A global update on the status of prevention of folic acid-preventable spina bifida and anencephaly in year 2022

IF 1.6 4区医学 Q4 DEVELOPMENTAL BIOLOGY Birth Defects Research Pub Date : 2024-04-30 DOI:10.1002/bdr2.2343

Kaustubh Wagh, Vijaya Kancherla, Amanda Dorsey, Helena Pachón, Godfrey P. Oakley Jr

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Abstract

Background

Mandatory fortification of staple foods with folic acid is an effective public health strategy to prevent folic acid-preventable spina bifida and anencephaly (FAP SBA). We estimated the global proportion of FAP SBA prevented through mandatory folic acid fortification of cereal grains (i.e., wheat flour, maize flour, and rice).

Methods

We used year 2022 data from the Food Fortification Initiative to identify countries (n = 69) with mandatory fortification of grains that includes folic acid. Sixty-eight countries were eligible for analysis with complete data. Proportion of FAP SBA prevention was modeled assuming >150 mcg/day of folic acid fortification protects against FAP SBA, reducing post-fortification prevalence to a lowest achievable level of 0.5 cases per 1000 births.

Results

Our analysis found that a total of 63,520 cases of FAP SBA were prevented in the year 2022 in 68 countries implementing mandatory folic acid fortification of grains with folic acid. This translated to a 23.7% prevention of all possible FAP SBA prevention globally. An excess of 204,430 cases of FAPSBA still occurred in over 100 countries where mandatory staple food fortification with folic acid is not implemented.

Conclusion

Our study showed that only a quarter of all FAP SBA cases were averted through mandatory folic acid fortification in the year 2022; many countries are not implementing the policy, resulting in a large proportion of FAP SBA cases that can be prevented. Fortification will help countries with achieving 2030 Sustainable Development Goals on neonatal- and under-five mortality, disability, stillbirths, and elective terminations prevention, from FAP SBA.

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2022 年叶酸可预防脊柱裂和无脑畸形的全球最新预防状况

背景强制在主食中添加叶酸是预防可通过叶酸预防的脊柱裂和无脑畸形（FAP SBA）的有效公共卫生策略。我们估算了通过在谷物（即小麦粉、玉米粉和大米）中强制添加叶酸可预防脊柱裂和无脑畸形的全球比例。方法我们利用食品营养强化计划（Food Fortification Initiative）提供的 2022 年数据，确定了强制在谷物中添加叶酸营养强化剂的国家（n = 69）。有 68 个国家符合分析条件，并提供了完整的数据。假定每天 150 微克的叶酸强化可预防 FAP SBA，将强化后的发病率降至每 1000 例新生儿中 0.5 例的最低水平。结果我们的分析发现，在实施叶酸强化谷物的 68 个国家中，2022 年共预防了 63,520 例肥胖症 SBA。这相当于在全球范围内预防了 23.7% 的急性膀胱炎。在 100 多个未实施强制主食叶酸强化的国家中，仍有 204,430 例过量的 FAPSBA 病例发生。结论我们的研究表明，到 2022 年，通过强制叶酸强化仅能避免四分之一的 FAP SBA 病例；许多国家并未实施该政策，导致很大一部分 FAP SBA 病例是可以预防的。强化叶酸将有助于各国实现 2030 年可持续发展目标，即预防新生儿和五岁以下儿童死亡、残疾、死胎和非自愿终止妊娠。

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来源期刊

Birth Defects Research Medicine-Embryology

CiteScore

3.60

自引率

9.50%

发文量

153

期刊介绍： The journal Birth Defects Research publishes original research and reviews in areas related to the etiology of adverse developmental and reproductive outcome. In particular the journal is devoted to the publication of original scientific research that contributes to the understanding of the biology of embryonic development and the prenatal causative factors and mechanisms leading to adverse pregnancy outcomes, namely structural and functional birth defects, pregnancy loss, postnatal functional defects in the human population, and to the identification of prenatal factors and biological mechanisms that reduce these risks. Adverse reproductive and developmental outcomes may have genetic, environmental, nutritional or epigenetic causes. Accordingly, the journal Birth Defects Research takes an integrated, multidisciplinary approach in its organization and publication strategy. The journal Birth Defects Research contains separate sections for clinical and molecular teratology, developmental and reproductive toxicology, and reviews in developmental biology to acknowledge and accommodate the integrative nature of research in this field. Each section has a dedicated editor who is a leader in his/her field and who has full editorial authority in his/her area.