Written Answers - Birth Defects.
Michael Finucane
Question:
13
Mr. Finucane
asked the
Minister for Health
the studies, if any, that have gone into the investigation of the apparent high incidence of physical birth defects in Ireland; and if he will make a statement on the matter with particular reference to the comparison with other European countries.
John Browne
Question:
19
Mr. Browne (Carlow-Kilkenny)
asked the
Minister for Health
the extent, if any, to which he proposes to make available funding on medical research into the causes of specific birth deficiency; if he will co-ordinate his research with information available from the pharmaceutical companies; and if he will make a statement on the matter.
Ivor Callely
Question:
42
Mr. Callely
asked the
Minister for Health
the way in which his Department register and monitor limb defects in newborn babies; if there is any noticeable geographic problem; if he has received submissions on this matter; and if he will make a statement on the matter.
P. J. Sheehan
Question:
58
Mr. Sheehan
asked the
Minister for Health
whether he intends to initiate research into the incidence of children born with limb defects; the proposals, if any, he has in this regard; if his attention has been drawn to overseas research into the problem, with particular reference to rationalisation of the issue; and if he will make a statement on the matter.
Pat Upton
Question:
75
Dr. Upton
asked the
Minister for Health
the plans, if any, he has to establish a national register of birth defects; and if he will make a statement on the matter.
Bernard J. Durkan
Question:
92
Mr. Durkan
asked the
Minister for Health
if his attention has been drawn to the needs of Reach Ireland Association; if he will offer financial assistance towards research in an effort to identify the causes of physical birth defects in Ireland; and if he will make a statement on the matter.
Eamon Gilmore
Question:
104
Mr. Gilmore
asked the
Minister for Health
the plans, if any, he has to provide a register of birth defects to provide information as to the geographical location and preponderance of birth defects to help in identifying possible causes of such defects; and if he will make a statement on the matter.
Michael Noonan
Question:
108
Mr. Noonan (Limerick East)
asked the
Minister for Health
the plans, if any, he has to provide a national register of birth defects with a view to facilitating present and future planning of the necessary medical services in this area; and if he will make a statement on the matter.
Pat Upton
Question:
111
Dr. Upton
asked the
Minister for Health
the plans, if any, he has to provide funds specifically for research into the cause of the incidence of birth defects in Ireland.
Seán Barrett
Question:
146
Mr. Barrett
asked the
Minister for Health
the reason for the apparent high incidence of birth defects in Ireland in comparison with other European countries; and if he will make a statement on the matter.
Seán Barrett
Question:
147
Mr. Barrett
asked the
Minister for Health
if he will provide a national register of birth defects in Ireland for the collation of statistics on the various abnormalities at birth, thereby facilitating the present and future planning of national medical services.
Seán Barrett
Question:
148
Mr. Barrett
asked the
Minister for Health
the reason more money is not spent annually on medical research into the causes of specific birth defects.
James McDaid
Question:
149
Dr. McDaid
asked the
Minister for Health
his views on the apparent high incidence of birth defects in Ireland in comparison with other European countries; if he will provide a national register of birth defects so that statistics could be obtained on the various abnormalities; and if he will consider the provision of medical cards for all children born with birth deficiencies.
Richard Bruton
Question:
150
Mr. R. Bruton
asked the
Minister for Health
if his attention has been drawn to the campaign by Reach Ireland seeking a national register of births defects; research into the causes of these defects; medical card provision for children with birth deficiencies liable to create significant financial burden; and if he will make a statement on the matter.
Richard Bruton
Question:
156
Mr. R. Bruton
asked the
Minister for Health
if he will issue a circular letter to the chief executive officers of health boards indicating that it is the Government's desire that children born with a significant disability should have the benefit of medical card cover regardless of the income of their parents.
Bernard J. Durkan
Question:
179
Mr. Durkan
asked the
Minister for Health
if he will authorise the issue of medical cards to children born with limb defects; and if he will make a statement on the matter.
I propose to take Questions Nos. 13, 19, 42, 58, 75, 92, 104, 108, 111, 146, 147, 148, 149, 150, 156 and 179 together.
State funding for medical and related research is channelled through the Health Research Board, which carries the statutory responsibility for promoting, conducting or commissioning medical and epidemiological research. The board has funded considerable research into birth defects, especially neural tube defects, and some of this research is still in progress. This research is set out in detail in a tabular statement which I will circulate in the Official Report. Further research proposals in this area would, of course be considered by the board on an ongoing basis.
In view of the specific statutory responsibility of the Health Research Board in regard to research it would not be appropriate for me to initiate research on this matter. I should point out that I increased the board's allocation by 30 per cent in this year's estimates.
Information on birth defects is available from a number of sources: registers operate in the Eastern Health Board area and in Galway; the birth notification scheme collects information on birth defects which are apparent before a new born baby is discharged from hospital and information would also be available from the hospital in-patient inquiry scheme in respect of babies with birth defects who were subsequently treated in an acute hospital.
Consequently, I consider that it would be more appropriate to consider how existing sources of information on birth defects can be developed rather than to establish a separate register.
In relation to international comparisons, it must be borne in mind that a crude comparison of incidence rates can be misleading given differences in national policies on abortion as well as significant variations in birth rates among older women between countries.
