A 2019 global update on folic acid‐preventable spina bifida and anencephaly

Abstract

Background Mandatory folic acid fortification of staples is a proven intervention to prevent spina bifida and anencephaly, two life‐threatening and disabling neural tube defects. We estimated the global proportion of folic acid‐preventable spina bifida and anencephaly (FAP SBA) prevented through mandatory folic acid fortification of wheat and/or maize flour in 2019. Methods Using data from the Global Fortification Data Exchange, we identified countries with mandatory fortification policies that required at least 1.0 ppm folic acid be added to wheat and/or maize flour and had information on percentage of industrially milled flour that is fortified. We built FAP SBA prevention models assuming mandatory folic acid fortification at 200 μg/day of folic acid fully protects against FAP SBA and would lower the prevalence neural tube defects to 0.5 per 1,000 live births. Results In 2019, 56 countries met our criteria for mandatory folic acid fortification of wheat (n = 56 countries) and/or maize (n = 15 countries) flour and with complete data for our modeling. Overall, our prevention model estimated that 65,380 FAP SBA cases were prevented in 2019 through folic acid fortification of wheat and/or maize flour. We estimated the current global prevention proportion of all preventable FAP SBA cases worldwide to be at 23% of total possible prevention. Conclusion Global prevention efforts for FAP SBA are slow and have stalled. Mandatory fortification should be urgently implemented in all countries to prevent epidemics of FAP SBA, and to achieve health‐related Sustainable Development Goals for year 2030 by reducing child mortality due to preventable FAP SBA.

Inadequate Status and Low Awareness of Folate in Switzerland—A Call to Strengthen Public Health Measures to Ensure Sufficient Intakes

“…Mandatory fortification of staple foods with folic acid is another proven intervention to increase the folate intake in the general population and decrease the incidence of NTDs [11,12]. This typically provides an additional 100-200 µg folic acid/day to WRA [13].…”

“…Globally, 84 countries had mandatory fortification in 2019 [14,15]. However, an estimated 215,000 NTD-affected pregnancies still occurred as a result of inadequate or nonexistent fortification policies [11]. In Switzerland, the prevalence of NTDs is comparable to other European countries and lower than the global estimates [16][17][18].…”

Current levels of coverage of iron and folic acid fortification are insufficient to meet the recommended intake for women of reproductive age in low- and middle-income countries

“…Therefore, we include compliance data in our estimate for coverage to reflect situation in the real world. Since WRA had a higher daily need for both iron and folic acid and many LMICs has low compliance, our estimated impact of coverage might be lower than previously estimated coverage when using international standard and without adjustment for compliance, where it was estimated that 65 380 neural tube defect cases were prevented in a year [ 18 ].…”

O uso da suplementação materna para prevenção de defeitos congênitos e outros agravos na gestação / The use of maternal supplementation to prevent congenital defects and other aggregates in pregnancy

“…Com tal nutriente adicionado a estes alimentos, estimou-se que 65.380 casos de espinha bífida e anencefalia foram evitados, sendo, portanto, essa uma medida muito importante para a prevenção de efeitos no tubo neural e mostrando com isso que o ácido fólico tem um papel central no bom desenvolvimento deste sistema. Ademais, o estudo ainda concluiu que até 23% dos casos de espinha bífida e anencefalia poderiam ser evitados em todo mundo com a adição de ácido fólico nas farinhas, já que são alimentos muito consumidos em grande parte do globo (KANCHERLA et al, 2020).…”