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Prevalence of spina bifida and anencephaly during the transition to mandatory folic acid fortification in the United States.
Teratology. 2002 Jul; 66(1):33-9.T

Abstract

BACKGROUND

In 1992, the United States Public Health Service recommended that all women of childbearing age consume 400 microg of folic acid daily. The Food and Drug Administration authorized the addition of synthetic folic acid to grain products in March 1996 with mandatory compliance by January 1998. The impact of these public health policies on the prevalence of neural tube defects needs to be evaluated. We sought to determine the prevalences of spina bifida and anencephaly during the transition to mandatory folic acid fortification.

METHODS

Twenty-four population-based surveillance systems were used to identify 5,630 cases of spina bifida and anencephaly from 1995-99. Cases were divided into three temporal categories depending on whether neural tube development occurred before folic acid fortification (January 1995 to December 1996), during optional fortification (January 1997 to September 1998), or during mandatory fortification (October 1998 to December 1999). Prevalences for each defect were calculated for each time period. Data were also stratified by programs that did and did not ascertain prenatally diagnosed cases.

RESULTS

The prevalence of spina bifida decreased 31% (prevalence ratio [PR] = 0.69, 95% confidence interval [CI] = 0.63-0.74) from the pre- to the mandatory fortification period and the prevalence of anencephaly decreased 16% (PR = 0.84, 95% CI = 0.75-0.95). Stratification by prenatal ascertainment did not alter results for spina bifida but did impact anencephaly trends.

CONCLUSIONS

The decline in the prevalence of spina bifida was temporally associated with folic acid fortification of US grain supplies. The temporal association between fortification and the prevalence of anencephaly is unclear.

Authors+Show Affiliations

National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia 30341, USA. lnw9@cdc.govNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, U.S. Gov't, P.H.S.

Language

eng

PubMed ID

12115778

Citation

Williams, Laura J., et al. "Prevalence of Spina Bifida and Anencephaly During the Transition to Mandatory Folic Acid Fortification in the United States." Teratology, vol. 66, no. 1, 2002, pp. 33-9.
Williams LJ, Mai CT, Edmonds LD, et al. Prevalence of spina bifida and anencephaly during the transition to mandatory folic acid fortification in the United States. Teratology. 2002;66(1):33-9.
Williams, L. J., Mai, C. T., Edmonds, L. D., Shaw, G. M., Kirby, R. S., Hobbs, C. A., Sever, L. E., Miller, L. A., Meaney, F. J., & Levitt, M. (2002). Prevalence of spina bifida and anencephaly during the transition to mandatory folic acid fortification in the United States. Teratology, 66(1), 33-9.
Williams LJ, et al. Prevalence of Spina Bifida and Anencephaly During the Transition to Mandatory Folic Acid Fortification in the United States. Teratology. 2002;66(1):33-9. PubMed PMID: 12115778.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Prevalence of spina bifida and anencephaly during the transition to mandatory folic acid fortification in the United States. AU - Williams,Laura J, AU - Mai,Cara T, AU - Edmonds,Larry D, AU - Shaw,Gary M, AU - Kirby,Russell S, AU - Hobbs,Charlotte A, AU - Sever,Lowell E, AU - Miller,Lisa A, AU - Meaney,F John, AU - Levitt,Miriam, PY - 2002/7/13/pubmed PY - 2003/3/4/medline PY - 2002/7/13/entrez SP - 33 EP - 9 JF - Teratology JO - Teratology VL - 66 IS - 1 N2 - BACKGROUND: In 1992, the United States Public Health Service recommended that all women of childbearing age consume 400 microg of folic acid daily. The Food and Drug Administration authorized the addition of synthetic folic acid to grain products in March 1996 with mandatory compliance by January 1998. The impact of these public health policies on the prevalence of neural tube defects needs to be evaluated. We sought to determine the prevalences of spina bifida and anencephaly during the transition to mandatory folic acid fortification. METHODS: Twenty-four population-based surveillance systems were used to identify 5,630 cases of spina bifida and anencephaly from 1995-99. Cases were divided into three temporal categories depending on whether neural tube development occurred before folic acid fortification (January 1995 to December 1996), during optional fortification (January 1997 to September 1998), or during mandatory fortification (October 1998 to December 1999). Prevalences for each defect were calculated for each time period. Data were also stratified by programs that did and did not ascertain prenatally diagnosed cases. RESULTS: The prevalence of spina bifida decreased 31% (prevalence ratio [PR] = 0.69, 95% confidence interval [CI] = 0.63-0.74) from the pre- to the mandatory fortification period and the prevalence of anencephaly decreased 16% (PR = 0.84, 95% CI = 0.75-0.95). Stratification by prenatal ascertainment did not alter results for spina bifida but did impact anencephaly trends. CONCLUSIONS: The decline in the prevalence of spina bifida was temporally associated with folic acid fortification of US grain supplies. The temporal association between fortification and the prevalence of anencephaly is unclear. SN - 0040-3709 UR - https://www.unboundmedicine.com/medline/citation/12115778/Prevalence_of_spina_bifida_and_anencephaly_during_the_transition_to_mandatory_folic_acid_fortification_in_the_United_States_ L2 - https://doi.org/10.1002/tera.10060 DB - PRIME DP - Unbound Medicine ER -