Global Initiative to Eliminate Folic Acid-Preventable Neural Tube Defects

Neural tube defects are serious birth defects of the spine and brain, and are a significant cause of infant mortality and childhood morbidity worldwide.

The two most common neural tube defects are spina bifida and anencephaly.
In the U.S., 3,000 pregnancies are affected by neural tube defects every year (1), and Hispanic women have a higher rate of neural tube defect-affected pregnancies than non-Hispanic women.(2)
Globally there are more than 300,000 babies born with neural tube defects each year. (3)
The total lifetime cost of care for a child born with spina bifida is estimated to be $560,000. (4)

CDC has made a significant contribution in neural tube defects prevention over the past two decades and led the way in establishing that every woman who can get pregnant should consume 400 mcg of folic acid daily to prevent neural tube defects.

What has been done?

In 1996, the Food and Drug Administration (FDA) established regulations requiring that by 1998 all standardized enriched cereal grain products sold in the U. S. include 140 micrograms folic acid/100 grams and allowed for the addition of folic acid to breakfast cereals, corn grits, infant formulas, medical foods, and foods for special dietary use.
Before fortification, about 4,130 babies had neural tube defects each year in the U. S., and nearly 1,200 died. After folic acid fortification, the yearly number of pregnancies affected by neural tube defects dropped to about 3,000, and the related deaths declined to 840. (1)

Expanding Global Efforts

Expansion of global folic acid fortification efforts can have a significant impact on infant mortality and childhood morbidity worldwide. CDC’s National Center on Birth Defects and Developmental Disabilities (NCBDDD) has developed the Global Initiative to Eliminate Folic Acid-Preventable Neural Tube Defects (GIENTD) to significantly reduce infant mortality and childhood morbidity resulting from the more than 300,000 neural tube defect-affected births worldwide each year, contribute to the achievement of United Nations Millennium Development Goal 4

, and help to meet the Global Health Initiative Child Health Goal

.
The initiative builds on CDC’s expertise and experience in neural tube defect prevention and aims to expand the number of low and middle income countries with mandatory folic acid fortification of staple foods consumed by a large proportion of the population (such as wheat flour and maize flour) and provide support for long-term sustainable interventions to eliminate folic acid-preventable neural tube defects worldwide. Key components of the initiative are to provide needed technical expertise for surveillance of neural tube defects, monitor fortification efforts and improve laboratory capacity. The GIENTD strategic objectives are centered on policy, program and science, and underscore the importance of effective partnerships to reach countries with the most need and where the health impact would be greatest.

The GIENTD strategic objectives are to:

Work with the World Health Organization (WHO) and others to establish a global policy to support and advance country-level fortification efforts
Strengthen and expand global folic acid fortification and other intervention efforts, and fill scientific and technical gaps by engaging in strategic partnerships
Strengthen the public health capacity for blood folate and neural tube defect surveillance, epidemiology and laboratory capacity globally, including determining biomarkers for optimal blood folate concentrations for neural tube defect prevention

Public Health Impact

With more than 300,000 neural tube defect-affected pregnancies annually, expanding the reach of global folic acid fortification in low and middle income countries can lead to the prevention of 150,000-210,000 neural tube defects worldwide each year. (5)
Many countries currently do not have the surveillance systems that can accurately monitor prevalence of neural tube defects and other observable birth defects. Through this initiative, CDC can provide needed technical expertise for surveillance of neural tube defects, monitoring of fortification efforts and improvement of laboratory capacity.

References

CDC. Spina Bifida and Anencephaly Before and After Folic Acid Mandate --- United States, 1995--1996 and 1999—2000. MMWR 2004; 53(17): 362-365.
Williams LJ, Rasmussen SA, Flores A, Kirby ES, Edmonds LD. Decline in the prevalence of spina bifida and anencephaly by race/ethnicity: 1995-2002. Pediatrics. 2005 Sep:116(3):580-6.
Shibuya K, Murray CJ. Congenital anomalies. In: Health dimensions of sex and reproduction: the global burden of sexually transmitted diseases, HIV, maternal conditions, perinatal disorders, and congenital anomalies. Murray CJ, Lopez AD, eds. Boston, Massachusetts: the Harvard School of Public Health on behalf of the World Health Organization and the World Bank; 1998:455-512.
Grosse SD, Oyang L, Collins JS, Green D, Dean JH, Stevenson RE. Economic Evaluation of a Neural Tube Defect Recurrence–Prevention Program. Am J Prev Med. 2008 Dec:35(6):572-7.
CDC. CDC Grand Rounds: Additional Opportunities to Prevent Neural Tube Defects with Folic Acid Fortification. MMWR 2010; 59(31);980-984.