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Reduction in neural-tube defects after folic acid fortification in Canada.
N Engl J Med. 2007 Jul 12; 357(2):135-42.NEJM

Abstract

BACKGROUND

In 1998, folic acid fortification of a large variety of cereal products became mandatory in Canada, a country where the prevalence of neural-tube defects was historically higher in the eastern provinces than in the western provinces. We assessed changes in the prevalence of neural-tube defects in Canada before and after food fortification with folic acid was implemented.

METHODS

The study population included live births, stillbirths, and terminations of pregnancies because of fetal anomalies among women residing in seven Canadian provinces from 1993 to 2002. On the basis of published results of testing of red-cell folate levels, the study period was divided into prefortification, partial-fortification, and full-fortification periods. We evaluated the relationship between baseline rates of neural-tube defects in each province and the magnitude of the decrease after fortification was implemented.

RESULTS

A total of 2446 subjects with neural-tube defects were recorded among 1.9 million births. The prevalence of neural-tube defects decreased from 1.58 per 1000 births before fortification to 0.86 per 1000 births during the full-fortification period, a 46% reduction (95% confidence interval, 40 to 51). The magnitude of the decrease was proportional to the prefortification baseline rate in each province, and geographical differences almost disappeared after fortification began. The observed reduction in rate was greater for spina bifida (a decrease of 53%) than for anencephaly and encephalocele (decreases of 38% and 31%, respectively).

CONCLUSIONS

Food fortification with folic acid was associated with a significant reduction in the rate of neural-tube defects in Canada. The decrease was greatest in areas in which the baseline rate was high.

Authors+Show Affiliations

Laval University, Quebec, Canada. philippe.dewals@msp.ulaval.caNo 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 availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

17625125

Citation

De Wals, Philippe, et al. "Reduction in Neural-tube Defects After Folic Acid Fortification in Canada." The New England Journal of Medicine, vol. 357, no. 2, 2007, pp. 135-42.
De Wals P, Tairou F, Van Allen MI, et al. Reduction in neural-tube defects after folic acid fortification in Canada. N Engl J Med. 2007;357(2):135-42.
De Wals, P., Tairou, F., Van Allen, M. I., Uh, S. H., Lowry, R. B., Sibbald, B., Evans, J. A., Van den Hof, M. C., Zimmer, P., Crowley, M., Fernandez, B., Lee, N. S., & Niyonsenga, T. (2007). Reduction in neural-tube defects after folic acid fortification in Canada. The New England Journal of Medicine, 357(2), 135-42.
De Wals P, et al. Reduction in Neural-tube Defects After Folic Acid Fortification in Canada. N Engl J Med. 2007 Jul 12;357(2):135-42. PubMed PMID: 17625125.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Reduction in neural-tube defects after folic acid fortification in Canada. AU - De Wals,Philippe, AU - Tairou,Fassiatou, AU - Van Allen,Margot I, AU - Uh,Soo-Hong, AU - Lowry,R Brian, AU - Sibbald,Barbara, AU - Evans,Jane A, AU - Van den Hof,Michiel C, AU - Zimmer,Pamela, AU - Crowley,Marian, AU - Fernandez,Bridget, AU - Lee,Nora S, AU - Niyonsenga,Theophile, PY - 2007/7/13/pubmed PY - 2007/7/18/medline PY - 2007/7/13/entrez SP - 135 EP - 42 JF - The New England journal of medicine JO - N. Engl. J. Med. VL - 357 IS - 2 N2 - BACKGROUND: In 1998, folic acid fortification of a large variety of cereal products became mandatory in Canada, a country where the prevalence of neural-tube defects was historically higher in the eastern provinces than in the western provinces. We assessed changes in the prevalence of neural-tube defects in Canada before and after food fortification with folic acid was implemented. METHODS: The study population included live births, stillbirths, and terminations of pregnancies because of fetal anomalies among women residing in seven Canadian provinces from 1993 to 2002. On the basis of published results of testing of red-cell folate levels, the study period was divided into prefortification, partial-fortification, and full-fortification periods. We evaluated the relationship between baseline rates of neural-tube defects in each province and the magnitude of the decrease after fortification was implemented. RESULTS: A total of 2446 subjects with neural-tube defects were recorded among 1.9 million births. The prevalence of neural-tube defects decreased from 1.58 per 1000 births before fortification to 0.86 per 1000 births during the full-fortification period, a 46% reduction (95% confidence interval, 40 to 51). The magnitude of the decrease was proportional to the prefortification baseline rate in each province, and geographical differences almost disappeared after fortification began. The observed reduction in rate was greater for spina bifida (a decrease of 53%) than for anencephaly and encephalocele (decreases of 38% and 31%, respectively). CONCLUSIONS: Food fortification with folic acid was associated with a significant reduction in the rate of neural-tube defects in Canada. The decrease was greatest in areas in which the baseline rate was high. SN - 1533-4406 UR - https://www.unboundmedicine.com/medline/citation/17625125/Reduction_in_neural_tube_defects_after_folic_acid_fortification_in_Canada_ L2 - http://www.nejm.org/doi/full/10.1056/NEJMoa067103?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -