Reduction in Neural-Tube Defects after Folic Acid Fortification in Canada

Department of Social and Preventive Medicine, Laval University, Quebec City, Quebec, Canada
New England Journal of Medicine (Impact Factor: 55.87). 08/2007; 357(2):135-42. DOI: 10.1056/NEJMoa067103
Source: PubMed


In 1998, folic acid fortification of a large variety of cereal products became mandatory in Canada, a country where the prevalence of neural-tube defects was historically higher in the eastern provinces than in the western provinces. We assessed changes in the prevalence of neural-tube defects in Canada before and after food fortification with folic acid was implemented.
The study population included live births, stillbirths, and terminations of pregnancies because of fetal anomalies among women residing in seven Canadian provinces from 1993 to 2002. On the basis of published results of testing of red-cell folate levels, the study period was divided into prefortification, partial-fortification, and full-fortification periods. We evaluated the relationship between baseline rates of neural-tube defects in each province and the magnitude of the decrease after fortification was implemented.
A total of 2446 subjects with neural-tube defects were recorded among 1.9 million births. The prevalence of neural-tube defects decreased from 1.58 per 1000 births before fortification to 0.86 per 1000 births during the full-fortification period, a 46% reduction (95% confidence interval, 40 to 51). The magnitude of the decrease was proportional to the prefortification baseline rate in each province, and geographical differences almost disappeared after fortification began. The observed reduction in rate was greater for spina bifida (a decrease of 53%) than for anencephaly and encephalocele (decreases of 38% and 31%, respectively).
Food fortification with folic acid was associated with a significant reduction in the rate of neural-tube defects in Canada. The decrease was greatest in areas in which the baseline rate was high.

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Available from: Michiel Van den Hof, Sep 30, 2015
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    • "Spina bifida describes a spectrum of neurological impairment resulting from failure of fusion of the caudal neural tube. It is one of the most common congenital disorders leading to disability (Mitchell et al. 2004) with a prevalence of 4.1 affected children per 10 000 births in Canada (8.6 per 10 000 births for all neural-tube defects) (De Wals et al. 2007). Children born with spina bifida are at risk for hydrocephalus, leg weakness and paralysis, sensory loss, and bladder and bowel incontinence (Mitchell et al. 2004). "
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    ABSTRACT: Background Urinary incontinence is frequently experienced by children with spina bifida, putting them at increased risk for low self-esteem and impacting upon participation in home, school and leisure activities. However, little is known about children's experiences of these continence issues.Objective This study explored the experiences of children and young people with spina bifida around continence issues, social participation and peer relationships, in order to identify potential areas of support healthcare professionals can provide.Methods Children and youth aged 6–18 years with diagnoses of spina bifida and neurogenic bladder and their parents were invited to participate in semi-structured interviews. Descriptive thematic analysis was employed.ResultsEleven children (with a range of mobility levels, types of spina bifida and degrees of bladder control) and their parents participated in the study. Three broad themes were identified, which encompassed the following: (1) normal versus different; (2) independence, ownership and the road to continence; and (3) peer relationships and acceptance.DiscussionThe experiences discussed by the children and parents in this study ranged from minimal impact of incontinence on their day-to-day living to significant social isolation and rejection. The stigma of incontinence was apparent in all interviews. Children and youth who were able to control their bladder with minimal accidents had greater independence and more opportunities for social participation. Healthcare professionals need to take into account that parents and their children may differ in attitudes and desires about the management of incontinence.
    Child Care Health and Development 05/2015; DOI:10.1111/cch.12257 · 1.69 Impact Factor
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    • "One environmental change, with the potential to affect all residents, was the addition of folic acid to cereals starting in 1998. This was done to reduce the incidence of neural tube defects in newborns [23]. "
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    ABSTRACT: Background Nova Scotia has one of the highest incidences of inflammatory bowel disease (IBD) in the world. We wished to determine trends of IBD over time. Methods All Provincial residents have government provided health insurance and all interactions with the hospital, and physician billing systems, are captured on an administrative database. We used a validated measure to define incident cases of Crohn’s (CD), ulcerative colitis (UC) and undifferentiated IBD (IBDU). Incidence rates of these diseases for the years 1996–2009 were calculated. Results Over the study period, 7,153 new cases of IBD were observed of which 3,046 cases were categorized as CD (42.6%), 2,960 as UC (41.4%) and 1,147 as IBDU (16.0%). Annual age standardized incidence rates were very high but have declined for CD from 27.4 to 17.7/100,000 population and for UC from 21.4 to 16.7/100,000. The decline was seen in all age groups and both genders. The decrease was not explained by a small increase in IBDU. Conclusion The incidence of CD and UC are decreasing in Nova Scotia. If replicated elsewhere this indicates a reversal after a long period of increasing occurrence of IBD. This has implications for both epidemiology and health planning.
    BMC Gastroenterology 08/2014; 14(1):140. DOI:10.1186/1471-230X-14-140 · 2.37 Impact Factor
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    • "The multifactorial etiology of NTDs includes genetic predisposition, maternal nutritional deficiencies and other environmental factors (Eskes, 1998; Melvin et al., 2000). Notably, folate deficiency during pregnancy is one of the most important risk factors for NTDs and the periconceptional supplementation of folic acid has proven to prevent 50-70% of NTDs (Wald et al., 1991; De Wals et al., 2007). "
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    ABSTRACT: Abnormalities in maternal folate and carbohydrate metabolism have both been shown to induce neural tube defects (NTD) in humans and animal models. However, the relationship between these two factors in the development of NTDs remains unclear. Data from mothers of children with spina bifida seen at the Unidad de Espina Bífida del Hospital Infantil Virgen del Rocío (case group) were compared to mothers of healthy children with no NTD (control group) who were randomly selected from patients seen at the outpatient ward in the same hospital. There were 25 individuals in the case group and 41 in the control group. Analysis of genotypes for the methylenetetrahydrofolate reductase (MTHFR) 677CT polymorphism in women with or without risk factors for abnormal carbohydrate metabolism revealed that mothers who were homozygous for the MTHFR 677TT polymorphism and at risk of abnormal carbohydrate metabolism were more likely to have offspring with spina bifida and high levels of homocysteine, compared to the control group. The increased incidence of NTDs in mothers homozygous for the MTHFR 677TT polymorphism and at risk of abnormal carbohydrate metabolism stresses the need for careful metabolic screening in pregnant women, and, if necessary, determination of the MTHFR 677CT genotype in those mothers at risk of developing abnormal carbohydrate metabolism.
    Genetics and molecular research: GMR 03/2014; 13(1):2200-2207. DOI:10.4238/2014.March.26.8 · 0.78 Impact Factor
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