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 -