age, with a goal of 100% compliance. Log each dose taken and set reminders for consistent daily intake.
- Set a daily alarm to take a folic acid supplement at the same time each day. Add folic acid-fortified foods to your diet (fortified cereals, bread, and grains) and log these in your nutrition tracker to ensure adequate intake from multiple sources.
- Monitor folic acid intake consistency over months and years, not days. Track prenatal care appointments and ultrasound screening dates. For women with a family history of neural tube defects, maintain ongoing communication with healthcare providers about individual risk factors and prevention strategies.
This research describes the epidemiology of neural tube defects in Puerto Rico and should not be used for individual medical diagnosis or treatment decisions. Women planning pregnancy should consult with their healthcare provider about appropriate folic acid supplementation and prenatal care. This study is observational and cannot prove causation. Individual risk factors, genetics, and medical history vary, so personalized medical advice from a qualified healthcare professional is essential for pregnancy planning and prenatal care.
This research translation is published by Gram Research, the science division of Gram, an AI-powered nutrition tracking app.