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Folic acid to reduce neonatal mortality from neural tube disorders.
Int J Epidemiol. 2010 Apr; 39 Suppl 1:i110-21.IJ

Abstract

BACKGROUND

Neural tube defects (NTDs) remain an important, preventable cause of mortality and morbidity. High-income countries have reported large reductions in NTDs associated with folic acid supplementation or fortification. The burden of NTDs in low-income countries and the effectiveness of folic acid fortification/supplementation are unclear.

OBJECTIVE

To review the evidence for, and estimate the effect of, folic acid fortification/supplementation on neonatal mortality due to NTDs, especially in low-income countries.

METHODS

We conducted systematic reviews, abstracted data meeting inclusion criteria and evaluated evidence quality using adapted Grading of Recommendations, Assessment, Development and Evaluation (GRADE) methodology. Where appropriate, meta-analyses were performed.

RESULTS

Meta-analysis of three randomized controlled trials (RCTs) of folic acid supplementation for women with a previous pregnancy with NTD indicates a 70% [95% confidence interval (CI): 35-86] reduction in recurrence (secondary prevention). For NTD primary prevention through folic acid supplementation, combining one RCT with three cohort studies which adjusted for confounding, suggested a reduction of 62% (95% CI: 49-71). A meta-analysis of eight population-based observational studies examining folic acid food fortification gave an estimated reduction in NTD incidence of 46% (95% CI: 37-54). In low-income countries an estimated 29% of neonatal deaths related to visible congenital abnormalities are attributed to NTD. Assuming that fortification reduces the incidence of NTDs, but does not alter severity or case-fatality rates, we estimate that folic acid fortification could prevent 13% of neonatal deaths currently attributed to congenital abnormalities in low-income countries.

DISCUSSION

Scale-up of periconceptional supplementation programmes is challenging. Our final effect estimate was therefore based on folic acid fortification data. If folic acid food fortification achieved 100% population coverage the number of NTDs in low-income countries could be approximately halved.

CONCLUSION

The evidence supports both folic acid supplementation and fortification as effective in reducing neonatal mortality from NTDs.

Links

  • PMC Free PDF
    • Publisher Full Text
    ncbi.nlm.nih.gov
    academic.oup.com

    Authors+Show Affiliations

    Blencowe H
    London School of Hygiene and Tropical Medicine, London, UK. hblencowe@gmail.com
    Cousens S
    No affiliation info available
    Modell B
    No affiliation info available
    Lawn J
    No affiliation info available

    MeSH

    Dietary SupplementsFemaleFolic AcidFood, FortifiedHumansIncidenceInfant, NewbornMaleNeural Tube DefectsPovertyPreconception CarePregnancyPrenatal CarePrimary PreventionRandomized Controlled Trials as TopicRecurrenceVitamin B Complex

    Pub Type(s)

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

    Language

    eng

    PubMed ID

    20348114

    Citation

    Blencowe, Hannah, et al. "Folic Acid to Reduce Neonatal Mortality From Neural Tube Disorders." International Journal of Epidemiology, vol. 39 Suppl 1, 2010, pp. i110-21.
    Blencowe H, Cousens S, Modell B, et al. Folic acid to reduce neonatal mortality from neural tube disorders. Int J Epidemiol. 2010;39 Suppl 1:i110-21.
    Blencowe, H., Cousens, S., Modell, B., & Lawn, J. (2010). Folic acid to reduce neonatal mortality from neural tube disorders. International Journal of Epidemiology, 39 Suppl 1, i110-21. https://doi.org/10.1093/ije/dyq028
    Blencowe H, et al. Folic Acid to Reduce Neonatal Mortality From Neural Tube Disorders. Int J Epidemiol. 2010;39 Suppl 1:i110-21. PubMed PMID: 20348114.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - Folic acid to reduce neonatal mortality from neural tube disorders. AU - Blencowe,Hannah, AU - Cousens,Simon, AU - Modell,Bernadette, AU - Lawn,Joy, PY - 2010/3/30/entrez PY - 2010/4/2/pubmed PY - 2010/4/28/medline SP - i110 EP - 21 JF - International journal of epidemiology JO - Int J Epidemiol VL - 39 Suppl 1 N2 - BACKGROUND: Neural tube defects (NTDs) remain an important, preventable cause of mortality and morbidity. High-income countries have reported large reductions in NTDs associated with folic acid supplementation or fortification. The burden of NTDs in low-income countries and the effectiveness of folic acid fortification/supplementation are unclear. OBJECTIVE: To review the evidence for, and estimate the effect of, folic acid fortification/supplementation on neonatal mortality due to NTDs, especially in low-income countries. METHODS: We conducted systematic reviews, abstracted data meeting inclusion criteria and evaluated evidence quality using adapted Grading of Recommendations, Assessment, Development and Evaluation (GRADE) methodology. Where appropriate, meta-analyses were performed. RESULTS: Meta-analysis of three randomized controlled trials (RCTs) of folic acid supplementation for women with a previous pregnancy with NTD indicates a 70% [95% confidence interval (CI): 35-86] reduction in recurrence (secondary prevention). For NTD primary prevention through folic acid supplementation, combining one RCT with three cohort studies which adjusted for confounding, suggested a reduction of 62% (95% CI: 49-71). A meta-analysis of eight population-based observational studies examining folic acid food fortification gave an estimated reduction in NTD incidence of 46% (95% CI: 37-54). In low-income countries an estimated 29% of neonatal deaths related to visible congenital abnormalities are attributed to NTD. Assuming that fortification reduces the incidence of NTDs, but does not alter severity or case-fatality rates, we estimate that folic acid fortification could prevent 13% of neonatal deaths currently attributed to congenital abnormalities in low-income countries. DISCUSSION: Scale-up of periconceptional supplementation programmes is challenging. Our final effect estimate was therefore based on folic acid fortification data. If folic acid food fortification achieved 100% population coverage the number of NTDs in low-income countries could be approximately halved. CONCLUSION: The evidence supports both folic acid supplementation and fortification as effective in reducing neonatal mortality from NTDs. SN - 1464-3685 UR - https://www.unboundmedicine.com/medline/citation/20348114/Folic_acid_to_reduce_neonatal_mortality_from_neural_tube_disorders_ L2 - https://academic.oup.com/ije/article-lookup/doi/10.1093/ije/dyq028 DB - PRIME DP - Unbound Medicine ER -