Red Blood Cell Folate Insufficiency among nonpregnant Women of Childbearing age in Guatemala 2009 to 2010: Prevalence and predicted Neural Tube Defects risk

Rosenthal, Jorge; Reeve, Mary-Elizabeth; Ramirez, Nicte; Crider, Krista S.; Sniezek, Joseph E.; Vellozzi, Claudia; Devine, Owen; Lopez-Pazos, Eunice

doi:10.1002/bdra.23499

Cited by 22 publications

(34 citation statements)

References 26 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Consistent with a recent report from Guatemala (Rosenthal et al, ), gaps were present in folate concentrations between rural and urban women: Urban women had higher folate concentrations than rural women. Moreover, rural women had a higher proportion of folate insufficiency than urban women, replicating findings from our previous study (Liu, Gao, et al, ).…”

Section: Discussionsupporting

confidence: 89%

Folate of pregnant women after a nationwide folic acid supplementation in China

Zhang¹,

Liu

Jin

et al. 2019

Maternal & Child Nutrition

View full text Add to dashboard Cite

Folate insufficiency during the periconceptional period increases the risk of neural tube defects (NTDs) in offspring, and folic acid supplementation substantially reduces the risk. Widespread large‐scale folic acid supplementation (0.4‐mg folic acid tablet) has been adopted as a main strategy to prevent NTDs in China since 2009. We examined folate concentrations in plasma and red blood cells (RBCs) of pregnant women and the factors associated with blood folate concentrations in a population with a high prevalence of NTDs in northern China. A cross‐sectional survey was conducted in 2014, and 1,107 pregnant women were recruited from 11 county or city maternal and child health centres across Shanxi province. Microbiological assays were used to determine folate concentrations. Factors associated with blood folate insufficiency were identified. The median (25th and 75th percentiles) folate concentrations were 28.4 (17.6, 45.2) nmol L−1 and 1,001.2 (658.7, 1,402.5) nmol L−1 in plasma and RBCs, respectively. According to the proposed RBC (906 nmol L−1) concentrations for optimal NTD prevention, 42.4% participants had RBC folate insufficiency. Rural women had a higher proportion of folate insufficiency than urban women. Folic acid supplementation was the only factor associated with RBC folate insufficiency. A large proportion of women had RBC folate concentrations that are not optimal for the prevention of NTDs despite free access to folic acid supplements. Actions that aim to improve folic acid supplementation compliance are needed to reach the full potential of the nationwide folic acid supplementation programme in terms of NTD prevention.

show abstract

Section: Discussionsupporting

confidence: 89%

Folate of pregnant women after a nationwide folic acid supplementation in China

Zhang¹,

Liu

Jin

et al. 2019

Maternal & Child Nutrition

View full text Add to dashboard Cite

show abstract

“…This is an important public health concern (30). The prevalence of RBC folate insufficiency was slightly higher than that reported by Guatemala (47.2%) (43) but was much higher than that reported by the United States (22.1%) (27). Thus, with Belize’s voluntary folic acid fortification program, there is a high prevalence of folate deficiency and insufficiency.…”

Section: Discussioncontrasting

confidence: 59%

Folate Deficiency Is Prevalent in Women of Childbearing Age in Belize and Is Negatively Affected by Coexisting Vitamin B-12 Deficiency: Belize National Micronutrient Survey 2011

