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A 2015 global update on folic acid-preventable spina bifida and anencephaly
Annelise Arth1, Vijaya Kancherla1, Helena Pachón2,3
1Center for Spina Bifida Prevention, Department of Epidemiology, Rollins School of Public Health of Emory University, Atlanta, Georgia.
Insights
Folic acid fortification prevented 13.2% of neural tube defects in 2015, but widespread implementation is needed. This simple intervention can significantly reduce birth defects and improve global health outcomes.
Area of Science:
- Public Health
- Nutritional Epidemiology
- Birth Defects Prevention
Background:
- Spina bifida and anencephaly are major neural tube defects causing significant mortality and disability.
- These conditions contribute substantially to adverse perinatal and infant health outcomes globally.
- Monitoring the prevention of folic acid-preventable spina bifida and anencephaly (FAP SBA) is crucial for public health initiatives.
Purpose of the Study:
- To assess the global status of FAP SBA prevention in 2015.
- To quantify the impact of mandatory folic acid fortification on FAP SBA rates.
- To identify regions with low implementation of folic acid fortification programs.
Main Methods:
- Modeled the proportion of FAP SBA prevented by mandatory folic acid fortification in countries with wheat/maize flour fortification (≥1.0 ppm).
- Assumed 200 μg/day folic acid fortification is fully protective, reducing FAP SBA rates to a minimum of 0.5 per 1000 births.
- Included countries with complete coverage information for mandatory fortification programs.
Main Results:
- In 2015, mandatory folic acid fortification prevented an estimated 13.2% (35,500 cases) of FAP SBA globally across 58 countries.
- Wheat and maize flour fortification were the primary vehicles for folic acid delivery in these countries.
- Significant gaps in mandatory fortification implementation were observed, particularly in Europe, Africa, and Asia.
Conclusions:
- Despite 25 years of knowledge on folic acid's preventive effects, a small fraction of FAP SBA is currently prevented worldwide.
- Many countries continue to experience high rates of FAP SBA, indicating a substantial burden of preventable disability and mortality.
- Implementing mandatory folic acid fortification is a proven, rapid strategy for governments to prevent FAP SBA and achieve Sustainable Development Goals.
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.
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