A 2015 global update on folic acid‐preventable spina bifida and anencephaly

Arth, Annelise; Kancherla, Vijaya; Pachón, Helena; Zimmerman, Sarah; Johnson, Quentin; Oakley, Godfrey P.

doi:10.1002/bdra.23529

Cited by 64 publications

(84 citation statements)

References 39 publications

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“…Long-term intake of folic acid–fortified foods should complement preconceptional folic acid supplementation. Arth et al reported that mandatory folic acid fortification of wheat and maize flour prevented 13.2% folic acid–preventable NTDs (35,500 of approximately 268,700 global cases) in 58 countries [12]. Seventy-eight countries have fortified flour with folic acid mandatorily, while most countries in Asia, Europe and Africa do not mandate folic acid fortification [13].…”

Section: B-vitamins One-carbon Metabolism and Ntdsmentioning

confidence: 99%

Nutrition, One-Carbon Metabolism and Neural Tube Defects: A Review

Wahlqvist

2016

Nutrients

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Neural tube defects (NTDs) are a group of severe congenital malformations, induced by the combined effects of genes and the environment. The most valuable finding so far has been the protective effect of folic acid supplementation against NTDs. However, many women do not take folic acid supplements until they are pregnant, which is too late to prevent NTDs effectively. Long-term intake of folic acid–fortified food is a good choice to solve this problem, and mandatory folic acid fortification should be further promoted, especially in Europe, Asia and Africa. Vitamin B2, vitamin B-6, vitamin B-12, choline, betaine and n-3 polyunsaturated fatty acids (PUFAs) can also reduce the NTD risk by interacting with the one-carbon metabolism pathway. This suggest that multivitamin B combined with choline, betaine and n-3 PUFAs supplementation may have a better protective effect against NTDs than folic acid alone. Genetic polymorphisms involved in one-carbon metabolism are associated with NTD risk, and gene screening for women of childbearing age prior to pregnancy may help prevent NTDs induced by the risk allele. In addition, the consumption of alcohol, tea and coffee, and low intakes of fruit and vegetable are also associated with the increased risk of NTDs, and should be avoided by women of childbearing age.

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Section: B-vitamins One-carbon Metabolism and Ntdsmentioning

confidence: 99%

Nutrition, One-Carbon Metabolism and Neural Tube Defects: A Review

Wahlqvist

2016

Nutrients

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“…Preconceptional supplementation with folate increases maternal folate status and prevents a significant number of births with neural tube defects (NTDs) [1–4], even when women are not folate deficient. Therefore, it is recommended that women planning pregnancy or capable of being pregnant should achieve additional intake of 400 µg/day folic acid through supplements and/or fortified foods at least 1 month before pregnancy [5, 6].…”

Section: Introductionmentioning

confidence: 99%

The effectiveness of daily supplementation with 400 or 800 µg/day folate in reaching protective red blood folate concentrations in non-pregnant women: a randomized trial

et al. 2017

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PurposeFolate required to achieve desirable red blood cell (RBC) folate concentrations within 4–8 weeks pre-pregnancy is not known. We studied the effect of supplementation with 400 or 800 µg/day folate in achieving RBC-folate ≥906 nmol/L.MethodsNon-pregnant women were randomized to receive multinutrient supplements containing 400 µg/day (n = 100) or 800 µg/day (n = 101) folate [folic acid and (6S)-5-CH3-H4folate-Ca (1:1)]. The changes of folate biomarkers were studied after 4 and 8 weeks in the 198 women who returned at least for visit 2.ResultsAt baseline, 12 of the 198 participants (6.1%) had RBC-folate <340 nmol/L, but 88% had levels <906 nmol/L. The RBC-folate concentrations increased significantly in the 800 µg/day (mean ± SD = 652 ± 295 at baseline; 928 ± 330 at 4 weeks; and 1218 ± 435 nmol/L at 8 weeks) compared with the 400 µg/day [632 ± 285 at baseline (p = 0.578); 805 ± 363 at 4 weeks (p < 0.001); 1021 ± 414 nmol/L at 8 weeks (p < 0.001)]. The changes of RBC-folate were greater in the 800 µg/day than in the 400 µg/day at any time (changes after 8 weeks: 566 ± 260 vs. 389 ± 229 nmol/L; p < 0.001). Significantly more women in the 800 µg group achieved desirable RBC-folate concentrations at 4 weeks (45.5 vs. 31.3%; p = 0.041) or 8 weeks (83.8 vs. 54.5%; p < 0.001) compared with the 400 µg group. RBC-folate levels below the population median (590 nmol/L) were associated with a reduced response to supplements.Conclusions88% of the women had insufficient RBC-folate to prevent birth defects, while 6.1% had deficiency. Women with low RBC-folate were unlikely to achieve desirable levels within 4–8 weeks, unless they receive 800 µg/day. The current supplementation recommendations are not sufficient in countries not applying fortification.Trials registerThe trial was registered at The German Clinical Trials Register: DRKS-ID: DRKS00009770.Electronic supplementary materialThe online version of this article (doi:10.1007/s00394-017-1461-8) contains supplementary material, which is available to authorized users.

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“…Worldwide we are preventing only about 10% of the neural tube defects that can be avoided by folate 1. The EU and some of the world’s largest countries have not adopted mandatory fortification, the only population strategy definitively shown to reduce the incidence of these devastating birth defects 1.…”

Section: Yes—james L Mills Anne M Molloymentioning

confidence: 99%

“…The EU and some of the world’s largest countries have not adopted mandatory fortification, the only population strategy definitively shown to reduce the incidence of these devastating birth defects 1. Some have argued that fortification will benefit only a small number of children at the expense of an unproved risk to a much larger number of elderly people.…”

Section: Yes—james L Mills Anne M Molloymentioning

confidence: 99%