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

Vijaya Kancherla, Department of Epidemiology, Center for Spina Bifida Prevention, Rollins School of Public Health, Emory University, Atlanta, GA, USA. Electronic address: vijaya.kancherla@emory.edu.
Lorenzo D. Botto, Division of Medical Genetics, Department of Pediatrics, School of Medicine, University of Utah, Salt Lake City, UT, USA.
Laura A. Rowe, Food Fortification Initiative, Atlanta, GA, USA.
Nathan A. Shlobin, Department of Neurological Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.
Adrian Caceres, Department of Neurosurgery, National Children's Hospital of Costa Rica Dr Carlos Saenz Herrera, San José, Costa Rica.
Anastasia Arynchyna-Smith, Department of Neurosurgery, Children's of Alabama, University of Alabama at Birmingham, Birmingham, AL, USA.
Kathrin Zimmerman, Department of Neurosurgery, Children's of Alabama, University of Alabama at Birmingham, Birmingham, AL, USA.
Jeffrey Blount, Department of Neurosurgery, Children's of Alabama, University of Alabama at Birmingham, Birmingham, AL, USA.
Zewdie Kibruyisfaw, Department of Neurosurgery, Addis Ababa University, Addis Ababa, Ethiopia.
Kemel A. Ghotme, 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, Department of Paediatric Surgery, Lilavati Hospital and Research Centre, Mumbai, India.
Graham Fieggen, Department of Neurosurgery, Neuroscience Institute, University of Cape Town, Cape Town, South Africa.
Sylvia Roozen, International Federation for Spina Bifida and Hydrocephalus, Brussels, Belgium.
Godfrey P. Oakley, Department of Epidemiology, Center for Spina Bifida Prevention, Rollins School of Public Health, Emory University, Atlanta, GA, USA.
Gail Rosseau, Department of Neurosurgery, School of Medicine and Health Sciences, George Washington University, Washington, DC, USA.
Robert J. Berry, Department of Epidemiology, Center for Spina Bifida Prevention, Rollins School of Public Health, Emory University, Atlanta, GA, USA.

Document Type

Journal Article

Publication Date

5-23-2022

Journal

The Lancet. Global health

DOI

10.1016/S2214-109X(22)00213-3

Abstract

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 B) 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.

Department

Neurological Surgery

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