Global strategies for the prevention of neural tube defects through the improvement of folate status in women of reproductive age

Martı́nez, Homero; Benavides‐Lara, Adriana; Arynchyna-Smith, Anastasia; Ghotme, Kemel A.; Arabi, Mandana; Arynchyn, Alexander

doi:10.1007/s00381-023-05913-4

Cited by 11 publications

(2 citation statements)

References 73 publications

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“…These cases are likely under-reported in LMICs or infrequently discussed with regard to income status. 59 Risk factors for mortality in infants with NTD have also been reported. In the United States, Black and Hispanic infants have higher mortality compared with White infants.…”

Section: Other Risk Factorsmentioning

confidence: 99%

Comparative Scoping Review of Prenatal Care Resources for Families of Children With Spinal Dysraphism and Hydrocephalus in High-Income Countries and Low- and Middle-Income Countries

Jiang,

Kalluri,

Ran

et al. 2023

Neurosurgery

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BACKGROUND AND OBJECTIVES: Low- and middle-income countries (LMICs) face higher incidences and burdens of care for neural tube defects (NTDs) and hydrocephalus compared with high-income countries (HICs), in part due to limited access to neurosurgical intervention. In this scoping review, we aim to integrate studies on prenatal care, counseling, and surgical management for families of children with spinal dysraphism and hydrocephalus in LMICs and HICs. METHODS: PubMed, Embase, Global Index Medicus, and Web of Science electronic databases were searched for English language articles pertaining to prenatal care, counseling, and surgical management for families of children with spinal dysraphism and hydrocephalus in HICs and LMICs. Identified abstracts were screened for full-text review. Studies meeting inclusion criteria were reviewed in full and analyzed. RESULTS: Seventy studies met the inclusion criteria. Twelve studies (16.9%) were conducted in HICs only, 50 studies (70.4%) were conducted in LMICs only, and 9 studies (12.7%) encompassed both. On thematic analysis, seven underlying topics were identified: epidemiology, folate deficiency and supplementation/fortification, risk factors other than folate deficiency, prenatal screening, attitudes and perceptions about NTDs and their care, surgical management, and recommendations for guideline implementation. CONCLUSION: NTDs have become a widely acknowledged public health problem in many LMICs. Prenatal counseling and care and folate fortification are critical in the prevention of spinal dysraphism. However, high-quality, standardized studies reporting their epidemiology, prevention, and management remain scarce. Compared with NTDs, research on the prevention and screening of hydrocephalus is even further limited. Future studies are necessary to quantify the burden of disease and identify strategies for improving global outcomes in treating and reducing the prevalence of NTDs and hydrocephalus. Surgical management of NTDs in LMICs is currently limited, but pediatric neurosurgeons may be uniquely equipped to address disparities in the care and counseling of families of children with spinal dysraphism and hydrocephalus.

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Section: Other Risk Factorsmentioning

confidence: 99%

Comparative Scoping Review of Prenatal Care Resources for Families of Children With Spinal Dysraphism and Hydrocephalus in High-Income Countries and Low- and Middle-Income Countries

Jiang,

Kalluri,

Ran

et al. 2023

Neurosurgery

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“…The prevalence of such pregnancies has decreased in countries that mandated folic acid fortification of wheat flour, maize flour, or other food staples . Costa Rica has reported one of the highest reductions in the prevalence of neural tube defects, probably due to fortifying wheat flour (1.8 mg/kg), maize flour (1.3 mg/kg), milk (4 mg/250 mL), and rice (1.8 mg/kg) to ensure that all women benefit from fortification . In the US the reduction has been more modest at around 20%, probably due to a lower fortification level and the more limited scope of foods fortified.…”

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confidence: 99%

Fully Effective Folic Acid Fortification

Morris

Wald

2023

JAMA

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Neural tube defects occur within the first 4 weeks of conception when the neural tube in the embryo does not close properly, resulting in the fetus developing spina bifida, anencephaly, or encephalocele, depending on where the lesion occurs and how large it is. In 1991 a randomized clinical trial funded by the UK Medical Research Council showed that about 80% of neural tube defects could be prevented by taking a 4-mg folic acid supplement every day, starting before pregnancy. 1 It has been confirmed that starting after a pregnancy is too late-the preventive opportunity will have passed. Other trials and studies have confirmed the protective effect of folic acid. 2 17. Institute of Medicine Food and Nutrition Board.

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Letter to the Editor Regarding: Postnatal Surgical Correction of Myelomeningoceles: Preoperative and Intraoperative Risk Factors Associated with Postoperative Neurologic Outcomes

Salazar,

Figueredo,

Ramírez

et al. 2023

World Neurosurgery

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Global strategies for the prevention of neural tube defects through the improvement of folate status in women of reproductive age

Cited by 11 publications

References 73 publications

Comparative Scoping Review of Prenatal Care Resources for Families of Children With Spinal Dysraphism and Hydrocephalus in High-Income Countries and Low- and Middle-Income Countries

Comparative Scoping Review of Prenatal Care Resources for Families of Children With Spinal Dysraphism and Hydrocephalus in High-Income Countries and Low- and Middle-Income Countries

Fully Effective Folic Acid Fortification

Letter to the Editor Regarding: Postnatal Surgical Correction of Myelomeningoceles: Preoperative and Intraoperative Risk Factors Associated with Postoperative Neurologic Outcomes

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