Prevalence Differentials Of Neural Tube Defects In Newborns And Addition Of Folic Acid To Processed Foods

Abstract

Introduction: prevention of neural tube defects (NTD) in pregnancy was implemented in Brazil since June 2004, by enriching industrialized flour with folic acid. The irregularity in industry compliance and handicraft production of flour leave doubts to the legal rules effectiveness and their impact on the reduction of NTD. We analyzed the impact of this policy on development regions of the state of Pernambuco - Brazil, comparing some indicators of regional development and access to health services. Method: newborns registered in the system of live birth information - SINASC were evaluated in this study and those with NTD (anencephaly, spina bifida and encephalocele) where identified, considering the periods between the years 2000-2004 and 2008-2012. We calculated the prevalence of NTD in both periods and the prevalence ratio - PR for Pernambuco as a whole and for its 12 development regions. The results were discussed according to the Human Development Index - HDI, per capita income - PCR, pregnant women with seven or more prenatal consultations (%) - GPN and seasonal crop planted area (%) - AP. Results: there was no significant reduction in the prevalence of NTD in Pernambuco comparing the five-year periods 2000-2004 and 2008-2012: PR = 1.4 (95% CI: 0.91-1.20). Only the Metropolitan Area has shown decreased prevalence: PR = 0.76 (95% CI: 0.71-0.94), which has the highest HDI (0.68) and PCR (R$ 512.00) and occupies the 1st and 3rd positions on GPN (66.0%) and AP (20.5%). Three regions showed increased PR of NTD and for the remnants, variations of PR were not significant. Conclusion: The Brazilian public policy of adding folic acid to flour to prevent NTD had a positive impact only in the Metropolitan Area of Recife, where the development of indicators and access to services are better.