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

• Type of Material: Article
• Authors: Vijaya Kancherla, Emory University; Lorenzo D. Botto, University of Utah; Laura A. Rowe, Food Fortification Initiative; Nathan A. Shlobin, Northwestern University Feinberg School of Medicine; Adrian Caceres, Hospital Nacional de Niños de Costa Rica; Anastasia Arynchyna-Smith, University of Alabama Birmingham; Kathrin Zimmerman, University of Alabama Birmingham; Jeffrey Blount, University of Alabama Birmingham; Zewdie Kibruyisfaw, Addis Ababa University; Kemel A. Ghotme, Universidad de La Sabana; Santosh Karmarkar, Lilavati Hospital & Research Centre; Graham Fieggen, University of Cape Town; Sylvia Roozen, International Federation for Spina Bifida and Hydrocephalus; Godfrey P. Oakley, Jr., Emory University; Gail Rosseau, George Washington University; Robert J. Berry, Emory University
• Language: English
• Date: 2022-07-01
• Publisher: Elsevier
• Publication Version: Final Published Version
• Copyright Statement: © 2022 The Author(s). Published by Elsevier Ltd.
• License: Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1016/S2214-109X(22)00213-3
• Title of Journal or Parent Work: The Lancet Global Health
• Volume: 10
• Issue: 7
• Start Page: e1053
• End Page: e1057
• Keywords: Folic Acid; Humans; Pregnancy; Food, Fortified; Anencephaly; Child; Female; Prevalence; Spinal Dysraphism; Infant; Health Equity
• Research Categories: Health Sciences, Obstetrics and Gynecology; Health Sciences, Nutrition

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 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.