Food Fortification and Decline in the Prevalence of Neural Tube Defects: Does Public Intervention Reduce the Socioeconomic Gap in Prevalence?

Richard Glazier,Rahim Moineddin,Aideen Moore,Astrid Guttmann,Mohammad Agha

doi:10.3390/ijerph10041312

Abstract

Objective: A significant decline in the prevalence of neural tube defects (NTD) through food fortification has been reported. Questions remain, however, about the effectiveness of this intervention in reducing the gap in prevalence across socioeconomic status (SES). Study Design: Using health number and through record linkage, children born in Ontario hospitals between 1994 and 2009 were followed for the diagnosis of congenital anomalies. SES quintiles were assigned to each child using census information at the time of birth. Adjusted rates and multivariate models were used to compare trends among children born in different SES groups. Results: Children born in low SES areas had significantly higher rates of NTDs (RR = 1.25, CI: 1.14–1.37). Prevalence of NTDs among children born in low and high SES areas declined since food fortification began in 1999 although has started rising again since 2006. While the crude decline was greater in low SES areas, after adjustment for maternal age, the slope of decline and SES gap in prevalence rates remained unchanged overtime. Conclusions: While food fortification is successful in reducing the prevalence of NTDs, it was not associated with removing the gap between high and low SES groups.

Highlights

Despite advances in diagnosis, treatment and prevention, every year an estimated 7.9 million children worldwide are born with serious congenital abnormalities [1]
In several countries, including the United States and Canada, recommendations to consume folic acid supplements are integrated with a public intervention of widespread fortification of flour in the US and flour, cornmeal, and pasta in Canada, to ensure that the entire population receives at least a small amount of folic acid regardless of access to supplements
While the birth prevalence of neural tube defects (NTD) has declined, questions remain regarding accessibility and effectiveness of preventive measures for children born to mothers from different socioeconomic status (SES) groups

Summary

Introduction

Treatment and prevention, every year an estimated 7.9 million children worldwide are born with serious congenital abnormalities [1]. For those who survive, these disorders can cause lifelong mental, physical, auditory or visual disability. According to 2006 report [1] at least 3.3 million children less than five years of age die from congenital abnormalities each year, and an estimated 3.2 million of those who survive may have persistent disabilities. The prevalence rate of major birth defects overall has remained stable over the last two decades in Canada [2].

Methods

Results

Conclusion