Improving maternal folate status to prevent infant neural tube defects: working group conclusions and a framework for action

Abstract

As infectious disease control programs achieve increasing success, further reductions in child mortality in low- and middle-income countries (LMICs) will require focused prevention strategies for birth defects and other noninfectious diseases. Neural tube defects (NTDs) can cause early death or lifelong disability. Preventing NTDs provides a feasible, significant opportunity to decrease the toll of birth defects and contribute to further reducing child mortality globally. The Micronutrient Forum convened a technical consultation on Folate Status in Women and Neural Tube Defects Prevention to develop a roadmap to inform and prioritize investments in NTD prevention in LMICs; help guide implementation efforts in terms of the feasibility of interventions and the potential for acceleration; and identify research and knowledge gaps. Here, we describe the impetus for and approach to the consultation and present the conclusions and a framework for developing a roadmap for action to accelerate NTD prevention in LMICs. The framework (1) provides options for action on folate status assessment; (2) outlines a way forward to develop and implement a time-bound global action plan for NTD prevention; and (3) identifies common impediments to NTD prevention, broad strategies to overcome or minimize these impediments, and basic building blocks necessary to accelerate action.

Folate intake, markers of folate status and oral clefts: An updated set of systematic reviews and meta‐analyses

“…Global changes in dietary patterns (e.g., as a result of global warming, or intended to reduce greenhouse gas emissions by changes in agriculture) and large‐scale intervention program (e.g., intended to promote healthy diets, prevent under‐nutrition, prevent NTDs [Martinez et al, 2018]) may change population micronutrient status. Over 820 million people lack sufficient food resources and an even larger number suffer from micronutrient deficiency and diet‐related obesity due to low quality diets (Willett et al, 2019).…”

Global folate status in women of reproductive age: a systematic review with emphasis on methodological issues

“…Many countries have sought to increase folic acid consumption through fortification of staple foods and targeted supplementation programs. To enhance these efforts, the Micronutrient Forum, with support from the Bill & Melinda Gates Foundation, convened a “Technical Consultation on Folate Status in Women and Neural Tube Defect Prevention” to develop a roadmap to better inform and prioritize investments in folate‐preventable NTDs . The consultation also sought to identify the global prevalence of folate insufficiency in WRA and determine the fraction of NTDs currently attributable to folate insufficiency.…”

“…To enhance these efforts, the Micronutrient Forum, with support from the Bill & Melinda Gates Foundation, convened a "Technical Consultation on Folate Status in Women and Neural Tube Defect Prevention" to develop a roadmap to better inform and prioritize investments in folate-preventable NTDs. 14 The consultation also sought to identify the global prevalence of folate insufficiency in WRA and determine the fraction of NTDs currently attributable to folate insufficiency. Global folate status was first reviewed in a 2005 WHO Technical Consultation on folate and vitamin B12 deficiencies.…”

Excess micronutrient intake: defining toxic effects and upper limits in vulnerable populations

“…Adverse outcomes of lifetime excess are still being investigated (see Ref. for proposed research priorities) and no clear consensus exists regarding the safety of high intakes of folic acid . Intake data from the United States and Mexico show that folic acid intake among young children approximates the UL (Table ).…”