Preventing birth defects, saving lives, and promoting health equity: an urgent call to action for universal mandatory food fortification with folic acid

Comprehensive and equitable approaches to the management of neurological conditions in low-and middle-income countries-A call to action

“…CHYSPR specifically recommends mandatory folic acid fortification and affordable folic acid supplementation for all women of childbearing age to prevent spina bifida. This is in line with an urgent call to action, addressed at the 75th World Health Assembly in Geneva in May 2022, and supported by a publication in the Lancet Global Health ( Kancherla et al., 2022 ). Moreover, a major causative factor for hydrocephalus in LMICs is post-infectious, and a recent meta-analysis concluded that, in Africa, this constitutes the main etiology in hydrocephalic children ( Aukrust et al., 2022 ).…”

Beyond the OR doors: presidential address to the 48th annual meeting of the International Society for Pediatric Neurosurgery (ISPN)

“…Finally, I have asked Kemel Ghotme, MD, PhD, in his presidential lecture to speak regarding the third issue for which we should advocate, and that is spina bifida. It has been three decades since we were given class I evidence that micronutrient supplementation of general diets with folic acid could prevent over 70% of spina bifida births [ 10 ], and yet, less than one-quarter of the countries in our world to date have adopted folic acid supplementation as a national strategy to help these children be born without a neural tube defect. We, as pediatric neurosurgeons, spend our nights and holidays in the operating room fixing broken shunts, repairing myelomeningoceles, and untethering spinal cords; but how many of us have taken the time to speak to our elected officials in support of legislation that could change our world and the world of our patients in less time than it takes for us to train one new neurosurgeon?…”

A Paternal Methylation Error in the Congenital Hydrocephalic Texas (H-Tx) Rat Is Partially Rescued with Natural Folate Supplements

“…Little or no research has been carried out on the contribution of methylation and the potential beneficial effects of supplementation in both sexes. Food fortification supplements for both men and women in the USA are associated not only with a reduction in neural tube defects but also congenital heart defects, cardiovascular issues and certain cancers [ 60 ] indicating a potential paternal benefit of fortification including unexplained infertility [ 61 ]. Due to our finding that the risk of hydrocephalus in the H-Tx rat, with its unknown genetic cause, can be reduced with folate, we hypothesised that a methylation error in either or both parents may be responsible.…”