title: Prevention of neural tube defects by the fortification of flour with folic acid: a population-based retrospective study in Brazil.
abstract: OBJECTIVE
  To determine if the fortification of wheat and maize flours with iron and folic acid - which became mandatory in Brazil from June 2004 - is effective in the prevention of neural tube defects.
  
  
  METHODS
  Using data from national information systems on births in central, south-eastern and southern Brazil, we determined the prevalence of neural tube defects among live births and stillbirths in a pre-fortification period - i.e. 2001-2004 - and in a post-fortification period - i.e. 2005-2014. We distinguished between anencephaly, encephalocele, meningocele, myelomeningocele and other forms of spina bifida.
  
  
  RESULTS
  There were 8554 neural tube defects for 17,925,729 live births notified between 2001 and 2014. For the same period, 2673 neural tube defects were reported for 194,858 stillbirths. The overall prevalence of neural tube defects fell from 0.79 per 1000 pre-fortification to 0.55 per 1000 post-fortification (prevalence ratio, PR: 1.43; 95% confidence interval, CI: 1.38-1.50). For stillbirths, prevalence fell from 17.74 per 1000 stillbirths pre-fortification to 11.70 per 1000 stillbirths post-fortification. The corresponding values among live births were 0.57 and 0.44, respectively.
  
  
  CONCLUSIONS
  The introduction of the mandatory fortification of flour with iron and folic acid in Brazil was followed by a significant reduction in the prevalence of neural tube defects in our study area.
authors.affiliation: Departamento de Saúde Coletiva, Universidade de Brasília, Campus Universitário Darcy Ribeiro, 70910-900, Brasília, DF, Brazil .
authors.forename: Leonor Maria Pacheco
authors.initials: LM
authors.lastname: Santos
authors.affiliation: Secretaria de Vigilância em Saúde, Ministério da Saúde, Brasília, Brazil .
authors.forename: Roberto Carlos Reyes
authors.initials: RC
authors.lastname: Lecca
authors.affiliation: Organização Pan-Americana da Saúde, Brasília, Brazil .
authors.forename: Juan Jose
authors.initials: JJ
authors.lastname: Cortez-Escalante
authors.affiliation: Departamento de Saúde Coletiva, Universidade de Brasília, Campus Universitário Darcy Ribeiro, 70910-900, Brasília, DF, Brazil .
authors.forename: Mauro Niskier
authors.initials: MN
authors.lastname: Sanchez
authors.affiliation: Faculdades Integradas Pitágoras de Montes Claros, Montes Claros, Brazil .
authors.forename: Humberto Gabriel
authors.initials: HG
authors.lastname: Rodrigues
mesh_terms: D000328:Adult; D001938:Brazil / Q000453:epidemiology; D005260:Female; D005433:Flour; D005492:Folic Acid / Q000008:administration & dosage*; D005494:Folic Acid Deficiency / Q000150:complications / Q000517:prevention & control*; D005527:Food, Fortified; D006801:Humans; D015994:Incidence; D007231:Infant, Newborn; D007881:Legislation, Food; D008297:Male; D008423:Maternal Age; D009436:Neural Tube Defects / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control*; D011247:Pregnancy; D015995:Prevalence; D012189:Retrospective Studies; D017678:Sex Distribution; D050497:Stillbirth / Q000453:epidemiology*; D055815:Young Adult
chemical_list: D005492:Folic Acid