A 2019 global update on folic acid‐preventable spina bifida and anencephaly

• Published in: Birth defects research 2021-01, Vol.113 (1), p.77-89
• Main Authors: Kancherla, Vijaya, Wagh, Kaustubh, Pachón, Helena, Oakley, Godfrey P.
• Format: Article
• Language: English
• Subjects: Acids; Anencephaly; congenital anomalies; Corn; Data exchange; Defects; disability; Epidemics; epidemiology; Flour; flour fortification; folate; Folic acid; mortality; Neural tube defects; Prevention; Spina bifida; Staples; Sustainable development; Vitamin B; Wheat
• ISSN: 2472-1727; 2472-1727
• DOI: 10.1002/bdr2.1835

Background Mandatory folic acid fortification of staples is a proven intervention to prevent spina bifida and anencephaly, two life‐threatening and disabling neural tube defects. We estimated the global proportion of folic acid‐preventable spina bifida and anencephaly (FAP SBA) prevented through mandatory folic acid fortification of wheat and/or maize flour in 2019. Methods Using data from the Global Fortification Data Exchange, we identified countries with mandatory fortification policies that required at least 1.0 ppm folic acid be added to wheat and/or maize flour and had information on percentage of industrially milled flour that is fortified. We built FAP SBA prevention models assuming mandatory folic acid fortification at 200 μg/day of folic acid fully protects against FAP SBA and would lower the prevalence neural tube defects to 0.5 per 1,000 live births. Results In 2019, 56 countries met our criteria for mandatory folic acid fortification of wheat (n = 56 countries) and/or maize (n = 15 countries) flour and with complete data for our modeling. Overall, our prevention model estimated that 65,380 FAP SBA cases were prevented in 2019 through folic acid fortification of wheat and/or maize flour. We estimated the current global prevention proportion of all preventable FAP SBA cases worldwide to be at 23% of total possible prevention. Conclusion Global prevention efforts for FAP SBA are slow and have stalled. Mandatory fortification should be urgently implemented in all countries to prevent epidemics of FAP SBA, and to achieve health‐related Sustainable Development Goals for year 2030 by reducing child mortality due to preventable FAP SBA.