A Cluster of Anencephaly Cases: The Potential Preventative Role of Folic Acid Fortification

Abstract

Introduction
There were four cases of severely abnormal fetal cranial views on ultrasound over a two-week period at a peripheral maternity unit. We describe three of these cases with consent.

Cases
All cases were confirmed anencephaly/acrania by fetal medicine at a tertiary referral centre between 12-16-weeks’ gestation. In two cases the parents opted for genetic testing. This condition is not compatible with life and this cluster highlights the difficult decisions individuals and couples are faced with.

Outcome
Two of the couples opted for termination under Section 11 of the Health Act 2018. One set of parents chose to continue the pregnancy and had an emergency caesarean section followed by a neonatal death within hours of delivery.

Discussion
Given how rare these conditions are, this cluster gives an opportunity to review an important and largely preventable anomaly. The introduction of folic acid food fortification could majorly contribute to prevention.