title: Awareness of folic acid use increases its consumption, and reduces the risk of spina bifida.
abstract: The majority of neural tube defects were believed to be folic acid (FA)-preventable in the 1990s. The Japanese government recommended women planning pregnancy to take FA supplements of 400 μg/d in 2000, but the incidence of spina bifida has not decreased. We aimed to evaluate the OR of having an infant with spina bifida for women who periconceptionally took FA supplements and the association between an increase in supplement use and possible promoters for the increase. This is a case-control study which used 360 case women who gave birth to newborns afflicted with spina bifida, and 2333 control women who gave birth to healthy newborns during the first 12 years of this century. They were divided into two 6-year periods; from 2001 to 2006 and from 2007 to 2012. Logistic regression analyses were conducted to compute OR between cases and controls. The adjusted OR of having an infant with spina bifida for supplement users was 0.48 in the first period, and 0.53 in the second period. The proportion of women who periconceptionally consumed supplements significantly increased from 10 % in the first period to 30 % in the second period. Awareness of the preventive role of FA was a promoter for an increase in supplement use, and thus an FA campaign in high school seems rational and effective. The failure of the current public health policy is responsible for an epidemic of spina bifida. Mandatory food fortification with FA is urgent and long overdue in Japan.
authors.affiliation: Department of Urology,Tsushima Rehabilitation Hospital,Minami-Shinkai 1-114,Tsushima496-0072,Japan.
authors.forename: Atsuo
authors.initials: A
authors.lastname: Kondo
authors.affiliation: Division of Neurosurgery, National Center for Child Health and Development,Okura 2-10-1, Setagayaku,Tokyo157-8535,Japan.
authors.forename: Nobuhito
authors.initials: N
authors.lastname: Morota
authors.affiliation: Department of Neurosurgery,Chiba Children's Hospital,Heta 579-1, Midoriku,Chiba266-0007,Japan.
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Date
authors.affiliation: Department of Neurosurgery,Children's Medical Center,Ichijo 1-240, Kanayama, Teineku,Sapporo006-0041,Japan.
authors.forename: Kazuhisa
authors.initials: K
authors.lastname: Yoshifuji
authors.affiliation: Department of Orthopedics,Hamanasu Rehabilitation Center for Children with Disabilities,Otsuka 17-729, Okubo,Hachinohe031-0833,Japan.
authors.forename: Toshibumi
authors.initials: T
authors.lastname: Morishima
authors.affiliation: Department of Urology,Graduate School of Medicine, University of the Ryukyu,Chihara 1, Nishihara, Nakagami-gun,Okinawa903-0213,Japan.
authors.forename: Minoru
authors.initials: M
authors.lastname: Miyazato
authors.affiliation: Department of Neurosurgery,Miyagi Children's Hospital,Ochiai 4-3-17, Aoba-ku,Sendai989-3126,Japan.
authors.forename: Reizo
authors.initials: R
authors.lastname: Shirane
authors.affiliation: Department of Urology,Nagasaki University Graduate School of Biomedical Sciences,Sakamoto 1-7-1,Nagasaki852-8501,Japan.
authors.forename: Hideki
authors.initials: H
authors.lastname: Sakai
authors.affiliation: Department of Neurosurgery,National Shikoku Medical Center for Children and Adults,Zentsuji 2603,Zentsuji765-8501,Japan.
authors.forename: Kyong Hon
authors.initials: KH
authors.lastname: Pooh
authors.affiliation: Department of Nutritional Science,Faculty of Psychological and Physical Science, Aichi Gakuin University,Araike 12, Iwasaki,Nisshin470-0195,Japan.
authors.forename: Tomoyuki
authors.initials: T
authors.lastname: Watanabe
mesh_terms: D000328:Adult; D001364:Awareness; D016022:Case-Control Studies; D004032:Diet; D019587:Dietary Supplements; D005260:Female; D005492:Folic Acid / Q000008:administration & dosage*; D005527:Food, Fortified; D006291:Health Policy; D006801:Humans; D007231:Infant, Newborn; D007564:Japan / Q000453:epidemiology; D016017:Odds Ratio; D016742:Preconception Care; D011247:Pregnancy; D016135:Spinal Dysraphism / Q000453:epidemiology / Q000517:prevention & control*; D011795:Surveys and Questionnaires
chemical_list: D005492:Folic Acid
keywords: Folic acid; Knowledge; Mandatory food fortification; Neural tube defects; Spina bifida