Talk:Neural tube defect

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This article is currently the subject of a Wiki Education Foundation-supported course assignment, between 19 October 2021 and 31 May 2022. Further details are available on the course page. Student editor(s): Madiqw.

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This article is or was the subject of a Wiki Education Foundation-supported course assignment. Further details are available on the course page. Student editor(s): Noah Liberman, Plt09.

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Proposed merger
At present, neural tube defect is a redirect to neural tube defects. I propose to merge the two pages into neural tube defect, thus allowing the more flexible use of the singular or plural as needed in other pages. --Una Smith 20:32, 11 November 2007 (UTC)
 * Since neural tube defect is just a redirect, this operation is really just a page move, not a merge. It just requires that an administrator move neural tube defects over the old redirect, so I'll go ahead and do that.  Ioeth (talk contribs friendly) 00:30, 14 January 2008 (UTC)

nb: "incidence" as described in the introductory paragraph should be stated with respect to a certain timeframe. Alternatively, the statistic could be described as "prevalence" if it describes the total number of cases related to a neural tube defect, but with respect to a certain moment in time. —Preceding unsigned comment added by 115.64.121.5 (talk) 13:13, 13 March 2009 (UTC)

Problem in section Cause, paragraph Folate Deficiency
The sentence, "Importantly, a deficiency of folate itself does not cause neural tube defects." is jarringly at odds with the context and does not integrate well with either what precedes or follows. Perhaps the whole paragraph needs a rewrite. I do not have the technical background to do it. Both the composition and the technical subject matter need to be clarified. The intended meaning could be that folate deficiency does not produce NTD in all cases due to genetic variability, but the intended meaning could also be that other factors can produce NTD even in the presence of sufficient folate. It is very much unclear. 7802mark (talk) 17:48, 18 July 2015 (UTC)

Proposed Changes for Article
Hello, we are a group of medical students editing this page as part of our class assignment. We have compiled a list of suggestions to improve this article and would appreciate community feedback before we proceed with these edits. Here is a list of our suggestions:

1. We propose to insert the following content into the Neural Tube Defect "Diagnosis" section: In Canada, clinical practice guidelines recommend secondary trimester ultrasound as the primary screening tool for NTDs, and MSAFP as a secondary screening tool. This is due to increased safety, increased sensitivity and decreased false positive rate of ultrasound as compared to MSAFP.
 * Do you mean "second" trimester ultrasound here?JenOttawa (talk)
 * The article presently states: "Tests for neural tube defects include ultrasound examination and measurement of maternal serum alpha-fetoprotein (MSAFP)(no citation)". I agree with 's comment below. I feel your suggested citation is strong. Is it necessary to state that this is a Canadian practice guideline? If guidelines are different in other countries, I could understand why you feel it is important. If there are not any significant (or clinically relevant) differences, you could use your Cdn guideline citation to improve the existing sentence in the article.JenOttawa (talk) 01:08, 11 November 2017 (UTC)

Our group agrees with your comments. We will take out "In Canada" and change "secondary" to "second" as that was a typo. Merepoole (talk) 15:01, 15 November 2017 (UTC)

2. We noticed that Reference #24 is a primary source. We propose replacing it with the source:  "Meta-analysis of the association of maternal smoking and passive smoking during pregnancy with neural tube defects. "
 * Agreed! Ref 24 is a population-based case-control study published in 2008. Your suggested source is a meta-analysis of "Case-control and cohort studies" published in 2017, an improvement. I cannot access the full text.
 * The article text before this reference presently reads: "A mechanism by which maternal exposure to cigarette smoke could increase NTD risk in offspring is suggested by several studies that show an association between cigarette smoking and elevations of homocysteine levels. The study suggests that cigarette smoke, including secondhand exposure, is not only hazardous to the mother, but may also interfere with neural tube closure in the developing embryo.[24]" How are you planning to change it? Can you verify and find a good citation for the proceeding sentence that discusses increased homocysteine levels?JenOttawa (talk) 01:35, 11 November 2017 (UTC)
 * We cannot find any good citation for the preceding sentence that connects homocysteine levels and neural tube defects. We will change our edit to remove that first sentence, and reword the second to read "Cigarette smoke during pregnancy, including secondhand exposure, can increase the risk of neural tube defects in the fetus. " 14cm90 (talk) 17:15, 15 November 2017 (UTC)
 * I would leave the sentence about homocysteine for now. I will add a "citation needed" tag to the sentence and try to revisit it soon.JenOttawa (talk) 04:11, 16 November 2017 (UTC)

