Impact of flour fortification with folic acid on the prevalence of neural tube defects in Northern Iran

Abstract

Several studies reported that enriched cereal grains have been fortified with folic acid to reduce the incidence of neural tube defects (NTDs). The present study was done to evaluate the impact of flour fortification with folic acid on the prevalence of NTDs in Northern Iran. In this hospital-based study conducted between March 2006 and September 2009, we screened all live births at 16 hospitals and therapeutic abortions in legal centers in Golestan province of Northern Iran. The number of births, per 1000, affected by NTDs during the periods before (March 2006-June 2007), during (July 2007-March 2008) and after (May 2008-September 2009) folic acid fortification was assessed. NTDs including anencephaly, encephalocele and spina bifida were defined in accordance with the international classification of diseases, 10th revision (international classification of diseases-10). A total of 126 subjects with NTDs were recorded among live births (104,232) and therapeutic abortions (131) from March 2006 to September 2009. The prevalence of NTDs reduced from 1.78 per 1,000 births before fortification (95% confidence interval: 1.36 to 2.28) to 0.84 per 1,000 after full fortification (95% confidence interval: 0.60 to 1.14). The reduction rate of NTDs between before and after fortification was 52.81%. This study showed that flour fortification with folic acid is associated with a significant reduction in the rate of NTDs in Golestan province of Northern Iran.