It should also be noted that the provision of services for children with birth defects is in no way adversely affected by the lack of full availability of information on the incidence of these defects.
Under the 1970 Health Act, medical cards are issued to persons who, in the opinion of the chief executive officer of the appropriate health board are unable, without undue hardship, to provide general practitioners' services for themselves and their dependants.
Income guidelines are available to assist chief executive officers in the determination of a person's eligibility and these guidelines are revised annually in line with the Consumer Price Index. However, these guidelines are not statutorily binding and even though a person's income exceeds the guidelines, that person may still be awarded a medical card if the chief executive officer considers that the person's medical needs would justify this. This special provision is intended to ensure that any person in genuine need of a medical card will receive one. In view of this, I do not think that it is justifiable to extend an automatic entitlement to a medical card to any specific group without any reference to their means or, in the case of children, to their parents' means, particularly in view of the many areas of pressing need in the health services and the limited resources available to meet them.
Tabular Statement.
Research on Birth Defects.
Since 1985 the Health Research Board has funded research by Dr. P. Kirke to test the hypothesis that periconceptional supplementation with either a multivitamin preparation alone or folic acid alone can reduce the risk of neural tube defects. The work has been conducted in association with Trinity College and since late 1992 has been co-funded by the National Institute of Health USA. This research constitutes the board's main commitment at present in the area of research into birth defects. The following publications have resulted from this work.
Papers:
1. MacCarthy PA, Dalyrymple IJ, Duignan NM, Elwood JH, Guiney EJ, Hanratty TD, Kirke PN, MacDonald DW. Recurrence rates of neural tube defects in Dublin maternity hospitals. Irish Medical Journal 1983;76: 78-9.
2. Molloy AM, Kirke P, Hillary I, Weir DG, Scott JM. Maternal serum folate and vitamin B 12 levels in pregnancies associated with neural tube defects. Archives of Disease in Childhood 1985;60: 660-5.
3. Kirke PN, Daly LE, Elwood JH. A randomised trial of low dose folic acid to prevent neural tube defects. Archives of Disease in Childhood 1992;67: 1442-6.
4. Scott JM, Kirke PN, Weir DG. Folic acid in the prevention of neural tube defects. Irish Journal of Medical Science 1992;161: 579-81.
5. Kirke PN, Molloy AM, Daly LE, Burke H, Weir DG and Scott JM. Maternal plasma folate and vitamin B 12 are independent risk factors for neural tube defects. Quarterly Journal of Medicine 1993;86: 703-8.
6. Kirke P. Vitamins, neural tube defects and ethics committees. Lancet 1980;i: 1,300-1 (letter).
7. Kirke PN, Elwood JH. Anencephaly in the United Kingdom and Republic of Ireland. British Medical Journal 1984;289: 1621 (letter).
8. Scott JM, Kirke P, O'Broin S, Weir DG, Folic acid to prevent neural tube defects. Lancet 1991;338: 505 (letter).
Book Chapters:
1. Scott JM, Kirke PN, Weir DG. The role of nutrition in neural tube defects. In: Annual review of nutrition, 1990 (Vol 10). Palo Alto, California; Annual Review Inc, 1990: 277-95.
2. Scott JM, Weir DG, Molloy AM, McPartlin J, Daly LE, Kirke PN. Folic acid metabolism and mechanisms of neural tube defects. In: Neural tube defects (CIBA Foundation symposium 181). Chichester; Wiley, 1994: 180-191.
Book:
1. Dobbing J, ed. Prevention of spina bifida and other neural tube defects. London: Academic Press, 1983. Several contributions by PN Kirke in this book.
Published abstracts:
1. Molloy AM, Kirke PN, Hillary I, Weir DG, Scott JM. Maternal serum folate and vitamin B 12 levels during pregnancies resulting in infants with neural tube defects. European Journal of Epidemiology 1986;2: 322.
2. Kirke PN, Molloy AM, Hillary I, Weir DG, Scott JM. Serum folate and vitamin B 12 levels in pregnancies associated with neural tube defects. Irish Journal of Medical Science 1987;156: 129.
3. Lenehan P, MacDonald D, Kirke PN. Neural tube defects and vitamin prophylaxis. In: Berger H, ed. Vitamins and minerals in pregnancy and lactation. Nestle Nutrition Workshop Series, Vol. 16. New York: Raven Press, 1988: 177.
4. Kirke PN. Vitamins, minerals and neural tube defects. Irish Journal of Food Science and Technology 1987,11: 196-7.
Other relevant research:
The HRB has also supported research into the genetics of Schizophrenia and Retinus Pigmentosa. Other research funded by the Board in recent years would include:
(a) Detection of listeria DNA in placentae from late unexplained still births.
(b) Maternal influenza and the risk of later schizophrenia in off-spring.
(c) The relationship between obstetric-complications and adult psychiatric illness.
(d) In vitro fibrinolysis of trophoblast from the placental bed in pre eclampsia and intra-uterine fetal growth retardation.
(e) Is the 300 KDA Mannose 6-phosphate receptor a regulator of embryonic development.
Limited information is available from EUROCAT, an EU funded concerted action programme. However, this gathers information from localised registries only and no national information is available.