3. We propose altering the first sentence of the article, as it is missing the key fact that Neural Tube Defects are birth defects. We would change it to read: "Neural Tube Defects (NTDs) are a group of severe birth defects in which there is incomplete closure of the neural tube in embryonic development."
 * Check on your use of the word "severe". I would suggest leaving the present wording but adding in birth defect if you wish. You also want to make sure you keep this in lay terms. Personally, I like the way the present wording uses "early in human development" instead of "embryonic development", especially for the opening sentence.JenOttawa (talk) 01:35, 11 November 2017 (UTC)
 * We agree. We will instead change the first sentence to read "Neural tube defects (NTDs) are a group of birth defects in which an opening in the spinal cord or brain remains from early in human development." 14cm90 (talk) 17:15, 15 November 2017 (UTC)

4. Reference #10 only somewhat supports the first sentence claim since the study primarily focuses on B12 and just mentions folate as it is referenced by other studies. We propose adding the following Cochrane systematic review, which focuses on Folate:  "Effects and safety of periconceptional oral folate supplementation for preventing birth defects "
 * Will there be any changes to the text based on the conclusions of the Cochrane Review?JenOttawa (talk) 02:03, 11 November 2017 (UTC)


 * We would have liked to, yes, but we believe that this would probably be too large of a change because it would disrupt the flow of the section to put the review conclusions here at the beginning of the “Causes” section. Mdkheinelt (talk) 16:38, 15 November 2017 (UTC)
 * Be sure that the sentence you are citing is at least still accurate with the citation replacement. So you are using the Cochrane Review to cite background info, rather than the results of the review? This is fine to do. I will look at the review conclusions.JenOttawa (talk)


 * Yes definitely, we see what you are saying. We think this is now resolved by changing the structure as in point 5 below since the overall conclusion of the review (although with more detail) is that supplementation with folate during pregnancy reduces the risk of NTDs. Mdkheinelt (talk) 14:40, 16 November 2017 (UTC)

5. We noticed that the first sentence of Causes is a little bit confusing because it includes both B12 and folate, whereas the section only talks about Folic Acid Deficiency. We propose changing it from "Folate (vitamin B9) and vitamin B12 are very important in reducing the occurrences of NTDs.” to “Folate (vitamin B9) is very important in reducing the occurrence of NTDs. Vitamin B12, which is involved in the same biopathway, also plays a role although B12 deficiency is less common.”
 * Is "biopathway" the correct term to use here?
 * Please include a citation after every sentence, even if it is the same source
 * We can wait for more community feedback here, but I have some thoughts about this sentence as it stands in the present article. My question is, why is the first sentence of the "causes" paragraph describing how to "reduce" NTDs? Looking at the present citation,, I think it would be more accurate to share information about how low or inadequate levels of folate or vitamin B12 during pregnancy leads to an increased risk of the baby developing a NTD.JenOttawa (talk) 02:03, 11 November 2017 (UTC)


 * The term “biopathway” is the term that our expert consultant used and it is also used in the existing article therefore our group believes it is the correct term to use. And our group agrees with your comments, we just were hesitant to make such a big change. In response, therefore, we propose the following change with the 2 citations included at the end of each sentence instead: “Inadequate levels of Folate (vitamin B9) and vitamin B12 during pregnancy have been found to lead to increased risk of NTDs. Although both are part of the same biopathway, folate deficiency is much more common and therefore more of a concern." Mdkheinelt (talk) 16:38, 15 November 2017 (UTC)
 * Ok!JenOttawa (talk) 04:11, 16 November 2017 (UTC)

6. We propose adding the following systematic review  "Maternal obesity and the risk of neural tube defects in offspring: A meta-analysis" as a citation to the first sentence in the gene-environment section in “Causes”. It is a systematic review analyzing the relationship between maternal obesity and NTDs.
 * Looks like a quality reliable source. Did you verify that no changes need to be made to the sentence you are citing?JenOttawa (talk) 14:43, 13 November 2017 (UTC)
 * Taking a closer look, the sentence you are referring to already has three references citing it. Wikipedia generally needs one quality source per sentence. How does your reference add to what is already cited?
 * Current sentence reads:"Other potential causes can include folate antimetabolites (such as methotrexate), maternal diabetes, maternal obesity, mycotoxins in contaminated corn meal, arsenic, hyperthermia in early development, and radiation.[20][21][22]"JenOttawa (talk) 14:50, 13 November 2017 (UTC)


 * Our group agrees with your suggestion. Our rational for adding this citation is that the citations added to the previous sentence don’t explicitly list maternal obesity as a cause of neural tube defects. The first reference (20) is a reference to an article on neural tube defects by eMedicine and doesn’t address maternal obesity as a cause. The second reference (21) is a case control study analyzing toxic waste as a cause of NTDs. The third reference (22) is a primary research article studying alcohol as a cause of NTDs on mice. To accurately cite this meta analysis we suggest removing maternal obesity from this sentence and adding the following sentence behind it: “Maternal obesity has also been found to be a risk factor for NTDs.” We would then add the suggested citation to this sentence.Plt09 (talk) 15:22, 15 November 2017 (UTC) Plt09 (talk) 17:17, 15 November 2017 (UTC)

