CDC Grand Rounds: Additional Opportunities to Prevent Neural Tube Defects with Folic Acid Fortification

Document Sample
CDC Grand Rounds: Additional Opportunities to Prevent Neural Tube Defects with Folic Acid Fortification Powered By Docstoc
					                                               MMWR Morbidity and Mortality Weekly Report



         CDC Grand Rounds: Additional Opportunities to Prevent Neural
                   Tube Defects with Folic Acid Fortification

           Neural tube defects (NTDs) are serious birth                        pregnancies are unplanned. Fortifying foods with folic
      defects that result from the failure of the neural tube                  acid has been a highly effective and more uniform
      to close in the cranial region (anencephaly) or more                     intervention, because fortification makes folic acid
      caudally along the spine (spina bifida) by the 28th                      accessible to all women of childbearing age without
      day of gestation. Infants born with anencephaly usu-                     requiring behavior change.
      ally die within a few days of birth, and those with                          In 1992, the U.S. Public Health Service (USPHS)
      spina bifida have life-long disabilities with varying                    recommended that all women of childbearing age
      degrees of paralysis. Currently, identified risk fac-                    capable of becoming pregnant consume 400 µg of
      tors for NTDs include a mother who previously                            folic acid daily for prevention of NTDs. In 1996, the
      had an NTD-affected pregnancy, maternal diabetes,                        Food and Drug Administration (FDA) established
      obesity, hyperthermia, certain antiseizure medica-                       regulations that required that by 1998 all standard-
      tions, genetic variants, race/ethnicity, and nutrition                   ized enriched cereal grain products sold in the United
      (particularly folic acid insufficiency). In the United                   States include 140 µg folic acid/100 g and provided
      States, during 1995–1996, approximately 4,000                            for the addition of folic acid to breakfast cereals,
      pregnancies were affected by an NTD. This number                         corn grits, infant formulas, medical foods, and foods
      declined to 3,000 pregnancies in 1999–2000 after                         for special dietary use. Also in 1998, the Institute of
      fortification of enriched cereal grain products with                     Medicine (IOM) conducted an independent review,
      folic acid was mandated (1). Worldwide, in 1998,                         with conclusions supporting the USPHS recom-
      approximately 300,000 births were affected by an                         mendations for folic acid consumption; in 2009, the
      NTD (Figure 1).                                                          U.S. Preventive Services Task Force published updated
           Both observational and intervention studies,                        guidelines reinforcing these recommendations (4).
      including randomized, controlled trials, have dem-
      onstrated that adequate consumption of folic acid                        Impact of Fortification with Folic Acid
      periconceptionally can prevent 50%—70% of NTDs                               U.S. NTD and blood folate trends. The man-
      (2). Three approaches can increase intake of folate/                     datory fortification of standardized enriched cereal
      folic acid*: dietary improvement, supplementation,                       grain products in the United States resulted in a
      and food fortification. Efforts to improve women’s                       substantial increase in blood folate concentrations
      dietary habits so that they consume more foods rich                      and a concomitant decrease in NTD prevalence. The
      in folate or daily vitamin supplements have had                          percentage of the population with low serum folate
      little success because they require behavior change,                     (<3 ng/mL) declined from 21% in the period before
				
DOCUMENT INFO
Description: Neural tube defects (NTDs) are serious birth defects that result from the failure of the neural tube to close in the cranial region (anencephaly) or more caudally along the spine (spina bifida) by the 28th day of gestation. In the US, during 1995-1996, an approximately 4,000 pregnancies were affected by an NTD. This number declined to 3,000 pregnancies in 1999-2000 after fortification of enriched cereal grain products with folic acid was mandated. Cordero et al discuss the effectiveness of folic acid fortification in preventing NTDs and detail current opportunities and strategies to further reinforce it.
BUY THIS DOCUMENT NOW PRICE: $6.95 100% MONEY BACK GUARANTEED
PARTNER ProQuest LLC
ProQuest creates specialized information resources and technologies that propel successful research, discovery, and lifelong learning.