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Estimate of the potential impact of folic acid fortification of corn masa flour on the prevention of neural tube defects.
Birth Defects Res A Clin Mol Teratol. 2013 Oct; 97(10):649-57.BD

Abstract

BACKGROUND

Hispanics in the US have a higher prevalence of neural tube defect (NTD) -affected pregnancies than non-Hispanic whites, and lower median total folic acid (FA) intake. FA fortification of corn masa flour (CMF) is a policy-level intervention for NTD prevention; however, the impact on NTD prevalence has not been estimated.

METHODS

We developed a model to estimate the percentage reduction in prevalence of spina bifida and anencephaly (NTDs) that could occur with FA fortification of CMF. Model inputs included estimates of the percentage reduction in United States NTD prevalence attributed to FA fortification of enriched cereal grain products (1995-1996 vs. 1998-2002), the increase in median FA intake after enriched cereal grain product fortification, and the estimated increase in median FA intake that could occur with CMF fortification at the same level as enriched cereal grain products (140 μg/100 g). We used Monte Carlo simulation to quantify uncertainty. We stratified analyses by racial/ethnic group and rounded results to the nearest 10.

RESULTS

We estimated CMF fortification could prevent 30 Hispanic infants from having spina bifida (95% uncertainty interval: 0, 80) and 10 infants from having anencephaly (95% uncertainty interval: 0, 40) annually. The estimated impact among non-Hispanic whites and blacks was smaller.

CONCLUSION

CMF fortification with FA could prevent from 0 to 120 infants, with the most likely value of approximately 40, from having spina bifida or anencephaly among Hispanics, the population most likely to benefit from the proposed intervention. While this estimated reduction is unlikely to be discernible using current birth defect surveillance methods, it still suggests an important benefit to the target population.

Authors+Show Affiliations

National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia.No 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

Language

eng

PubMed ID

24142499

Citation

Tinker, Sarah C., et al. "Estimate of the Potential Impact of Folic Acid Fortification of Corn Masa Flour On the Prevention of Neural Tube Defects." Birth Defects Research. Part A, Clinical and Molecular Teratology, vol. 97, no. 10, 2013, pp. 649-57.
Tinker SC, Devine O, Mai C, et al. Estimate of the potential impact of folic acid fortification of corn masa flour on the prevention of neural tube defects. Birth Defects Res Part A Clin Mol Teratol. 2013;97(10):649-57.
Tinker, S. C., Devine, O., Mai, C., Hamner, H. C., Reefhuis, J., Gilboa, S. M., Dowling, N. F., & Honein, M. A. (2013). Estimate of the potential impact of folic acid fortification of corn masa flour on the prevention of neural tube defects. Birth Defects Research. Part A, Clinical and Molecular Teratology, 97(10), 649-57. https://doi.org/10.1002/bdra.23158
Tinker SC, et al. Estimate of the Potential Impact of Folic Acid Fortification of Corn Masa Flour On the Prevention of Neural Tube Defects. Birth Defects Res Part A Clin Mol Teratol. 2013;97(10):649-57. PubMed PMID: 24142499.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Estimate of the potential impact of folic acid fortification of corn masa flour on the prevention of neural tube defects. AU - Tinker,Sarah C, AU - Devine,Owen, AU - Mai,Cara, AU - Hamner,Heather C, AU - Reefhuis,Jennita, AU - Gilboa,Suzanne M, AU - Dowling,Nicole F, AU - Honein,Margaret A, PY - 2013/03/07/received PY - 2013/05/20/revised PY - 2013/05/21/accepted PY - 2013/10/22/entrez PY - 2013/10/22/pubmed PY - 2014/6/4/medline KW - folic acid KW - fortification KW - neural tube defects KW - prevention SP - 649 EP - 57 JF - Birth defects research. Part A, Clinical and molecular teratology JO - Birth Defects Res. Part A Clin. Mol. Teratol. VL - 97 IS - 10 N2 - BACKGROUND: Hispanics in the US have a higher prevalence of neural tube defect (NTD) -affected pregnancies than non-Hispanic whites, and lower median total folic acid (FA) intake. FA fortification of corn masa flour (CMF) is a policy-level intervention for NTD prevention; however, the impact on NTD prevalence has not been estimated. METHODS: We developed a model to estimate the percentage reduction in prevalence of spina bifida and anencephaly (NTDs) that could occur with FA fortification of CMF. Model inputs included estimates of the percentage reduction in United States NTD prevalence attributed to FA fortification of enriched cereal grain products (1995-1996 vs. 1998-2002), the increase in median FA intake after enriched cereal grain product fortification, and the estimated increase in median FA intake that could occur with CMF fortification at the same level as enriched cereal grain products (140 μg/100 g). We used Monte Carlo simulation to quantify uncertainty. We stratified analyses by racial/ethnic group and rounded results to the nearest 10. RESULTS: We estimated CMF fortification could prevent 30 Hispanic infants from having spina bifida (95% uncertainty interval: 0, 80) and 10 infants from having anencephaly (95% uncertainty interval: 0, 40) annually. The estimated impact among non-Hispanic whites and blacks was smaller. CONCLUSION: CMF fortification with FA could prevent from 0 to 120 infants, with the most likely value of approximately 40, from having spina bifida or anencephaly among Hispanics, the population most likely to benefit from the proposed intervention. While this estimated reduction is unlikely to be discernible using current birth defect surveillance methods, it still suggests an important benefit to the target population. SN - 1542-0760 UR - https://www.unboundmedicine.com/medline/citation/24142499/Estimate_of_the_potential_impact_of_folic_acid_fortification_of_corn_masa_flour_on_the_prevention_of_neural_tube_defects_ L2 - https://doi.org/10.1002/bdra.23158 DB - PRIME DP - Unbound Medicine ER -