Background: Neural tube defects (NTDs) are congenital anomalies caused by incomplete neural tube closure during early embryonic development. Around 70% of cases are folate dependent.

Objectives: This study investigates the impact of the COVID-19 pandemic on NTD incidence in Jordan, considering reduced antenatal care, limited folic acid supplementation, and increased obesity among women during lockdowns.

Methods: A comparative observational study was conducted across 12 hospitals in northern Jordan. NTDs incidence was compared between two groups: those conceived before and during the pandemic. Data were collected from medical records and parent interviews, covering sociodemographic, medical, antenatal, anthropometric, and nutritional variables.

Results: NTD incidence was 1.3 per 1,000 births during the pandemic versus 1.1 before. Myelomeningocele was the most common subtype (61.4%), with a slight female predominance (51.1%). Case fatality was significantly higher during the pandemic (29.5% vs. 13.9%, P = 0.0183), and in non-spina bifida cases (87.5% vs. 23.7%, P = 0.0007). Family history had less impact on spina bifida (5%) compared to other NTDs (37.5%, P = 0.0149). Despite the pandemic, 84.1% of mothers attended antenatal clinics and 61.4% took folic acid. A higher BMI (≥ 29 kg/m²) was noted in 37.1% of mothers, up from 30.6% pre-pandemic.

Conclusions: The NTD incidence closely mirrors pre-pandemic levels, indicating effective antenatal care in Jordan. Continued screening and risk factor identification are essential for reducing NTDs burden. Further national studies are recommended.

Implications for nursing: Nurses educate, support, and advocate for maternal health, emphasizing folic acid, antenatal care, nutrition, and emotional support.