scholarly journals Sex differences in the prevalence of neural tube defects and preventive effects of folic acid (FA) supplementation among five counties in northern China: results from a population-based birth defect surveillance programme

BMJ Open ◽  
2018 ◽  
Vol 8 (11) ◽  
pp. e022565 ◽  
Author(s):  
Jufen Liu ◽  
Jing Xie ◽  
Zhiwen Li ◽  
Nicholas D E Greene ◽  
Aiguo Ren
Keyword(s):  
Sex Differences ◽  
Folic Acid ◽  
Neural Tube ◽  
Neural Tube Defects ◽  
Gestational Age ◽  
Birth Defect ◽  
Northern China ◽  
Population Based ◽  
Secondary Outcome ◽  
Surveillance Programme

ObjectivesSex differences in prevalence of neural tube defects (NTDs) have previously been recognised; however, the different susceptibility of men and women have not been examined in relation to the effects of folic acid (FA) supplementation. We hypothesised that FA may have a disproportionate effect that alters the sex-specific prevalence of NTDs.SettingData from two time points, before (2003–2004) and after (2011–2016) the start of the supplementation programme, were obtained from a population-based birth defect surveillance programme among five counties in northern China. All live births (28 or more complete gestational weeks), all stillbirths of at least 20 weeks’ gestational age and pregnancy terminations at any gestational age following the prenatal diagnosis of NTDs were included.ParticipantsA total of 25 249 and 83 996 births before and after the programme were included respectively.Primary and secondary outcome measuresThe prevalence of NTDs by sex and subtype, Male:female rate ratios and their 95% CI were calculated.ResultsOverall, NTDs were less prevalent among men than among women (rate ratio (RR) 0.92; 95% CI 0.90 to 0.94), so was anencephaly (RR 0.77; 95% CI 0.73 to 0.81) and encephalocele (RR 0.75; 95% CI 0.61 to 0.92), while spina bifida showed a male predominance (RR 1.10; 95% CI 1.05 to 1.15). The overall prevalence of NTDs decreased by 78/10 000 in men and 108.7/10 000 in women from 2003 to 2004 to 2011 to 2016. There was a significant sex difference in the magnitude of reduction, being greater in women than men, particularly for anencephaly.ConclusionsThe prevalence of NTDs decreased in both sexes after the implementation of a massive FA supplementation programme. While female predominance was observed in open NTDs and total NTDs, they also had a greater rate of decrease in NTDs after the supplementation programme.

scholarly journals Folic Acid in Prenatal Supplements: Labeled Amounts Compared to Recommendations (P11-024-19)

2019 ◽  
Vol 3 (Supplement_1) ◽  
Author(s):  
Leila Saldanha ◽  
Johanna Dwyer ◽  
Nancy Potischman ◽  
Karen Andrews
Keyword(s):  
Folic Acid ◽  
Dietary Supplements ◽  
Neural Tube ◽  
Neural Tube Defects ◽  
Task Force ◽  
Daily Intake ◽  
Population Based ◽  
Health Claim ◽  
Dietary Folate ◽  
The Us

Abstract Objectives Most prenatal supplements available in the US contain synthetic folic acid. We compared the labeled amounts of folic acid in prenatal supplements with: 1) the Recommended Dietary Allowance (RDA) of 360 mcg and Tolerable Upper Intake Level (UL) of 1000 mcg for pregnant women established by National Academies of Science, Engineering and Medicine's Food and Nutrition Board (FNB) and expressed as synthetic folic acid from supplements and fortified foods; 2) current population-based Daily Values (DV) used for labeling dietary supplements and established by the US Food and Drug Administration (FDA); 3) FDA criteria for making a neural tube defects health claim on prenatal supplement labels; and 4) 2009/2016 recommendations for the prevention of neural tube defects by the US Preventive Services Task Force (USPSTF). In 2016, the FDA revised its DV to 600 mcg DFE folate (360 mcg folic acid) to reflect amounts consistent with the RDAs. This new DV is lower than the pre-2016 DV of 800 mcg from food and supplement sources and the 800 mcg level to make a health claim. Methods We reviewed the synthetic folic acid content as declared on prenatal supplement labels sold with and without a prescription, using data in the Dietary Supplements Label Database (DSLD) (website: https://dsld.nlm.nih.gov/dsld/) and DailyMed (website: https://dailymed.nlm.nih.gov/dailymed/index.cfm). Results The many recommendations for folate versus folic acid are often unclear (e.g., Dietary Folate Equivalents vs. mcg folic acid). Amounts ≥ 800 mcg folic acid per serving, the prior DV, were present on 99% of 79 prescription and 91% of 121 nonprescription labels reviewed. 94% of the prescription and 16% of nonprescription prenatal supplements were labeled at 1000 mcg per serving, and none (0%) of the prescription and 74% of the nonprescription were labeled at 800 mcg. These labeled amounts (from supplements alone) were higher than the USPSTF recommended daily intake of 400 to 800 mcg and the current DV and RDA values. Conclusions The DV, UL, the criterion for making a health claim on prenatal supplement labels, the USPSTF recommendations, and the units used for expressing folate and folic acid recommendations need to be harmonized and clarified. Funding Sources Office of Dietary Supplements, NIH.

