Update on prevention of folic acid-preventable spina bifida and anencephaly.
BACKGROUND
The number of countries fortifying wheat and maize flour with folic acid has increased in the past 2 years. Folic acid prevents most cases of spina bifida and anencephaly by raising serum folate levels among women capable of bearing children, as does encouraging women to consume folic acid supplements prior to pregnancy.


METHODS
The progress in preventing these serious birth defects can be measured by tracking the number of countries now fortifying and program coverage in each. Country estimates of the number of pregnancies affected by spina bifida and anencephaly are calculated using a prefortification birth prevalence baseline and estimates of the proportion prevented by wheat and maize flour fortified with folic acid.


RESULTS
Current fortification programs are preventing about 22,000, or 9% of the estimated folic acid-preventable spina bifida and anencephaly cases. This represents an annual global decrease of about 6,600 folic acid-preventable spina bifida and anencephaly cases since 2006.


CONCLUSIONS
The pace of preventing these serious birth defects can be accelerated if more countries require fortification of both wheat and maize flour and if regulators set fortification levels high enough to increase a woman's daily average consumption of folic acid to 400 mcg.
Bell
Karen N
KN
Department of Epidemiology, Rollins School of Public Health of Emory University, Gloucester, Massachusetts, USA.
Oakley
Godfrey P
GP
D000757:Anencephaly / Q000453:epidemiology* / Q000517:prevention & control*; D019587:Dietary Supplements; D005260:Female; D005433:Flour / Q000706:statistics & numerical data*; D005492:Folic Acid / Q000008:administration & dosage*; D005527:Food, Fortified / Q000706:statistics & numerical data*; D014943:Global Health; D006801:Humans; D009751:Nutritional Requirements; D011247:Pregnancy; D015397:Program Evaluation; D016135:Spinal Dysraphism / Q000453:epidemiology* / Q000517:prevention & control; D014908:Triticum; D003313:Zea mays
D005492:Folic Acid