Hospitalizations of newborns with folate-sensitive birth defects before and after fortification of foods with folic acid.
BACKGROUND
The prevalence of neural tube defects is reduced in populations of women who receive folic acid supplementation. Since 1998, grain products in the United States have been fortified with folic acid. Fortification may have additional benefits by reducing the national prevalence of newborn hospitalizations for other folate-sensitive birth defects.


OBJECTIVE
Our purpose with this work was to compare rates of hospitalizations of newborns with folate-sensitive birth defects before and after implementation of fortification of grains.


METHODS
National hospital discharge data from the Healthcare Cost and Utilization Project were used to compute rates of newborn hospitalizations for selected birth defects per 10,000 live births in the United States. Newborn hospitalization rates involving congenital anomalies recognizable at birth were analyzed for 5 years before fortification of grains and 5 years after fortification. Additional analyses compared changes in newborn hospitalization rates for birth defects by race/ethnicity, income, insurance status, and region of the country.


RESULTS
Newborn hospitalization rates for spina bifida decreased 21% from 1993-1997 to 1998-2002. Newborn hospitalization rates also decreased for anencephaly (20%) and limb-reduction defects (4%). Decline in hospitalizations for spina bifida occurred more often among Hispanic newborns (33%) than among white (13%) or black (21%) newborns. Decline in limb-reduction defects was seen primarily among blacks (11%). Findings using hospitalization data were similar to recent reports using birth defect surveillance systems with the exception of findings for orofacial clefts and conotruncal heart defects. No reductions were noted in newborn hospitalizations for these anomalies.


CONCLUSIONS
Results from this ecological study fail to demonstrate substantial declines in newborn hospitalizations beyond those anticipated from a reduction in neural tube defects. The society-wide impact of the fortification program on birth defects and other health conditions should continue to be monitored.
Robbins
James M
JM
Arkansas Center for Birth Defects Research and Prevention, College of Medicine,University of Arkansas for Medical Sciences, Arkansas Children's Hospital Research Institute, Little Rock, Arkansas 72202, USA. robbinsjamesm@uams.edu
Tilford
John M
JM
Bird
T M
TM
Cleves
Mario A
MA
Reading
J Alex
JA
Hobbs
Charlotte A
CA
D000013:Congenital Abnormalities / Q000453:epidemiology* / Q000517:prevention & control* / Q000628:therapy; D005260:Female; D005492:Folic Acid / Q000627:therapeutic use*; D005494:Folic Acid Deficiency / Q000150:complications*; D005527:Food, Fortified; D006801:Humans; D007231:Infant, Newborn; D008297:Male; D010343:Patient Admission / Q000706:statistics & numerical data*; D010351:Patient Discharge / Q000706:statistics & numerical data; D015995:Prevalence; D012189:Retrospective Studies; D016135:Spinal Dysraphism / Q000453:epidemiology / Q000517:prevention & control / Q000628:therapy; D014481:United States / Q000453:epidemiology
D005492:Folic Acid