scholarly journals Prevention of neural tube defects by the fortification of flour with folic acid: a population-based retrospective study in Brazil

2015 ◽  
Vol 94 (1) ◽  
pp. 22-29 ◽  
Author(s):  
Leonor Maria Pacheco Santos ◽  
Roberto Carlos Reyes Lecca ◽  
Juan Jose Cortez-Escalante ◽  
Mauro Niskier Sanchez ◽  
Humberto Gabriel Rodrigues
Keyword(s):  
Folic Acid ◽  
Retrospective Study ◽  
Neural Tube ◽  
Neural Tube Defects ◽  
Population Based

scholarly journals Neural Tube Defects in Costa Rica, 1987–2012: Origins and Development of Birth Defect Surveillance and Folic Acid Fortification

2014 ◽  
Vol 19 (3) ◽  
pp. 583-590 ◽  
Author(s):  
María de la Paz Barboza-Argüello ◽  
Lila M. Umaña-Solís ◽  
Alejandro Azofeifa ◽  
Diana Valencia ◽  
Alina L. Flores ◽  
...  
Keyword(s):  
Folic Acid ◽  
Costa Rica ◽  
Neural Tube ◽  
Neural Tube Defects ◽  
Birth Defect ◽  
Folic Acid Fortification

A Public Health Success Story: Folic Acid Fortification and Supplementation for Prevention of Neural Tube Defects

2004 ◽  
Author(s):  
Linda Longerich ◽  
Roy West ◽  
Ed Randell ◽  
Marian Crowley ◽  
Shiliang Liu ◽  
...  
Keyword(s):  
Public Health ◽  
Folic Acid ◽  
Neural Tube ◽  
Neural Tube Defects ◽  
Success Story ◽  
Folic Acid Fortification

scholarly journals Knowledge and intake of folic acid to prevent neural tube defects among pregnant women in urban China: a cross-sectional study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Mingming Cui ◽  
Xiao-Lin Lu ◽  
Yan-Yu Lyu ◽  
Fang Wang ◽  
Xiao-Lu Xie ◽  
...  
Keyword(s):  
Folic Acid ◽  
Pregnant Women ◽  
Neural Tube ◽  
Neural Tube Defects ◽  
Rural Women ◽  
Rural Areas ◽  
Urban Areas ◽  
Unplanned Pregnancy ◽  
Urban China ◽  
Cross Sectional

Abstract Background The prevalence of neural tube defects (NTDs) in China declined during 2000–2017 with periconceptional folic acid (FA) supplementation, which is effective in reducing the risk of birth defects. We aimed to assess the knowledge and actual use of FA among Chinese pregnant women and to explore factors associated with FA use before pregnancy. Methods All data were collected in face-to-face interviews during health visits among pregnant women. We collected information about knowledge and use of FA supplements and demographic, socioeconomic, and health status. One maternity and childcare hospital was chosen in each of four cities: Beijing, Huaibei, Kunming, and Haikou. In total, 435 pregnant women were randomly recruited for interviews conducted from June to December 2016. Results A total of 428 pregnant women were included in this survey. Of these, 82.0% (351/428) knew that FA can prevent NTDs, and 75.9% (325/428) knew the correct time to take FA. Overall, 65.9% (282/428) of women knew both that FA can prevent NTDs and the recommended time to take FA before pregnancy. Approximately 95.1% (407/428) of women reported having ever taken FA, only 46.3% (198/428) had begun to take FA supplementation before conception, and 64.5% (109/169) of women from rural areas failed to take FA before pregnancy. Women living in northern China (odds ratio [OR] = 1.81, 95% confidence interval [CI], 1.18–2.77), those with unplanned pregnancy (OR = 1.99, 95% CI 1.30–3.04), and highly educated women (OR = 2.37, 95% CI 1.45–3.88) were more likely to know about FA. Women who were homemakers (OR = 1.94, 95% CI 1.21–3.11) and had unplanned pregnancy (OR = 6.18, 95% CI 4.01–9.53) were less likely to begin taking FA before pregnancy. Conclusions Our survey showed that most pregnant women knew about FA. Although preconception intake of FA can help to reduce NTDs, improving the rate of FA intake before pregnancy is needed in urban areas of China, especially among homemakers and women from rural areas or with unplanned pregnancy. Campaigns are needed to increase awareness about FA and FA use before pregnancy among rural women, homemakers, and those with unplanned pregnancy and lower education levels.

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