4 times the national average? What's the standard deviation here? What is the probability that this would happen SOMEWHERE by random chance? If we have eliminated the impossible, whatever remains, however improbable, must be the truth. If we've eliminated an environmental factor, then it is probably just chance.

Fukushima?

So these aren't the types of neuro tube defects that are prevented by taking folic acid?

As the story suggests:

...One important consequence of inadequate consumption of fruits and vegetables is low intake of some micronutrients. For example, folic acid is one of the most common vitamin deficiencies in people who consume few dietary fruits and vegetables; folate deficiency causes chromosome breaks in humans by a mechanism that mimics radiation. Approximately 10% of the U.S. population had a lower folate level than that at which chromosome breaks occur. Folate supplementation above the recommended daily allowance (RDA) minimized chromosome breakage...

http://toxnet.nlm.nih.gov/cpdb/text/hand…

I know I'm cynical, but I feel they are covering for some rich prick who is fucking up the environment.

@2: No interviews were done. Information was abstracted from medical records and other sources. From the CDC's MMWR report last summer:

During February 2013, a case-control study was conducted by abstracting prenatal records from the 27 NTD-affected pregnancies and 108 randomly selected control subject pregnancies in women who had received care at the same 13 prenatal clinics. Control subjects were matched to case-patients by the month and year of last menstrual period. Eligibility criteria for control subjects included a pregnancy without an indication of a structural or genetic birth defect during routine prenatal care and prenatal residence in one of the three study counties. Information abstracted from medical records included sociodemographic characteristics, maternal and paternal occupations, maternal smoking and alcohol use, pregnancy health conditions (e.g., anemia, diabetes, or infectious diseases), parity, gravidity, prepregnancy height and weight, and medication use (including over-the-counter remedies, vitamins, and folic acid supplementation). Residential address during pregnancy was used to determine use of public versus private well-water supply.

Sorry, the above @7 was for GermanSausage @3.

...which is why it's so crucial to star taking folic acid before getting pregnant. Most vitamins are bullshit, but not this one.

Interesting. This sort of cluster also happened about 22 years ago in Brownsville, TX. Not only was folate low, but they found certain other things that increased the likelihood among the women there, including high nitrate/nitrite consumption (like processed meats), low serum B12 and high weight.

They apparently found little or no link between the heavy pollution across the border in the maquilladoras and the NTDs, but I'd really like to see more evidence on that part.

The frustrating thing is that you can't get a high-folic acid supplement without a prescription and in my experience, lots of doctors won't prescribe prenatal vitamins till you're actually confirmed pregnant. By that time most NTDs have already formed.

@11, yeah, I'm wondering if you're talking about some other kind of folic acid supplement than the ones that are in every Bartells, 100 caps for $5 or so. No prescription needed. Are those not the right kind for pregnant/soon-to-be-pregnant women?

The info @7 said that folic acid intake was part of what they looked at. If this is true, these birth defects were not due to low folic acid. What other causes can there be? Environmental contamination would seem to be at the front of the list. Hanford, or certain fertilizers or pesticides have to be looked at.

What @14 said. If this deformity is due to diet, why isn't this defect happening in nearby towns with similar demographics? I suspect they're not examining the environmental factors as closely as they should be.

Wasn't Hanford supposedly responsible for a brain tumor cluster a bunch of years ago?

@13: I think the problem is most women know that prenatal vitamins are important, but they don't know that the only vitamin that is actually proven to be necessary is folic acid. They also don't know that it's crucial to start taking folic acid before you're pregnant.

Prenatal vitamins have a bunch of other vitamins packaged up in them that have not been proven to have any positive effect on pregnancy and also increase their cost. Poor women have to wait until they get a prescription for prenatal vitamins in order to get them covered by Medicaid. The effect is women get a bunch of shit they don't need and denied access the one thing they do need.

Well, not denied, necessarily, because folic acid is pretty cheap, but they don't get empowered with the knowledge that they can reduce their baby's risks of neural tube defects for five dollars every three months.

I say this as someone who spent years interpreting for pregnant women on Medicaid. I saw this day after day. It's so fucking depressing.

It's also pretty off topic, given that lack of folic acid was ruled out already in these cases. Sorry, guys.

Nothing in common, except of course living in America's most contaminated nuclear site.

