Interpreting changes in the epidemiology of anencephaly and spina bifida following folic acid fortification of the U.S. grain supply in the setting of long‐term trends, Atlanta, Georgia, 1968–2003

Besser, Lilah M.; Williams, Laura; Cragan, Janet D.

doi:10.1002/bdra.20401

Cited by 31 publications

(34 citation statements)

References 19 publications

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“…Although it has been suggested that declines in the prevalence of spina bifida and anencephaly in the postfortification period may be the continuation of a long-term progressive decline that started long before the mandatory fortification of enriched cereal grain products (CDC, 1992b;Besser et al, 2007), we were unable to evaluate this hypothesis because the surveillance data used for this analysis are only available from 1995-2004. While many of the state-based surveillance programs included in this analysis use active case-finding methods, data for a number of these programs were limited to passively ascertained data, in several instances focusing only on cases identified among liveborn infants (National Birth Defects Prevention Network, 2004).…”

Section: Discussionmentioning

confidence: 94%

Trends in the postfortification prevalence of spina bifida and anencephaly in the United States

Boulet

Yang

Mai

et al. 2008

Birth Defects Research

251

152

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Section: Discussionmentioning

confidence: 94%

Trends in the postfortification prevalence of spina bifida and anencephaly in the United States

Boulet

Yang

Mai

et al. 2008

Birth Defects Research

251

152

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“…The smallest decrease occurred in the state of California in the USA (15?5 %) (23) . Twenty-one articles reported on the prevalence of spina bifida before and after flour fortification (15,16,19,(21)(22)(23)25,26,28,(30)(31)(32)(33)(34)(35)(36)(37)(38)(39)(40)(41) . The largest reductions reported were in Costa Rica (61 %) (28) , Canada (55 %) (21) and Chile (55 %) (25) The latter study examined the number of NTD cases between the years 1998 and 2007.…”

Section: Resultsmentioning

confidence: 99%

Impact of folic acid fortification of flour on neural tube defects: a systematic review

Castillo-Lancellotti

Tur

Uauy

2012

Public Health Nutr.

169

141

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Objective: To review the impact of folic acid fortification of flour on the prevalence of neural tube defects (NTD). Design: Systematic review of the literature on MEDLINE via PubMed, Scopus, OvidSP and LILACS (Latin American and Caribbean Health Sciences Literature) reporting the impact of folic acid fortification of flour on the prevalence of NTD in 2000-2011. Focusing on Santiago of Chile's birth defects registry (1999)(2000)(2001)(2002)(2003)(2004)(2005)(2006)(2007)(2008)(2009) and the monitoring of flour fortification, we analysed the prevalence (NTD cases/ 10 000 births) pre and post flour fortification and the percentile distribution of folic acid content in flour (2005)(2006)(2007)(2008)(2009). We explored the potential association between median folic acid in flour (mg/kg) and the prevalence of NTD. Setting: Chile, Argentina, Brazil, Canada, Costa Rica, Iran, Jordan, South Africa and the USA. Subjects: Live births and stillbirths. Results: Twenty-seven studies that met inclusion criteria were evaluated. Costa Rica showed a significant reduction in NTD ( , 60 %). Prevalence in Chile decreased from 18?6 to 7?3/10 000 births from 1999 to 2007 and showed a slight increase to 8?5 in 2008-2009, possibly due to changes in fortification limits. When we related the prevalence of NTD with levels of flour fortification, the lowest prevalence was observed at a folic acid level of 1?5 mg/kg. Conclusions: Fortification of flour with folic acid has had a major impact on NTD in all countries where this has been reported. Chile showed a 55 % reduction in NTD prevalence between 1999 and 2009. There is a need to constantly monitor the levels of flour fortification to maximize benefits and prevent the potential risk of folic acid excess, moreover to be vigilant for any new adverse effects associated with excess. Keywords Folic acid Neural tube defects Spinal dysraphism Food fortification Systematic reviewThe importance of nutrition in the aetiology of neural tube defects (NTD) was suggested by Hibbard and Smithells, who found that women deficient in folate had an increased number of abortions, placental abruptions and fetal malformations and intra-uterine growth retardation (1) . The first reports on folate deficiency and NTD, published by Smithells et al. (2,3) , showed the protective effect of folic acid on the recurrence of NTD. A randomised study by Czeizel and Dudas (4) showed a decrease in first NTD occurrence in women supplemented with twelve vitamins containing 0?8 mg of folic acid, but not in women supplemented with trace elements and a very low dose of vitamin C. A rigorous double-blind randomised controlled trial supported by the UK Medical Research Council showed that supplementing women who had a history of children with NTD with 4 mg of folic acid daily decreased recurrence by 72 % (5) . Although some studies were retrospective, their results revealed an inverse relationship between NTD and folic acid consumption of 100-400 mg/d (6,7) . Based on this information, in 1992 the US Public Health Service r...

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“…For example, using data from surveillance to evaluate the success of folic acid fortification programs is difficult because of the high frequency of prenatal diagnosis and TOP and the difficulty in separating the effects of the intervention from changes in prenatal diagnosis and TOP over time (Besser et al, 2007); in this situation, alternate strategies such as bio-monitoring might be warranted (Oakley et al, 2008).…”

Section: Discussionmentioning

confidence: 99%

Pregnancy termination following prenatal diagnosis of anencephaly or spina bifida: A systematic review of the literature

Johnson¹,

Honein²,

Flanders³

et al. 2012

Birth Defects Research

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Background-In regions where prenatal screening for anencephaly and spina bifida is widespread, many cases of these defects are prenatally diagnosed. The purpose of this study was to estimate the frequency of termination of pregnancy (TOP) following prenatal diagnosis of anencephaly or spina bifida and to investigate factors associated with TOP that might lead to selection bias in epidemiologic studies.

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Interpreting changes in the epidemiology of anencephaly and spina bifida following folic acid fortification of the U.S. grain supply in the setting of long‐term trends, Atlanta, Georgia, 1968–2003

Abstract: Our analysis suggests that changes in AN and SB surrounding folic acid fortification (Period 3) could be part of preexisting trends. This must be considered when evaluating prevention efforts.

Cited by 31 publications

References 19 publications

Trends in the postfortification prevalence of spina bifida and anencephaly in the United States

Trends in the postfortification prevalence of spina bifida and anencephaly in the United States

Impact of folic acid fortification of flour on neural tube defects: a systematic review

Pregnancy termination following prenatal diagnosis of anencephaly or spina bifida: A systematic review of the literature

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