Folic acid-preventable spina bifida and anencephaly

Abstract

1. Brief description of the condition/disease Spina bifida and anencephaly are among the most common and severe birth defects. Almost all affected persons with spina bifida have lower-body paralysis and significant physical disability. In many countries, spina bifida is the most common cause of infantile paralysis. Anencephaly is a common birth defect that contributes to fetal and infant mortality. An estimated 50-75% of these birth defects can be prevented by providing adequate intakes of synthetic folic acid (pteroylmonoglutamic acid) before and during the first trimester of pregnancy. Preventing folic-acid-preventable spina bifida and anencephaly presents all outstanding opportunity to improve the health of children throughout the world. Moreover, substantial evidence suggests that, in adults, suboptimal intake of folic acid is a major factor for increasing the risk of cardiovascular disease. 2. Current burden and rating within the overall burden of disease Each year, 300 000 to 400 000 infants worldwide are born with spina bifida and anencephaly. In China, 100 000 infants are born annually with these two birth defects, which are the leading cause of infant mortality. The rates are also high in Mexico and Central America. Together these conditions contribute significantly to infant morbidity and mortality. 3. Feasibility (biological) of elimination/eradication Approximately 75% of spina bifida and anencephaly are folic-acid-preventable, and it is biologically possible to prevent all folic-acid-preventable spina bifida and anencephaly. The prevention impact would be approximately equal to the prevention derived from poliomyelitis vaccines. The biological feasibility of preventing spina bifida and anencephaly using folic acid-containing vitamin supplements has been demonstrated in randomized controlled trials and other studies. Data from these studies indicate a 50-100% reduction in risk for women taking the supplement before conception and during the first trimester of pregnancy. No randomized controlled studies indicate that dietary changes alone will prevent these birth defects. The U.S. Public Health Service recommends that all women who could become pregnant should consume 400 [micro]g of folio acid daily to prevent these birth defects. Many other countries have policy statements seeking to increase consumption. The United States Institute of Medicine recommended in April 1998 that all women who could become pregnant should consume 400 [micro]g daily of synthetic folic acid to prevent birth defects. 4. Estimated costs and benefits of elimination/eradication Folic acid fortification of flour is feasible and inexpensive. In the USA, formal analysis of costs and benefits of fortification of wheat flour and other grains indicate that a fortification strategy would be highly cost-beneficial. Because costs associated with the purchase and distribution of folic-acid-containing supplements would be higher, programmes depending on pill consumption would break even. …