title: [Effect of flour folic acid fortification on the incidence of cranio encephalic congenital defects].
abstract: BACKGROUND
  In Chile, flour is fortified with folic acid since 2000, and the incidence of neural tube defects has decreased. Cranio-encephalic congenital defects (CECD) have a wider clinical scope, includind classical neural tube defects (NTD) such as anencephalia and acrania, but also incorporating other defects. Therefore, the effects of folic acid fortification on the incidence of CECD could be different.
  
  
  OBJECTIVE
  To study the effect of folic acid fortification on the incidence of CECD.
  
  
  METHODS
  All prenatal diagnoses of CECD and cases registered locally in the Latin American Collaborative Study of Congenital Malformations (ECLAMC) were reviewed. The obtained data were crossed with all death certificates of newborns or stillborns of more than 500 g in the Sixth Region, in Central Chile. All cases were classified again in four subtypes, according to their phenotype. The incidences of all subtypes prior (1996-2000) and after folic acid supplementation (2001-2004), were compared.
  
  
  RESULTS
  Between 1996 and 2004, there were 64 cases of CEDC among 109,176 infants born alive. The global rate was 8.86 per 10,000 born alive in the period prior to fortification and 3.03 per 10,000 born alive after fortification. Comparing both periods, there was a 66% reduction in all CECD and a 77 and 100% reduction in subtypes A and B of CECD, respectively (p <0.05). No significant reductions in type C and D CECD, were observed.
  
  
  CONCLUSIONS
  After the start of flour folic acid fortification, there was a global reduction in the incidence of CECD. However, only types A and B CECD, supposedly more responsive to folic acid, were reduced.
authors.affiliation: Unidad de Ecografía, Servicio de Obstetricia y Ginecología, Hospital Regional, Rancagua, Chile. galocorral@entelchile.net
authors.forename: Edgardo
authors.initials: E
authors.lastname: Corral S
authors.forename: Rodrigo
authors.initials: R
authors.lastname: Moreno S
authors.forename: Guillermo
authors.initials: G
authors.lastname: Pérez G
authors.forename: María Elena
authors.initials: ME
authors.lastname: Ojeda B
authors.forename: Hernán
authors.initials: H
authors.lastname: Valenzuela G
authors.forename: Mauricio
authors.initials: M
authors.lastname: Reascos M
authors.forename: Waldo
authors.initials: W
authors.lastname: Sepúlveda L
mesh_terms: D000757:Anencephaly / Q000453:epidemiology / Q000517:prevention & control; D002677:Chile / Q000453:epidemiology; D005433:Flour; D005492:Folic Acid / Q000008:administration & dosage*; D005527:Food, Fortified; D006801:Humans; D015994:Incidence; D007231:Infant, Newborn; D009436:Neural Tube Defects / Q000453:epidemiology / Q000517:prevention & control*; D012886:Skull / Q000002:abnormalities
chemical_list: D005492:Folic Acid