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Health See other Health Articles Title: Adding Folic Acid to Flour Cuts Neural Tube Defects in Brazil Medscape... The prevalence of neural tube defects in live and stillborn babies dropped significantly in Brazil after the introduction of mandatory folic acid and iron fortification of wheat and maize flours in 2004. In an article published in the January 2016 issue of the Bulletin of the World Health Organization, chemist Leonor Maria Pacheco Santos, PhD, from the University of Brazil's Department of Public Health in Brasilia, and colleagues found that the prevalence of neural tube defects fell in all births by 30.1%, going from 0.79 per 1000 in the prefortification period to 0.55 per 1000 after fortification (prevalence ratio prefortification, 1.43; 95% confidence interval, 1.38 - 1.50). In stillbirths, prevalence dropped from 17.74 per 1000 stillbirths before fortification to 11.70 per 1000 births afterward, for a decline of 34.0%. Among live births, the rates were 0.57 and 0.44, respectively, for a drop of 22.8%. The findings, based on birth data from central, south, and southeast Brazil, confirmed those of two previous Brazilian studies. The most common defects noted were anencephaly, spina bifida, and encephalocele. Rates for spina bifida and anencephaly were lower after fortification than before among live births and stillbirths alike. The rate for anencephaly fell to 0.16 per 1000 live births, from 0.21, and for spina bifida, the rate fell to 0.22 from 0.28. Encephalocele, although reported in just 39 stillbirths, was somewhat more prevalent in stillbirths in the postfortification than the prefortification period, at 0.73 per 1000 vs 0.60, and virtually the same in both periods, at 0.08 (pre) and 0.07 (post) for live births. The authors point out that although previous reports have focused on live births only, "It appears that, in Brazil at least, spina bifida occurs more frequently in stillbirths than in live births. The use of data from live births alone may lead to underestimates in the overall prevalence of neural tube defects." By ethnicity, neural tube defects were most prevalent among indigenous neonates, at 0.82 per 1000 (pre) and 0.50 (post), although birth and death records for indigenous neonates were sparse. Similarly, a Canadian study found the highest rate of neural tube defects in First Nations (Indian) neonates. Noting that neural tube defects are more common in female neonates and stillbirths than in males, the authors write: "Although the link between such defects and sex is probably complex, a female fetus requires more human chorionic gonadotropin than a male fetus and deficiencies in this hormone can increase the risk of neural tube defects." They note that the study assumed that children born in the second trimester of 2004 would not have had time to benefit from maternal consumption of fortified flour, but if some of these children did actually benefit, the advantages of fortification would have been even greater than those reported. The Brazilian National Research Council partially supported this work with a research fellowship to the lead author. The authors have disclosed no relevant financial relationships. Bull World Health Org. 2016;94:22-29. Full text Post Comment Private Reply Ignore Thread
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