Abstract
ObjectiveTo determine if the fortification of wheat and maize flours with iron and folic acid – which became mandatory in Brazil from June 2004 – is effective in the prevention of neural tube defects.MethodsUsing data from national information systems on births in central, south-eastern and southern Brazil, we determined the prevalence of neural tube defects among live births and stillbirths in a pre-fortification period – i.e. 2001–2004 – and in a post-fortification period – i.e. 2005–2014. We distinguished between anencephaly, encephalocele, meningocele, myelomeningocele and other forms of spina bifida.FindingsThere were 8554 neural tube defects for 17 925 729 live births notified between 2001 and 2014. For the same period, 2673 neural tube defects were reported for 194 858 stillbirths. The overall prevalence of neural tube defects fell from 0.79 per 1000 pre-fortification to 0.55 per 1000 post-fortification (prevalence ratio, PR: 1.43; 95% confidence interval, CI: 1.38–1.50). For stillbirths, prevalence fell from 17.74 per 1000 stillbirths pre-fortification to 11.70 per 1000 stillbirths post-fortification. The corresponding values among live births were 0.57 and 0.44, respectively.ConclusionThe introduction of the mandatory fortification of flour with iron and folic acid in Brazil was followed by a significant reduction in the prevalence of neural tube defects in our study area.
Highlights
Neural tube defects, which are detected in about 300 000 neonates worldwide each year, are a major cause of neonatal morbidity and mortality.[1]
Neural tube defects are divided into two main groups: defects affecting brain structures – such as anencephaly and encephalocele and defects that affect the structures of the spinal cord – such as meningocele, myelomeningocele and other forms of spina bifida.[4,5]
This defect can be covered by skin – when it is known as spina bifida occulta – or be associated with a cystic protrusion
Summary
Neural tube defects, which are detected in about 300 000 neonates worldwide each year, are a major cause of neonatal morbidity and mortality.[1]. Neural tube defects are divided into two main groups: defects affecting brain structures – such as anencephaly and encephalocele and defects that affect the structures of the spinal cord – such as meningocele, myelomeningocele and other forms of spina bifida.[4,5] Anencephaly – called exencephaly or craniorachischisis – is defined as the complete or partial absence of the brain. This defect, which is caused by a failure of the cephalic neural tube to close,[6,7] leads to fetal deaths, stillbirths or neonatal deaths. The cystic protrusion contains elements of the spinal cord and/or nerves
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