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A 2015 global update on folic acid-preventable spina bifida and anencephaly.
Birth Defects Res A Clin Mol Teratol. 2016 Jul; 106(7):520-9.BD

Abstract

BACKGROUND

Spina bifida and anencephaly are two major neural tube defects. They contribute substantially to perinatal, neonatal, infant, and under-five mortality and life-long disability. To monitor the progress toward the total prevention of folic acid-preventable spina bifida and anencephaly (FAP SBA), we examined their global status in 2015.

METHODS

Based on existing data, we modeled the proportion of FAP SBA that are prevented in the year 2015 through mandatory folic acid fortification globally. We included only those countries with mandatory fortification that added at least 1.0 ppm folic acid as a fortificant to wheat and maize flour, and had complete information on coverage. Our model assumed mandatory folic acid fortification at 200 μg/day is fully protective against FAP SBA, and reduces the rate of spina bifida and anencephaly to a minimum of 0.5 per 1000 births.

RESULTS

Our estimates show that, in 2015, 13.2% (35,500 of approximately 268,700 global cases) of FAP SBA were prevented in 58 countries through mandatory folic acid fortification of wheat and maize flour. Most countries in Europe, Africa, and Asia were not implementing mandatory fortification with folic acid.

CONCLUSION

Knowledge that folic acid prevents spina bifida and anencephaly has existed for 25 years, yet only a small fraction of FAP SBA is being prevented worldwide. Several countries still have 5- to 20-fold epidemics of FAP SBA. Implementation of mandatory fortification with folic acid offers governments a proven and rapid way to prevent FAP SBA-associated disability and mortality, and to help achieve health-related Sustainable Development Goals. Birth Defects Research (Part A) 106:520-529, 2016. © 2016 Wiley Periodicals, Inc.

Authors+Show Affiliations

Center for Spina Bifida Prevention, Department of Epidemiology, Rollins School of Public Health of Emory University, Atlanta, Georgia.Center for Spina Bifida Prevention, Department of Epidemiology, Rollins School of Public Health of Emory University, Atlanta, Georgia.Food Fortification Initiative, Atlanta, Georgia. Hubert Department of Global Health, Rollins School of Public Health of Emory University, Atlanta, Georgia.Food Fortification Initiative, Atlanta, Georgia.Food Fortification Initiative, Atlanta, Georgia.Center for Spina Bifida Prevention, Department of Epidemiology, Rollins School of Public Health of Emory University, Atlanta, Georgia.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

27418029

Citation

Arth, Annelise, et al. "A 2015 Global Update On Folic Acid-preventable Spina Bifida and Anencephaly." Birth Defects Research. Part A, Clinical and Molecular Teratology, vol. 106, no. 7, 2016, pp. 520-9.
Arth A, Kancherla V, Pachón H, et al. A 2015 global update on folic acid-preventable spina bifida and anencephaly. Birth Defects Res A Clin Mol Teratol. 2016;106(7):520-9.
Arth, A., Kancherla, V., Pachón, H., Zimmerman, S., Johnson, Q., & Oakley, G. P. (2016). A 2015 global update on folic acid-preventable spina bifida and anencephaly. Birth Defects Research. Part A, Clinical and Molecular Teratology, 106(7), 520-9. https://doi.org/10.1002/bdra.23529
Arth A, et al. A 2015 Global Update On Folic Acid-preventable Spina Bifida and Anencephaly. Birth Defects Res A Clin Mol Teratol. 2016;106(7):520-9. PubMed PMID: 27418029.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - A 2015 global update on folic acid-preventable spina bifida and anencephaly. AU - Arth,Annelise, AU - Kancherla,Vijaya, AU - Pachón,Helena, AU - Zimmerman,Sarah, AU - Johnson,Quentin, AU - Oakley,Godfrey P,Jr PY - 2015/10/15/received PY - 2016/04/14/revised PY - 2016/04/27/accepted PY - 2016/7/16/entrez PY - 2016/7/16/pubmed PY - 2017/10/13/medline KW - anencephaly KW - epidemiology KW - flour fortification KW - folic acid KW - prevention KW - spina bifida SP - 520 EP - 9 JF - Birth defects research. Part A, Clinical and molecular teratology JO - Birth Defects Res A Clin Mol Teratol VL - 106 IS - 7 N2 - BACKGROUND: Spina bifida and anencephaly are two major neural tube defects. They contribute substantially to perinatal, neonatal, infant, and under-five mortality and life-long disability. To monitor the progress toward the total prevention of folic acid-preventable spina bifida and anencephaly (FAP SBA), we examined their global status in 2015. METHODS: Based on existing data, we modeled the proportion of FAP SBA that are prevented in the year 2015 through mandatory folic acid fortification globally. We included only those countries with mandatory fortification that added at least 1.0 ppm folic acid as a fortificant to wheat and maize flour, and had complete information on coverage. Our model assumed mandatory folic acid fortification at 200 μg/day is fully protective against FAP SBA, and reduces the rate of spina bifida and anencephaly to a minimum of 0.5 per 1000 births. RESULTS: Our estimates show that, in 2015, 13.2% (35,500 of approximately 268,700 global cases) of FAP SBA were prevented in 58 countries through mandatory folic acid fortification of wheat and maize flour. Most countries in Europe, Africa, and Asia were not implementing mandatory fortification with folic acid. CONCLUSION: Knowledge that folic acid prevents spina bifida and anencephaly has existed for 25 years, yet only a small fraction of FAP SBA is being prevented worldwide. Several countries still have 5- to 20-fold epidemics of FAP SBA. Implementation of mandatory fortification with folic acid offers governments a proven and rapid way to prevent FAP SBA-associated disability and mortality, and to help achieve health-related Sustainable Development Goals. Birth Defects Research (Part A) 106:520-529, 2016. © 2016 Wiley Periodicals, Inc. SN - 1542-0760 UR - https://www.unboundmedicine.com/medline/citation/27418029/A_2015_global_update_on_folic_acid_preventable_spina_bifida_and_anencephaly_ L2 - https://doi.org/10.1002/bdra.23529 DB - PRIME DP - Unbound Medicine ER -