Beneficial effects of folic acid fortification in the prevention of Spina Bifida and reducing the orthopaedic procedures: A narrative review of the current literature

• Published in: Journal of Orthopaedic Reports 2023-09, Vol.2 (3), p.100175, Article 100175
• Main Authors: Mathur, Priyanka K., Dave, Pooja, Fuller, Samuel I., Cuero, Kendrick, Chiu, Anthony, Shah, Aribah, Rosseau, Gail L., Sarwark, John F.
• Format: Article
• Language: English
• Subjects: Folic acid; Prevention; Spina bifida; Spinal dysraphism; World health assembly
• ISSN: 2773-157X; 2773-157X
• DOI: 10.1016/j.jorep.2023.100175

Spina bifida (SB) is a neural tube defect that affects more than 200,000 pregnancies globally. Folic acid fortification has been shown to be the most effective public health strategy to prevent SB. Patients with SB require surgical and non-surgical orthopaedic care to correct a variety of deformities associated with spina bifida. The benefits of SB prevention compared to its costs — including surgical expenses, healthcare burden, and psychosocial effects — make folic acid fortification necessary. We conducted a literature review to explore the role of orthopaedic surgery in the care of patients with SB and the role of folic acid fortification in SB prevention. Orthopaedic surgery has a crucial role in spina bifida care with the goal to maximize a patient's functional status. The lifetime economic cost of SB through direct, indirect and educational costs is estimated to be greater than $600,000. Folic acid fortification has been shown to reduce the need for orthopaedic surgeries by decreasing the incidence of neural tube defects. This has been shown to have a high cost benefit ratio for countries. SB prevention leads to better psychosocial, economic and health outcomes for patients. Folic acid fortification has significant economic and health benefits by preventing SB and reducing the number of orthopaedic procedures necessary. We call on governments and healthcare organizations to support the World Health Assembly resolution for folic acid and micronutrient fortification in the prevention of neural tube defects.