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Global Burden of Neural Tube Defects, Risk Factors, and Prevention
A L Flores1, C Vellozzi1, D Valencia1
1Division of Birth Defects and Developmental Disabilities, National Center on Birth Defects and Developmental Disabilities, US Centers for Disease Control and Prevention, Atlanta, USA.
Insights
Neural tube defects (NTDs) are preventable with folic acid, yet access to supplements and fortified foods remains limited globally, especially in low-resource regions. Improved surveillance and fortification policies are crucial for NTD prevention and child mortality reduction.
Area of Science:
- Public Health
- Maternal and Child Health
- Preventive Medicine
Background:
- Neural tube defects (NTDs) are severe congenital anomalies affecting the brain and spine, leading to significant mortality and disability worldwide.
- An estimated 300,000 births annually are impacted by NTDs, with a disproportionately high burden in South East Asia.
- Prevention is possible through adequate folic acid intake during early pregnancy, but access to fortified foods and supplements is a major barrier in many regions.
Purpose of the Study:
- To highlight the global impact and preventability of neural tube defects (NTDs).
- To underscore the critical need for improved access to folic acid fortification and supplementation programs.
- To emphasize the importance of birth defect surveillance for informing public health interventions.
Main Methods:
- Review of global NTD prevalence and risk factors.
- Analysis of current folic acid fortification and supplementation strategies.
- Assessment of data gaps in birth defect surveillance in low and middle-income countries.
Main Results:
- NTDs pose a substantial global health challenge, preventable with folic acid.
- Limited access to folic acid interventions and inadequate surveillance data hinder prevention efforts, particularly in South East Asia.
- Current initiatives fall short of meeting global targets for NTD reduction.
Conclusions:
- Expanding folic acid fortification and supplementation programs is essential for reducing NTD prevalence.
- Strengthening birth defect surveillance systems is critical for effective public health planning and intervention.
- Global collaboration is needed to achieve reductions in NTDs and child mortality, aligning with UN and WHO goals.
Abstract:
Neural tube defects (NTDs), serious birth defects of the brain and spine usually resulting in death or paralysis, affect an estimated 300,000 births each year worldwide. Although the majority of NTDs are preventable with adequate folic acid consumption during the preconception period and throughout the first few weeks of gestation, many populations, in particular those in low and middle resource settings, do not have access to fortified foods or vitamin supplements containing folic acid. Further, accurate birth defects surveillance data, which could help inform mandatory fortification and other NTD prevention initiatives, are lacking in many of these settings. The burden of birth defects in South East Asia is among the highest in the world. Expanding global neural tube defects prevention initiatives can support the achievement of the United Nations Millennium Development Goal 4 to reduce child mortality, a goal which many countries in South East Asia are currently not poised to reach, and the 63rd World Health Assembly Resolution on birth defects. More work is needed to develop and implement mandatory folic acid fortification policies, as well as supplementation programs in countries where the reach of fortification is limited.
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