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BMC Pregnancy and Childbirth
Published in: BMC Pregnancy and Childbirth 1/2004

Open Access 01-12-2004 | Research article

A comprehensive evaluation of food fortification with folic acid for the primary prevention of neural tube defects

Authors: Shiliang Liu, Roy West, Edward Randell, Linda Longerich, Kathleen Steel O'Connor, Helen Scott, Marian Crowley, Angeline Lam, Victor Prabhakaran, Catherine McCourt

Published in: BMC Pregnancy and Childbirth | Issue 1/2004

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Abstract

Background

Periconceptional use of vitamin supplements containing folic acid reduces the risk of a neural tube defect (NTD). In November 1998, food fortification with folic acid was mandated in Canada, as a public health strategy to increase the folic acid intake of all women of childbearing age. We undertook a comprehensive population based study in Newfoundland to assess the benefits and possible adverse effects of this intervention.

Methods

This study was carried out in women aged 19–44 years and in seniors from November 1997 to March 1998, and from November 2000 to March 2001. The evaluation was comprised of four components: I) Determination of rates of NTDs; II) Dietary assessment; III) Blood analysis; IV) Assessment of knowledge and use of folic acid supplements.

Results

The annual rates of NTDs in Newfoundland varied greatly between 1976 and 1997, with a mean rate of 3.40 per 1,000 births. There was no significant change in the average rates between 1991–93 and 1994–97 (relative risk [RR] 1.01, 95% confidence interval [CI] 0.76–1.34). The rates of NTDs fell by 78% (95% CI 65%–86%) after the implementation of folic acid fortification, from an average of 4.36 per 1,000 births during 1991–1997 to 0.96 per 1,000 births during 1998–2001 (RR 0.22, 95% CI 0.14–0.35). The average dietary intake of folic acid due to fortification was 70 μg/day in women aged 19–44 years and 74 μg/day in seniors. There were significant increases in serum and RBC folate levels for women and seniors after mandatory fortification. Among seniors, there were no significant changes in indices typical of vitamin B12 deficiencies, and no evidence of improved folate status masking haematological manifestations of vitamin B12 deficiency. The proportion of women aged 19–44 years taking a vitamin supplement containing folic acid increased from 17% to 28%.

Conclusions

Based on these findings, mandatory food fortification in Canada should continue at the current levels. Public education regarding folic acid supplement use by women of childbearing age should also continue.
Appendix
Available only for authorised users
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Metadata
Title
A comprehensive evaluation of food fortification with folic acid for the primary prevention of neural tube defects
Authors
Shiliang Liu
Roy West
Edward Randell
Linda Longerich
Kathleen Steel O'Connor
Helen Scott
Marian Crowley
Angeline Lam
Victor Prabhakaran
Catherine McCourt
Publication date
01-12-2004
Publisher
BioMed Central
Published in
BMC Pregnancy and Childbirth / Issue 1/2004
Electronic ISSN: 1471-2393
DOI
https://doi.org/10.1186/1471-2393-4-20

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