Rosenthal

Largaespada

Bailey

et al. 2017

The Journal of Nutrition

Self Cite

View full text Add to dashboard Cite

Background Folate deficiency, vitamin B-12 deficiency, and anemia can have adverse effects on birth outcomes. Also, low vitamin B-12 reduces the formation of metabolically active folate. Objectives We sought to establish the baseline prevalence of and factors associated with folate deficiency and insufficiency, vitamin B-12 deficiency, and anemia among women of childbearing age (WCBA) in Belize. Methods In 2011, a national probability-based survey was completed among Belizean nonpregnant WCBA aged 15–49 y. Blood samples for determination of hemoglobin, folate (RBC and serum), and vitamin B-12 (plasma) and sociodemographic and health information were collected from 937 women. RBC and serum folate concentrations were measured by microbiologic assay (MBA). Folate status was defined based on both the WHO-recommended radioproteinbinding assay and the assay adjusted for the MBA. Results The national prevalence estimates for folate deficiency in WCBA, based on serum and RBC folate concentrations by using the assay-matched cutoffs, were 11.0% (95% CI: 8.6%, 14.0%) and 35.1% (95% CI: 31.3%, 39.2%), respectively. By using the assay-matched compared with the WHO-recommended cutoffs, a substantially higher prevalence of folate deficiency was observed based on serum (6.9% absolute difference) and RBC folate (28.9% absolute difference) concentrations. The prevalence for RBC folate insufficiency was 48.9% (95%CI: 44.8%, 53.1%). Prevalence estimates for vitamin B-12 deficiency and marginal deficiency and anemia were 17.2% (95% CI: 14.2%, 20.6%), 33.2% (95% CI: 29.6%, 37.1%), and 22.7% (95% CI: 19.5%, 26.2%), respectively. The adjusted geometric means of the RBC folate concentration increased significantly (P-trend < 0.001) in WCBA who had normal vitamin B-12 status relative to WCBA who were vitamin B-12 deficient. Conclusions In Belize, the prevalence of folate and vitamin B-12 deficiencies continues to be a public health concern among WCBA. Furthermore, low folate status co-occurred with low vitamin B-12 status, underlining the importance of providing adequate vitamin B-12 and folic acid intake through approaches such as mandatory food fortification.

show abstract

“…In addition to harmonizing MBA assay conditions and using assay‐matched cutoffs, the global assessment of folate status in WRA requires simplified data analysis and modeling approaches and greater consistency in the presentation of data to allow comparisons across countries. Modeling approaches used in some of the key studies detailed in this report are complex and may be challenging to utilize extensively. Further, RBC folate concentrations are variably presented as mean, geometric mean, or median values along with or in lieu of the prevalence of deficiency/insufficiency in published survey reports .…”

Section: Microbiologic Assay: Most Reliable Methods To Quantify Rbc Fomentioning

confidence: 99%

“…Rosenthal et al . were the first investigators to apply the WHO guideline for folate insufficiency in an LMIC.…”

Section: Assessing Ntd Risk With Population‐based Rbc Folate Concentrmentioning

confidence: 99%

“…Prevalence estimates of RBC folate insufficiency were determined using prevalence risk ratios for area type (urban or rural) and other biological (i.e., age and ethnicity) and socioeconomic status (SES) (i.e., level of education and wealth index) factors and region. The complex statistical approaches used to estimate NTD risk based on RBC folate concentrations were described previously …”

Section: Assessing Ntd Risk With Population‐based Rbc Folate Concentrmentioning

confidence: 99%

See 1 more Smart Citation

Folate status in women of reproductive age as basis of neural tube defect risk assessment

Bailey

Hausman

2017

Annals of the New York Academy of Sciences

View full text Add to dashboard Cite

Reliable folate status data for women of reproductive age (WRA) to assess global risk for neural tube defects (NTDs) are needed. We focus on a recent recommendation by the World Health Organization that a specific "optimal" red blood cell (RBC) folate concentration be used as the sole indicator of NTD risk within a population and discuss how to best apply this guidance to reach the goal of assessing NTD risk globally. We also emphasize the importance of using the microbiologic assay (MBA) as the most reliable assay for obtaining comparable results for RBC folate concentration across time and countries, the need for harmonization of the MBA through use of consistent key reagents and procedures within laboratories, and the requirement to apply assay-matched cutoffs for folate deficiency and insufficiency. To estimate NTD risk globally, the ideal scenario would be to have country-specific population-based surveys of RBC folate in WRA determined utilizing a harmonized MBA, as was done in recent studies in Guatemala and Belize. We conclude with guidance on next steps to best navigate the road map toward the goal of generating reliable folate status data on which to assess NTD risk in WRA in low-and middle-income countries.

show abstract

Red Blood Cell Folate Insufficiency among nonpregnant Women of Childbearing age in Guatemala 2009 to 2010: Prevalence and predicted Neural Tube Defects risk

Cited by 22 publications

References 26 publications

Folate of pregnant women after a nationwide folic acid supplementation in China

Folate of pregnant women after a nationwide folic acid supplementation in China

Folate Deficiency Is Prevalent in Women of Childbearing Age in Belize and Is Negatively Affected by Coexisting Vitamin B-12 Deficiency: Belize National Micronutrient Survey 2011

Folate status in women of reproductive age as basis of neural tube defect risk assessment

Contact Info

Product

Resources

About