Preventing birth defects, saving lives, and promoting health equity: an urgent call to action for universal mandatory food fortification with folic acid

Vijaya Kancherla, PhD; Lorenzo D Botto, MD; Laura A Rowe, MPH; Nathan A Shlobin, BA; Adrian Caceres, MD; Anastasia Arynchyna-Smith, MPH; Kathrin Zimmerman, BA; Jeffrey Blount, MD; Zewdie Kibruyisfaw, MD; Kemel A Ghotme, MD; Santosh Karmarkar, MCh; Graham Fieggen, MD; Sylvia Roozen, PhD; Godfrey P Oakley, Jr, MD; Gail Rosseau, MD; Robert J Berry, MD

The Lancet Global Health (Jul 2022)

Preventing birth defects, saving lives, and promoting health equity: an urgent call to action for universal mandatory food fortification with folic acid

Vijaya Kancherla, PhD,
Lorenzo D Botto, MD,
Laura A Rowe, MPH,
Nathan A Shlobin, BA,
Adrian Caceres, MD,
Anastasia Arynchyna-Smith, MPH,
Kathrin Zimmerman, BA,
Jeffrey Blount, MD,
Zewdie Kibruyisfaw, MD,
Kemel A Ghotme, MD,
Santosh Karmarkar, MCh,
Graham Fieggen, MD,
Sylvia Roozen, PhD,
Godfrey P Oakley, Jr, MD,
Gail Rosseau, MD,
Robert J Berry, MD

Affiliations

Vijaya Kancherla, PhD: Department of Epidemiology, Center for Spina Bifida Prevention, Rollins School of Public Health, Emory University, Atlanta, GA, USA; Correspondence to: Dr Vijaya Kancherla, Department of Epidemiology, Center for Spina Bifida Prevention, Rollins School of Public Health, Emory University, Atlanta, GA 30322, USA
Lorenzo D Botto, MD: Division of Medical Genetics, Department of Pediatrics, School of Medicine, University of Utah, Salt Lake City, UT, USA
Laura A Rowe, MPH: Food Fortification Initiative, Atlanta, GA, USA
Nathan A Shlobin, BA: Department of Neurological Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
Adrian Caceres, MD: Department of Neurosurgery, National Children's Hospital of Costa Rica Dr Carlos Saenz Herrera, San José, Costa Rica
Anastasia Arynchyna-Smith, MPH: Department of Neurosurgery, Children's of Alabama, University of Alabama at Birmingham, Birmingham, AL, USA
Kathrin Zimmerman, BA: Department of Neurosurgery, Children's of Alabama, University of Alabama at Birmingham, Birmingham, AL, USA
Jeffrey Blount, MD: Department of Neurosurgery, Children's of Alabama, University of Alabama at Birmingham, Birmingham, AL, USA
Zewdie Kibruyisfaw, MD: Department of Neurosurgery, Addis Ababa University, Addis Ababa, Ethiopia
Kemel A Ghotme, MD: Translational Neuroscience Research Lab, Faculty of Medicine, Universidad de La Sabana, Chía, Colombia; Department of Neurosurgery, Fundacion Santa Fe de Bogota, Bogota, Colombia
Santosh Karmarkar, MCh: Department of Paediatric Surgery, Lilavati Hospital and Research Centre, Mumbai, India
Graham Fieggen, MD: Department of Neurosurgery, Neuroscience Institute, University of Cape Town, Cape Town, South Africa
Sylvia Roozen, PhD: International Federation for Spina Bifida and Hydrocephalus, Brussels, Belgium
Godfrey P Oakley, Jr, MD: Department of Epidemiology, Center for Spina Bifida Prevention, Rollins School of Public Health, Emory University, Atlanta, GA, USA
Gail Rosseau, MD: Department of Neurosurgery, School of Medicine and Health Sciences, George Washington University, Washington, DC, USA
Robert J Berry, MD: Department of Epidemiology, Center for Spina Bifida Prevention, Rollins School of Public Health, Emory University, Atlanta, GA, USA

Journal volume & issue: Vol. 10, no. 7
pp. e1053 – e1057

Abstract

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Summary: July 20, 2021 marked the 30th anniversary of the publication of the landmark trial by the British Medical Research Council showing unequivocally that maternal intake of folic acid (vitamin B9) starting before pregnancy prevents most cases of infant spina bifida and anencephaly—two major neural tube defects that are severe, disabling, and often fatal. Mandatory food fortification with folic acid is a safe, cost-effective, and sustainable intervention to prevent spina bifida and anencephaly. Yet few countries implement fortification with folic acid; only a quarter of all preventable spina bifida and anencephaly cases worldwide are currently avoided by food fortification. We summarise scientific evidence supporting immediate, mandatory fortification with folic acid to prevent the development of spina bifida and anencephaly. We make an urgent call to action for the World Health Assembly to pass a resolution for universal mandatory folic acid fortification. Such a resolution could accelerate the slow pace of spina bifida and anencephaly prevention globally, and will assist countries to reach their 2030 Sustainable Development Goals on child mortality and health equity. The cost of inaction is profound, and disproportionately impacts susceptible populations in low-income and middle-income countries.

Published in The Lancet Global Health

ISSN: 2214-109X (Online)
Publisher: Elsevier
Country of publisher: United Kingdom
LCC subjects: Medicine: Public aspects of medicine
Website: http://www.lancet.com/journals/langlo/issue/current

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