Reduction in Neural-Tube Defects After Folic Acid Fortification in Canada

Abstract

D espite advancements in medicine, preterm infants continue to experience high neonatal mortality and morbidity, with many having lifelong neurodevelopmental deficits, such as cerebral palsy (CP) and impaired cognitive abilities. The risk of impairment increases with decreasing gestational age at birth and many studies of short-term and long-term outcomes have focused on infants born at <33-week gestation. There are few data, however, on neonates born at 33 or 34 weeks. Issues include optimal places for delivery of preterm infants and the optimal gestational age for delivery in women with such pregnancy complications as gestational hypertension, intrauterine growth restriction (IUGR), and preterm premature rupture of membranes. In this population-based study of infants born at 30 to 34 weeks, neonatal mortality and morbidity and 5-year neurodevelopmental outcomes were assessed.All live and stillbirths occurring between 30 and 32 weeks in 1997 (n = 2020) and all between 33 and 34 weeks in April and October of 1997 (n = 457) in all maternity units in 9 French regions were included in the EPIPAGE study. Data on the mother, pregnancy, and neonate were recorded on standardized forms and included maternal complications, gestational age at birth, adverse neonatal outcomes, and treatments used in the neonatal unit. Survivors had a medical and neuropsychological assessment at 5 years of age.Of the 2467 infants enrolled in the study, 2018 were eligible for follow-up and 1461 were evaluated at 5 years. The distribution of pregnancy complications varied with gestational age in that the proportion of pregnancies with singletons and IUGR or hypertension decreased from 26% at 30 weeks to 18% at 34 weeks. On the other hand, the proportion with preterm premature rupture of membranes increased from 19% at 30 weeks to 26% at 34 weeks. The rate of cesarean births, antenatal corticosteroid therapy, and birth in tertiary-care facilities decreased as gestational age increased. So did the rate of adverse neonatal outcomes, although such morbidities as respiratory distress syndrome and bronchopulmonary dysplasia continued through all birth ages. Hospital length of stay also decreased with increasing gestational age; however, 27% of infants born at 34 weeks required admission to the neonatal intensive care unit; 7% needed endotracheal ventilation; 16% received antibiotics for >7 d and 5%, parenteral nutrition for >10 d; 9% received caffeine for apneas; and 47% had phototherapy for jaundice. The CP rate was 6.3% in the 30-week group, 8.7% at 31 weeks, 4.1% at 32 weeks, 3.7% at 33weeks, and 0.7% at 34 weeks (P<0.01). The proportion of children with Mental Processing Composite scores below 70 ranged from 10% in the 30-week and 31-week groups to 5% in the 34-week group, with the mean Mental Processing Composite score increasing significantly from 94 at 30 weeks to 98 at 34weeks. There was little difference among age groups as to visual and hearing deficiencies. In multivariate analysis, only gestational age at birth and pregnancy complication...

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

“…The largest drops were observed in Costa Rica (58 %) (28) Argentina (49?7 %) (25) and Canada (49 %) (21) . The smallest decrease occurred in the state of California in the USA (15?5 %) (23) .…”

“…This country not only fortifies wheat flour but also maize flour, cow's milk and rice (28) . Other countries showed NTD reductions of about 50 % (16,20,21,57) and similar reductions in spina bifida (21,25,38) and anencephaly (16,35,39) . The results varied by country and depended on the integrity and quality of the country's surveillance system.…”

Factors associated with a positive intake of folic acid in the periconceptional period among Korean women

“…For example, in Norway, the country with the highest rate of facial clefts in Europe, the fortification of foods with FA has not been allowed (17) . In contrast, flour and other grain products are being fortified at a minimum level of 0.14 mg FA/100 g cereal grain in Canada and the USA and a decline in NTD was observed as a result of that fortification (18,19) . However, the fortification level should be enough to provide a daily intake of 0?6 to 0?8 mg FA in order to attain the highest benefits (20) .…”

Folate and vitamin B12status of women of reproductive age living in Hanoi City and Hai Duong Province of Vietnam

“…Several countries have introduced mandatory folic acid fortification to reduce NTD rates (4)(5)(6) . The reduction achieved in these countries has depended on the background rate of NTD; the higher the background rate the greater the reduction (6) .…”