The folic acid recommendation for pregnant women (or women trying to conceive) is higher than the RDI, and needs to be properly balanced with B12 and iron because each of the three can mask symptoms of deficiency in another. That has been one of the reasons given for making prenatal vitamins prescription-only.

The US has only been enriching flour with folate since the mid-90s. This has not only reduced the rate of neural tube defects but also certain childhood cancers.

And as I said, I'm not really accepting that folate is the simple cause of both of these clusters, since one happened in a heavily polluted (and badly regulated) industrial area, and this one's happening in an area with historical radiation and lots of pesticide application.

On a personal note, when I think of all the clouds of orchard pesticide overspray I inhaled as a kid in Wenatchee, it's a wonder I'm alive and had relatively healthy kids.

@14, 15, for sure more detailed environmental/dietary/genetic studies should be undertaken to get to the bottom of this. Unclear whether the money or the will is there. Several people chiming in on folate above does not nail it (or rather, its lack) as the cause; neither does asking about whether someone took multivitamins or other supplements without detailed dietary logs and clinical specimens over the course of a statistically significant number of pregnancies.

A longitudinal study would be a good project for an NGO, budding epidemiologist, etc. Folate is important because, as its absence favors genetic mutations, it is one of the things most likely to affect rapidly dividing cells, i.e. bone marrow, wound healing, fetal development.

I'm going to go ahead and guess "Hanford."

I'm not saying we can completely rule out environmental factors, but statistics is weird. Given enough time and people, we can expect to see really unlikely events to happen. Such as randomly having a cluster of medical conditions that is 4 times the national average. Which is all it is, an average over the entirety of the nation for the year. If anything, we actually *don't* expect the cases to be completely evenly distributed around the country. Because that would actually be less likely. Anyway, my understanding of statistics is only moderate, so hopefully someone who is an expert can weigh in.

AG!!!

@20: A prospective study in the area might be worthwhile, but interview-based retrospective studies of birth defects are notoriously subject to recall bias. The parent of a child with the defect scours his/her memory to try to determine what might have caused it. Parents of control (healthy) children don't do that. Given that problem, the use of records abstraction for the prenatal and early-pregnancy period (before the defect was known) are probably the most viable approach.

Has anyone run around that community with a decent radiation detector, like a scintillation counter? Some batches of common road paving material are heavily contaminated in some areas of the country. That's on top of any locally occurring sources of ionizing radiation. Some forms of home construction concentrate radon in their basements.

I see a lot of people assuming this is actually environmentally related, but we still haven't determined probability of significance. The odds of having identical twins is 1 in 285 births, but you shouldn't be surprised to meet a pair. Humans have a bad time judging the probability of things:

http://www.inquisitr.com/1105864/unbelie…

The odds of this sort of thing happening are incredibly high. It's like the odds of flipping heads 100 times in a row. It may be because you are in limbo (Rosencrantz and Guildenstern), or it may be because people have flipped coins 10^30th times, and with that large a pool, such an event is LIKELY.

If you have a sufficiently large sample of an event thought to be random, NOT seeing clumps is more surprising than seeing clumps, but humans react in the opposite way.

Regarding the suspicion that this might be a normally expected cluster that fits our national average for this defect: I think it is still correct to look for environmental causes. I'm willing to guess the national average is also due to environmental causes that could make these defects preventable nationwide even if this is not a local spike. Or it's a genetic defect, which I think could have been identified by now and also could still be triggered by an environmental stimuli. Also Yakima is a ways from Hanford but ground zero for lots of ag pesticides. Which probably includes copious amounts of the relatively new neonicitinoids, implicated in bee colony collapse, which have only been in use for a decade or so...

Came here to say what 28 did. There might be environmental factors, and those should be searched for. But it's also possible that there isn't, and it's just one of those things.

Anyone interested in randomness should read the book "Drunkard's Walk" by Leonard Mlodinow. Very entertaining, written for the lay reader.

I feel it is the insecticides.... there are some many crops grown there and farms, this is the only thing it could be. It is not the Fukushima exposure, because Seattle is closer to the Pacific and women who live and give birth in Seattle are not having babies born with this condition. Farmers need to stop spraying crops with dangerous insecticides and grow more organic. I live in Seattle, but this is concerning to me because my son will be starting Medical School there this fall and I do not want him exposed to the poison. It may also cause cancer in adults!!!