• Nadeem Shahzad Sialkot Medical College Sialkot.
  • Afshan Riaz
  • Uzma Ameer DHQ Sahiwal.
  • Daniyal Nadeem Aga Khan University Karachi.



Neural tube defects,, risk factors,, socio economic status,, previous history of NTDs.


Background: The most common congenital malformations are Neural tube
defects (NTDs) occurring in 0.6 per 1,000 live births in the United States, and almost 4000
pregnancies are recorded of babies with neural tube defects, among them anencephaly
and Spina bifida are the most common and their annual incidence is 2,500 to 3,000 births in
the United States. The etiology of NTDs is still an enigma, however, in the past few decades
valuable advances has been made in understanding the causation and measures to prevent
NTDs and many risk factors are indentified which are associated with it. Objectives: This study
was designed to determine the risk factors and their association with neural tube defects. Study
Design: Case control study. Place and Duration of Study: This study was conducted at unit
111 Lady Willingdon Hospital Lahore and duration was one year from 1.1.2016 to 31.12.2016.
Methodology: A total of 120 mothers were included in the study, of which 30 were having of
babies delivered with NTDs, matched with 90 mothers delivered babies without NTDs (Three
controls for each NTD case). Informations were collected on special Performa, data was analyzed
on SPSS version 20. Results: Majority of the patients in both groups were found between 31-
40 years of age, 43.33 %( n13) in patients with NTD group and 56.67 %( n51) in controls while
only 16.67% (n5) in NTD and 17.78 % (n16) were found between 21-30 years. The mean age
was recorded as 33.06+1.21 and 32.12+ 0.89 respectively. Regarding parity, 23.33% (n7) were
found between P1-2, 26.67% (n11) were P2-3 while 40% (n12) with Parity >4 in the NTD group,
while 21.11% (n19) were p1-2, 37.77% (n 34) with P 3-4 and 41.12% (n37) were P >4 in control
group. 86.67% (n 26) were found with poor economic status and 13.33% (n4) were found with
rich status in NTDs, while 18.89% (n17) were found with poor and 81.11% (n73) with rich status
in control group. Distribution of fetuses according to their gender revealed that 20% (n6) were
males, and 80% (n24) were females in NTDs while 47.77 %( n43) were found males and 52.23%
(n47) were females in controls. Regarding family history 80% (n24) with positive history of NTDs
in patients of NTD group and 20% (n6) with no history while 4.44% (n4) had positive history and
95.56% (n86) had no familial history of NTD in control cases. About previous history of NTDs,
93.33% (n28) were found with positive previous history of NTDs and only 6.67% (n2)with no
previous history of NTDs in NTD group, while only 5.56% (n5) were found with positive previous
history of NTDs and 94.44%(n85) with no previous history in controls. Conclusions: Poor socio
economic status, family history and previous history of a baby with Neural tube defects are the
major risk factors.

Author Biographies

Nadeem Shahzad, Sialkot Medical College Sialkot.

Msc (Medical Education)
Associate Professor
Head of Obstetrics &

Afshan Riaz

Senior Registrar unit 111

Uzma Ameer, DHQ Sahiwal.

House Officer 

Daniyal Nadeem, Aga Khan University Karachi.

Final Year Student