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Global strategies for the prevention of neural tube defects through the improvement of folate status in women of reproductive age

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Abstract

Introduction

Neural tube defects represent a global public health problem, mainly in countries where effective prevention strategies are not yet in place. The global prevalence of neural tube defects is estimated at 18.6/10,000 (uncertainty interval: 15.3–23.0) live births, where ~ 75% of cases result in under-five mortality. Most of the mortality burden is in low- and middle-income countries. The main risk factor for this condition is insufficient folate levels in women of reproductive age.

Methods

This paper reviews the extent of the problem, including the most recent global information on folate status in women of reproductive age and the most recent estimates of the prevalence of neural tube defects. Additionally, we provide an overview of the available interventions worldwide to reduce the risk of neural tube defects by improving folate status in the population, including dietary diversification, supplementation, education, and fortification.

Results

Large-scale food fortification with folic acid is the most successful and effective intervention to reduce the prevalence of neural tube defects and associated infant mortality. This strategy requires the coordination of several sectors, including governments, the food industry, health services providers, the education sector, and entities that monitor the quality of the service processes. It also requires technical knowledge and political will. An international collaboration between governmental and non-governmental organizations is essential to succeed in saving thousands of children from a disabling but preventable condition.

Discussion

We propose a logical model for building a national-level strategic plan for mandatory LSFF with folic acid and explain the actions needed for promoting sustainable system-level change.

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Data availability

All data provided in this article can be accessed through the corresponding references in the bibliography.

Abbreviations

CDC:

Centers for disease control and prevention

EAR:

Estimated average requirement

ETOPFA:

Elective termination of pregnancy for fetal anomaly

FDA:

Food and Drug Administration

HIC:

High-income countries

LIC:

Low-income countries

LMIC:

Low- and middle-income countries

LSFF:

Large-scale food fortification

MBA:

Microbiological assay

MIC:

Middle-income countries

NTD:

Neural tube defects

RBC:

Red blood cell

WHO:

World Health Organization

WIFAS:

Weekly iron and folic acid supplementation

WRA:

Women of reproductive age

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Authors and Affiliations

  1. Global Technical Services, Nutrition International, 180 Elgin St. suite 1000, ON, Ottawa, Canada

    Homero Martinez & Mandana Arabi

  2. Hospital Infantil de México Federico Gómez, Mexico City, Mexico

    Homero Martinez

  3. Costa Rican Birth Defects Register Center (CREC), Costa Rican Institute of Research and Education in Nutrition and Health (INCIENSA), Cartago, Costa Rica

    Adriana Benavides-Lara

  4. Division of Pediatric Neurosurgery, Department of Neurosurgery, University of Alabama at Birmingham, Birmingham, AL, USA

    Anastasia Arynchyna-Smith

  5. Translational Neuroscience Research Lab, Faculty of Medicine, Universidad de La Sabana, Chia, Colombia

    Kemel A. Ghotme

  6. Department of Neurosurgery, Fundación Santa Fe de Bogota, Bogota, Colombia

    Kemel A. Ghotme

  7. Division of Preventive Medicine, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA

    Alexander Arynchyn

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  1. Homero Martinez
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  2. Adriana Benavides-Lara
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  3. Anastasia Arynchyna-Smith
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  4. Kemel A. Ghotme
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Contributions

All authors contributed to the study’s conception and design. All authors contributed to the literature review and analysis. Kemel A. Ghotme conceptualized Figures 1, 2, 3. Adriana Benavides-Lara conceptualized and designed Table 4. Alexander Arynchyn, Kemel A. Ghotme, Mandana Arabi, and Homero Martinez performed critical revision of the manuscript. Homero Martinez wrote the first draft of the manuscript, and all authors commented on consequent versions. Kemel A. Ghotme conceptualized and devised the figures. All authors read and approved the final version of the manuscript.

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Correspondence to Homero Martinez.

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Martinez, H., Benavides-Lara, A., Arynchyna-Smith, A. et al. Global strategies for the prevention of neural tube defects through the improvement of folate status in women of reproductive age. Childs Nerv Syst 39, 1719–1736 (2023). https://doi.org/10.1007/s00381-023-05913-4

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