A global update on the status of prevention of folic acid‐preventable spina bifida and anencephaly in year 2020: 30‐Year anniversary of gaining knowledge about folic acid's prevention potential for neural tube defects

Abstract

Background Spina bifida and anencephaly are major neural tube defects largely preventable through maternal periconceptional intake of folic acid. We estimated the global proportion of folic acid‐preventable spina bifida and anencephaly (FAP SBA) prevented through mandatory folic acid fortification of cereal grains, including wheat flour, maize flour, and rice, at the end of year 2020, a time point marking the 30th anniversary of the publication of landmark British Medical Research Council (MRC) study providing unequivocal knowledge on folic acid's FAP SBA prevention potential. Methods The Food Fortification Initiative database was used to identify countries with mandatory fortification policies with folic acid added to cereal grains. We examined the status of FAP SBA prevention assuming mandatory folic acid fortification at 200 mcg/day of folic acid protects against FAP SBA and reduces their prevalence to a minimum achievable rate of 0.5 cases/1000 live births. Results Our analysis showed that 61,680 FAP SBA cases were prevented in the year 2020 through mandatory folic acid fortification of cereal grains in 58 countries, translating to 22% prevention of total possible FAP SBA prevention globally. Many countries in Africa, Asia, and Europe are yet to implement fortification. In 2020, 30 years after the MRC study was published, 218,270 preventable FAP SBA cases still occurred globally. Conclusion Global prevention efforts for FAP SBA are inadequate even after three decades of knowledge on their prevention. Universal mandatory fortification of staples should be urgently implemented to prevent thousands of FAP SBA and associated elective terminations, stillbirths, and child mortality.

Negative effects of endocrine disruptor bisphenol A on ovarian granulosa cells and the protective role of folic acid

“…This result indicates the importance of this research, as future findings could be used to improve the chances of conceiving and giving birth in women with higher levels of EDs in biological samples who have difficulty conceiving. In established clinical practice, folic acid is prescribed to pregnant women for healthy fetal development (van Gool et al 2018, Kancherla et al 2022 but not in patients with high concentrations of EDs in their biological samples. In addition, folic acid has been shown to reduce the toxic effects of EDs in animal models (Bilgi et al 2019, Lee et al 2019.…”

Paediatricians as champions for ending folic acid-preventable spina bifida, anencephaly globally

“… 2 While mandatory fortification benefits these 58 countries, over 100 other countries, many in Europe, Asia and Africa lag behind in SBA-F prevention by not investing in this proven public health intervention. 2 …”

“…1 As of 2020, 58 countries have mandatory policies for staple food fortification with folic acid, due to which about 22% of global cases of preventable SBA-F are prevented. 2 While mandatory fortification benefits these 58 countries, over 100 other countries, many in Europe, Asia and Africa lag behind in SBA-F prevention by not investing in this proven public health intervention. 2 At the May 2022 World Health Assembly (WHA) meeting, the Colombian government agreed to champion the passage of a resolution to promote global prevention of SBA-F.…”

“…2 While mandatory fortification benefits these 58 countries, over 100 other countries, many in Europe, Asia and Africa lag behind in SBA-F prevention by not investing in this proven public health intervention. 2 At the May 2022 World Health Assembly (WHA) meeting, the Colombian government agreed to champion the passage of a resolution to promote global prevention of SBA-F. This resolution calls for the adoption by all member nations of folic acid fortification of commonly consumed staple foods.…”

“…Thirty years ago, the British Medical Research Council’s landmark randomised control trial established that adequate intake of folic acid consumption by mothers before and during early pregnancy is the most effective public health strategy for preventing the majority of SBA cases, known as SBA-F (F indicates folic acid-preventable SBA) 1. As of 2020, 58 countries have mandatory policies for staple food fortification with folic acid, due to which about 22% of global cases of preventable SBA-F are prevented 2. While mandatory fortification benefits these 58 countries, over 100 other countries, many in Europe, Asia and Africa lag behind in SBA-F prevention by not investing in this proven public health intervention 2…”