Prevalence of spina bifida and anencephaly during the transition to mandatory folic acid fortification in the United States

Williams, Laura; Cara, T.; Edmonds, Larry D.; Shaw, Gary M.; Kirby, Russell S.; Hobbs, Charlotte A.; Sever, Lowell E.; Miller, Lisa; Meaney, F. John; Levitt, Miriam

doi:10.1002/tera.10060

Cited by 284 publications

(130 citation statements)

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“…It is well established that folic acid taken prior to conception and early in gestation reduces a woman's risk of having a baby with a neural tube defect (NTD) [19][20][21][22][23] and possibly other defects [24,25], and recent studies suggest that maternal folate status has a direct effect on low birth weight and preterm delivery [26,27]. Smoking during pregnancy is an independent risk factor for preterm birth and for certain types of birth defects including orofacial clefts and clubfoot [28,29].…”

Section: Discussionmentioning

confidence: 99%

“…Stratified analysis was used to assess factors potentially modifying the association between preterm birth and birth defects. Factors assessed included: maternal race/ethnicity (non-Hispanic white, non-Hispanic black, Hispanic, other), maternal age in years (13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32)(33)(34), C35) number of previous live births (none, 1 or more), maternal education (\12 years, 12 years, [12 years), initiation of prenatal care (first trimester, second trimester, third trimester, no prenatal care), and delivery method (vaginal, vaginal birth after C-section, primary C-section, repeat C-section). To improve comparability, birth certificates were used as the source of these data for both the numerator and denominator.…”

Section: Methodsmentioning

confidence: 99%

See 1 more Smart Citation

The Association Between Major Birth Defects and Preterm Birth

Honein¹,

Kirby

Meyer

et al. 2008

Matern Child Health J

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114

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Objective To evaluate the association between preterm birth and major birth defects by maternal and infant characteristics and specific types of birth defects. Study Design We pooled data for 1995-2000 from 13 states with population-based birth defects surveillance systems, representing about 30% of all U.S. births. Analyses were limited to singleton, live births from 24-44 weeks gestational age. Results Overall, birth defects were more than twice as common among preterm births (24-36 weeks) compared with term births (37-41 weeks gestation) (prevalence ratio [PR] = 2.65, 95% confidence interval [CI] 2.62-2.68), and approximately 8% of preterm births had a birth defect. Birth defects were over five times more likely among very preterm births (24-31 weeks gestation) compared with term births (PR = 5.25, 95% CI 5.15-5.35), with about 16% of very preterm births having a birth defect. Defects most strongly associated with very preterm birth included central nervous system defects (PR = 16.23, 95% CI 15.49-17.00) and cardiovascular defects (PR = 9.29, 95% CI 9.03-9.56). Conclusions Birth defects contribute to the occurrence of preterm birth. Research to identify shared causal pathways and risk factors could suggest appropriate interventions to reduce both preterm birth and birth defects.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

The Association Between Major Birth Defects and Preterm Birth

Honein¹,

Kirby

Meyer

et al. 2008

Matern Child Health J

Self Cite

114

View full text Add to dashboard Cite

show abstract

“…The level of fortification differs among countries; however, in all cases, these programs are designed to reduce the prevalence of pregnancies with NTDs. In the USA and Canada, these folic supplementation programs were thought to be successful because the population folate status was improved (Ray et al 2002) and reduced rates of NTDs were noted (Honein et al 2001; Williams et al 2002), although the results varied depending on ethnicity (Williams et al 2005). Data from the USA reported from the NHANES trial (Pfeiffer et al 2012) showed that the mean concentration of serum and RBC folate increased dramatically from the prefortification period (1988–1994) to the postfortification period (1990–2010), from 16.7 ± 0.5 to 41.0 ± 0.3 nM and from 747 ± 10 to 1120 ± 7 nM, respectively, resulting in a 31% reduction in the occurrence of NTDs (Williams et al 2002).…”

Section: Response Of Folate Status To Folate Intake and Supplementationmentioning

confidence: 99%

Genetic polymorphisms and folate status

Hiraoka

Kagawa

2017

Congenital Anomalies

136

102

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Moderate hyperhomocysteinemia‐induced low folate status is an independent risk factor for cardiovascular disease, dementia, and depression. Folate is an essential cofactor in the one‐carbon metabolism pathway and is necessary in amino acid metabolism, purine and thymidylate synthesis, and DNA methylation. In the folate cycle and homocysteine metabolism, folate, vitamin B12, vitamin B6, and vitamin B2 are important cofactors. Many enzymes are involved in folate transport and uptake, the folate pathway, and homocysteine (Hcy) metabolism, and various polymorphisms have been documented in these enzymes. Serum folate and total Hcy (tHcy) levels are influenced by folate intake and genetic polymorphisms in 5,10‐methylenetertahydrofolate reductase (MTHFR) such as C677T. The prevalence of the MTHFR 677TT genotype varies across ethnic groups and regions, with a frequency of approximately 15% in Japanese populations. Individuals with the TT genotype have significantly higher tHcy levels and lower folate levels in serum than those with the CT and TT genotypes. However, administration of folic acid has been shown to eliminate these differences. Moreover, data have suggested that interventions based on genotype may be effective for motivating individuals to change their lifestyle and improve their nutrition status. Accordingly, in this review, we discuss the effects of MTHFR C677T polymorphisms on serum tHcy and folate levels with folic acid intervention and evaluate approaches for overcoming folic acid deficiency and related symptoms.

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“…Implementation of food fortification with folic acid in 1998 in USA and Canada caused a significant decrease of NTDs. The incidence of spina bifida decreased by 31% and 53% in the USA and Canada, respectively [27,28]. A study conducted by Ionescu-Ittu et al showed a significant drop in incidence of congenital heart defects in Quebec province in Canada after implementation of mandatory food fortification [29].…”

Section: Discussionmentioning

confidence: 99%

Intake of folic acid by Polish women with higher education — a survey research: can we do more?

Pietrzykowska-Kuncman¹,

Zasina-Olaszek

Łukasz

et al. 2017

Ginekol Pol

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Objectives: The objective of the study is to determine efficacy of the Primary Prevention Program of Neural Tube Defects in Polish women with higher education in 5-year interval. Material and methods:Survey research was conducted twice (in 2008 and 2013) in 630 female students of universities: 305 female medical students and 325 female non-medical students. The survey was also done among women aged 27--35 who graduated from medical or non-medical universities and have at least one child. Questions concerned knowledge about prophylaxis and periconceptional folic acid intake. Chi square test was used to assess the significance. There was no significant difference in preconceptional folic acid intake among mothers with medical and non-medical education (53.3% vs. 45% p = 0.4). However, the highest folic acid intake was among mothers -medical doctors who treat children with neural tube defect. Conclusions:Difference between medical and non-medical students shows that better educational programs may improve knowledge about prophylaxis. Aside from knowledge, compliance with recommendations of Primary Prevention Program of Neural Tube Defects is unsatisfactory.

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Prevalence of spina bifida and anencephaly during the transition to mandatory folic acid fortification in the United States

Abstract: The decline in the prevalence of spina bifida was temporally associated with folic acid fortification of US grain supplies. The temporal association between fortification and the prevalence of anencephaly is unclear.

Cited by 284 publications

References 12 publications

The Association Between Major Birth Defects and Preterm Birth

The Association Between Major Birth Defects and Preterm Birth

Genetic polymorphisms and folate status

Intake of folic acid by Polish women with higher education — a survey research: can we do more?

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