2012 Update on global prevention of folic acid–preventable spina bifida and anencephaly

Abstract

We estimate an increasing prevention of FAPSBA in the world through folic acid fortification, yet the pace is slow. Our new model estimates that only 25% prevention and reminds us that there remains a lot of work to do in countries that do not implement mandatory fortification, which is key to achieving global and total prevention. If we are to prevent all FAPSBA, there is an urgent need to build the global political will to find sufficient resources to aid in this effort.

Urgent global opportunities to prevent birth defects

“…Accordingly, less than one-quarter of total preventable cases of FAPSBA were prevented worldwide. The number of cases of FAPSBA prevented have increased from 9% in 2006 [16] to 15% in 2012 [17]; however, more needs to be done to prevent remaining cases, which amount to 200 000 cases each year globally. There is an urgent need for those countries with the majority of these cases, such as India [18] and China [19,20], to implement mandatory folic acid fortification policies and to promote consumption among women of reproductive age.…”

Genetic, Epigenetic, and Environmental Contributions to Neural Tube Closure

“…Similar fortification campaigns in other countries have yielded comparable results (41, 42, 104). Overall, more than 75 countries have implemented mandatory FA fortification campaigns, primarily in wheat flour, and it is estimated that FA fortification has prevented 15–25% of FA-responsive NTDs worldwide (188). Interestingly, the incidence of spina bifida did not continue to decline after the initial decrease but rates of anencephaly did (21).…”

Birth Defect

“…Iodine deficiency, folate insufficiency, obesity, or uncontrolled diabetes mellitus are linked to some congenital anomalies [12][13][14] . For example folate insufficiency increases the risk of having a baby with neural tube defects 15 .…”