title: Red Blood Cell Folate Insufficiency among nonpregnant Women of Childbearing age in Guatemala 2009 to 2010: Prevalence and predicted Neural Tube Defects risk.
abstract: BACKGROUND
  The World Health Organization recently released recommendations stating that red blood cell (RBC) folate concentrations should be above 400 ng/L (906 nmol/L) for optimal prevention of folate-sensitive neural tube defects (NTDs). The objective of this study was to determine the distribution of folate insufficiency (FI) (<906 nmol/L) and potential risk of NTDs based on RBC folate concentrations among nonpregnant women of child-bearing age in Guatemala.
  
  
  METHODS
  A national and regional multistage cluster probability survey was completed during 2009 to 2010 among Guatemalan women of child-bearing age 15 to 49 years of age. Demographic and health information and blood samples for RBC folate analyses were collected from 1473 women. Prevalence rate ratios of FI and predicted NTD prevalence were estimated based on RBC folate concentrations comparing subpopulations of interest.
  
  
  RESULTS
  National FI prevalence was 47.2% [95% confidence interval, 43.3-51.1] and showed wide variation by region (18-81%). In all regions, FI prevalence was higher among indigenous (27-89%) than among nonindigenous populations (16-44%). National NTD risk based on RBC folate concentrations was estimated to be 14 per 10,000 live births (95% uncertainty interval, 11.1-18.6) and showed wide regional variation (from 11 NTDS in the Metropolitan region to 26 NTDs per 10,000 live births in the Norte region).
  
  
  CONCLUSIONS
  FI remains a common problem in populations with limited access to fortified products, specifically rural, low income, and indigenous populations. However, among subpopulations that are most likely to have fortified food, the prevalence of FI is similar to countries with well-established fortification programs. Birth Defects Research (Part A) 106:587-595, 2016. © 2016 Wiley Periodicals, Inc.
authors.affiliation: National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.
authors.forename: Jorge
authors.initials: J
authors.lastname: Rosenthal
authors.affiliation: Consultant, Global Maternal and Preconception Health, Healdsburg, CA.
authors.forename: Mary-Elizabeth
authors.initials: ME
authors.lastname: Reeve
authors.affiliation: Instituto de Nutrición de Centroamérica y Panamá, Guatemala.
authors.forename: Nicte
authors.initials: N
authors.lastname: Ramirez
authors.affiliation: National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.
authors.forename: Krista S
authors.initials: KS
authors.lastname: Crider
authors.affiliation: National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.
authors.forename: Joe
authors.initials: J
authors.lastname: Sniezek
authors.affiliation: National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.
authors.forename: Claudia
authors.initials: C
authors.lastname: Vellozzi
authors.affiliation: Carter Consulting, Inc, Atlanta, Georgia, USA.
authors.forename: Owen
authors.initials: O
authors.lastname: Devine
authors.affiliation: Guatemala Ministerio de Salud Pública y Asistencia Pública, Guatemala.
authors.forename: Eunice
authors.initials: E
authors.lastname: Lopez-Pazos
mesh_terms: D000293:Adolescent; D000328:Adult; D004912:Erythrocytes / Q000378:metabolism*; D005260:Female; D005492:Folic Acid / Q000097:blood*; D005494:Folic Acid Deficiency / Q000097:blood / Q000150:complications / Q000453:epidemiology; D006166:Guatemala / Q000453:epidemiology; D006801:Humans; D008875:Middle Aged; D009436:Neural Tube Defects / Q000453:epidemiology*; D012307:Risk Factors
chemical_list: D005492:Folic Acid
keywords: Folate; Guatemala; Neural Tube Defects Childbearing-age Women; Red Blood Cell Folate Insufficiency Prevalence