You did a nice job looking into this.JenOttawa (talk) 04:11, 16 November 2017 (UTC)

7. There is a sentence in the middle of the folate deficiency paragraph that mentions a “gene-environment interaction” and we propose that this should be moved to the next section where this sentence could be the topic sentence for the “gene-environment interaction” paragraph. Furthermore, this section mainly focuses on cigarette smoke as an environmental factor but based on evidence from this review  "Pre-conception Folic Acid and Multivitamin Supplementation for the Primary and Secondary Prevention of Neural Tube Defects and Other Folic Acid-Sensitive Congenital Anomalies"  we propose that the following environmental factors should also be added: GI abnormalities, alcohol, or other drug use.
 * Looks like a good WP:MEDRS citation. Please add in exactly how you propose to change the current sentenceJenOttawa (talk) 02:10, 11 November 2017 (UTC)
 * Thank you for your comment. Part way through the “Folate Deficiency” Section are 3 sentences that read: “Importantly, a deficiency of folate itself does not cause neural tube defects. The association seen between reduced neural tube defects and folic acid supplementation is due to a gene-environment interaction such as vulnerability caused by the C677T Methylenetetrahydrofolate reductase (MTHFR) variant. Supplementing folic acid during pregnancy reduces the prevalence of NTDs by not exposing this otherwise sub-clinical mutation to aggravating conditions.” Our group believes these 3 sentences are important information but they fit better in the “Gene-environment Interaction” section. Specifically this segment could be at the start of the next section, as a topic sentence. We will not change the quote itself other than removing the word “importantly” to start the sentence with “A deficiency…”Noah Liberman (talk) 15:39, 15 November 2017 (UTC)

7. In the epidemiology section, we propose adding “Surveillance capacity for neural tube defects vary widely across countries. There is especially lack of data on prevalence and incidence from low income countries. " These sentences provide context for epidemiological data regarding neural tube defects with evidence from "Describing the Prevalence of Neural Tube Defects Worldwide: A Systematic Literature Review."
 * Please include a citation after every sentence. Can you simplify theses two sentences a little (for general audience)?JenOttawa (talk) 02:10, 11 November 2017 (UTC)
 * Thanks for your suggestion. We will combine and simplify the 2 sentences before adding. We'll add: "Surveillance capacity for neural tube defects vary, with low income countries lacking data on prevalence and incidence. Bryanfranco (talk) 15:12, 15 November 2017 (UTC)

Mdkheinelt (talk) 19:22, 6 November 2017 (UTC)
 * COMMENTS: Small stuff - For your first suggestion, why lead with "In Canada"? Once folate is also identified as being vitamin B9, no need to repeat each time. The 12 in vitamin B12 needs to be subscripted, as does the 9 in vitamin Bvitamin B9. To your last suggestion: "...varies widely..." Most disease articles have a Prognosis section after Epidemiology. Do you have content that could be shifted to such a section? David notMD (talk) 19:56, 10 November 2017 (UTC)
 * General comment: Please ensure that all your reference go immediately after the punctuation (no spaces). If you don't mind, adjust them in the talk page, by moving your quotation marks, so your proposed content will be ready for the article. It should look like this.(99) Thanks!JenOttawa (talk) 02:15, 11 November 2017 (UTC)
 * ANOTHER COMMENT: Appears you have chosen a reference maker that inserts first names rather than just initials? Here is one that creates a more commonly used format:

https://tools.wmflabs.org/citation-template-filling/cgi-bin/index.cgi Use that, enter the PMID number for an article, add the < > stuff at either end, and you get what you see below as #8. David notMD (talk) 04:03, 15 November 2017 (UTC)

Why was my edit reverted? I wikified Folate deficiency
I believe there must be a link to Folate deficiency from this article because neural tube defects are associated with this condition. Why was my edit reverted? -- C opper K ettle  16:35, 9 February 2020 (UTC)
 * You made the wlink twice in the same paragraph in a section on folate deficiency. That is MOS:OL, as stated in the edit summary. I am restoring one wlink. --Zefr (talk) 16:47, 9 February 2020 (UTC)
 * Thank you! I think we could also add the "read further" link just under the section title, or something like that. I haven't been very active in Wikipedia for 10 years, so I don't recall how exactly this link is added. )) -- C opper K ettle  17:03, 9 February 2020 (UTC)