Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2022 Oct:249:59-66.e1.
doi: 10.1016/j.jpeds.2022.06.023. Epub 2022 Jun 27.

Changes in Spina Bifida Lesion Level after Folic Acid Fortification in the US

Cara T Mai  1 , Jane Evans  2 , Clinton J Alverson  3 , Xin Yue  4 , Timothy Flood  5 , Kathryn Arnold  3 , Eirini Nestoridi  6 , Lindsay Denson  7 , Olufunmilola Adisa  4 , Cynthia A Moore  3 , Amy Nance  8 , Katherine Zielke  9 , Sydney Rice  10 , Xiaoyi Shan  11 , Jane H Dean  12 , Mary Ethen  13 , Brenda Hansen  14 , Jennifer Isenburg  3 , Russell S Kirby  15
Affiliations

Changes in Spina Bifida Lesion Level after Folic Acid Fortification in the US

Cara T Mai et al. J Pediatr. 2022 Oct.

Abstract

Objective: To assess whether the severity of cases of spina bifida changed after the institution of mandatory folic acid fortification in the US.

Study design: Six active population-based birth defects programs provided data on cases of spina bifida for 1992-1996 (prefortification period) and 1999-2016 (postfortification period). The programs contributed varying years of data. Case information included both a medical record verbatim text description of the spina bifida diagnosis and spina bifida codes (International Classification of Diseases, Clinical Modification, or a modified birth defects surveillance coding system). Comparing the prefortification and postfortification periods, aORs for case severity (upper-level lesions [cervical, thoracic] vs lower-level lesions [lumbar, sacral]) and prevalence ratios (PRs) were estimated.

Results: A total of 2593 cases of spina bifida (out of 7 816 062 live births) met the inclusion criteria, including 573 cases from the prefortification period and 2020 cases from the postfortification period. Case severity decreased by 70% (aOR, 0.30; 95% CI, 0.26-0.35) between the fortification periods. The decrease was most pronounced for non-Hispanic White mothers. Overall spina bifida prevalence declined by 23% (PR, 0.77; 95% CI, 0.71-0.85), with similar reductions seen across the early, mid, and recent postfortification periods. A statistically significant decrease in upper-level lesions occurred in the postfortification period compared with the prefortification period (PR, 0.28; 95% CI, 0.22-0.34), whereas the prevalence of lower-level lesions remained relatively similar (PR, 0.94; 95% CI, 0.84-1.05).

Conclusions: The severity of spina bifida cases decreased after mandatory folic acid fortification in the US. Further examination is warranted to better understand the potential effect of folic acid on spina bifida severity.

Keywords: folic acid fortification; lesion level; meningocele; myelomeningocele; population-based surveillance; severity; spina bifida.

PubMed Disclaimer

Conflict of interest statement

The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention. The authors declare no conflicts of interest.

References

    1. Williams J, Mai CT, Mulinare J, Isenburg J, Flood TJ, Ethen M, et al. Updated estimates of neural tube defects prevented by mandatory folic acid fortification—United States, 1995-2011. MMWR Morb Mortal Wkly Rep 2015;64:1–5. - PMC - PubMed
    1. Williams LJ, Mai CT, Edmonds LD, Shaw GM, Kirby RS, Hobbs CA, et al. Prevalence of spina bifida and anencephaly during the transition to mandatory folic acid fortification in the United States. Teratology 2002;66:33–9. - PubMed
    1. De Wals P, Tairou F, Van Allen MI, Lowry RB, Evans JA, Van den Hof MC, et al. Spina bifida before and after folic acid fortification in Canada. Birth Defects Res A Clin Mol Teratol 2008;82:622–6. - PubMed
    1. Bergman JE, Otten E, Verheij JB, de Walle HE. Folic acid supplementation influences the distribution of neural tube defect subtypes: a registry-based study. Reprod Toxicol 2016;59:96–100. - PubMed
    1. Eldridge C, Bandlamuri S, Andrews JG, Galindo MK, Contreras D, Flood TJ, et al. Postfolate spina bifida lesion level change. Birth Defects Res 2018;110:949–55. - PubMed