title: Reduction of birth prevalence rates of neural tube defects after folic acid fortification in Chile.
abstract: To verify whether the decreasing neural tube defects birth prevalence rates in Chile are due to folic acid fortification or to pre-existing decreasing trends, we performed a population survey using a network of Estudio Colaborativo Latino Americano de Malformaciones Congenitas (ECLAMC, Latin American Collaborative Study of Congenital Malformations) maternity hospitals in Chile, between the years 1982 and 2002. Within each maternity hospital, birth prevalence rates of spina bifida and anencephaly were calculated from two pre-fortification periods (1982-1989 and 1990-2000), and from one fortified period (2001-2002). There was no historical trend for spina bifida birth prevalence rates before folic acid fortification, and there was a 51% (minimum 27%, maximum 66%) decrease in the birth prevalence rates of this anomaly in the fortified period. The relative risks of spina bifida were homogeneous among hospitals in the two period comparisons. There was no historical trend for the birth prevalence of anencephaly comparing the two pre-fortified periods, but the relative risks were heterogeneous among hospitals in this comparison. There was a 42% (minimum 10%, maximum 63%) decrease in the birth prevalence rate of anencephaly in the fortified period as compared with the immediately pre-fortified period, with homogeneous relative risks among hospitals. Within the methodological constraints of this study we conclude that the birth prevalence rates for both spina bifida and anencephaly decreased as a result of folic acid fortification, without interference of decreasing secular trends.
authors.affiliation: Estudo Colaborativo Latino Americano de Malformações Congênitas, ECLAMC at IMBICE, Instituto Multidisciplinario de Biologia Celular, La Plata, Argentina.
authors.forename: Jorge S
authors.initials: JS
authors.lastname: López-Camelo
authors.forename: Iêda M
authors.initials: IM
authors.lastname: Orioli
authors.forename: Maria
authors.initials: M
authors.lastname: da Graça Dutra
authors.forename: Julio
authors.initials: J
authors.lastname: Nazer-Herrera
authors.forename: Nelson
authors.initials: N
authors.lastname: Rivera
authors.forename: María Elena
authors.initials: ME
authors.lastname: Ojeda
authors.forename: Aurora
authors.initials: A
authors.lastname: Canessa
authors.forename: Elisabeth
authors.initials: E
authors.lastname: Wettig
authors.forename: Ana María
authors.initials: AM
authors.lastname: Fontannaz
authors.forename: Cecília
authors.initials: C
authors.lastname: Mellado
authors.forename: Eduardo E
authors.initials: EE
authors.lastname: Castilla
mesh_terms: D000757:Anencephaly / Q000453:epidemiology / Q000517:prevention & control; D002677:Chile / Q000453:epidemiology; D005492:Folic Acid / Q000008:administration & dosage*; D005527:Food, Fortified; D006801:Humans; D007231:Infant, Newborn; D009436:Neural Tube Defects / Q000453:epidemiology / Q000517:prevention & control*; D011159:Population Surveillance; D015995:Prevalence
chemical_list: D005492:Folic Acid