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

Details

• Alternative Title:
  J Pediatr
• Personal Author:
  Mai, Cara T. ; Evans, Jane ; Alverson, Clinton J. ; Yue, Xin ; Flood, Timothy ; Arnold, Kathryn ; Nestoridi, Eirini ; Denson, Lindsay ; Adisa, Olufunmilola ; Moore, Cynthia A. ; Nance, Amy ; Zielke, Katherine ; Rice, Sydney ; Shan, Xiaoyi ; Dean, Jane H. ; Ethen, Mary ; Hansen, Brenda ; Isenburg, Jennifer ; Kirby, Russell S.
• Description:
  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.
  
  
• Subjects:
  Female Folic Acid Food, Fortified Humans Live Birth Pregnancy Prevalence Spinal Dysraphism
• Source:
  J Pediatr. 249:59-66.e1
• Pubmed ID:
  35772508
• Pubmed Central ID:
  PMC10250025
• Document Type:
  Journal Article
• Funding:
  CC999999/ImCDC/Intramural CDC HHSUnited States/
• Place as Subject:
  United States
• Volume:
  249
• Collection(s):
  CDC Public Access
• Main Document Checksum:
  urn:sha256:04c1e1503ba7ba7cd4b9e505546bef670d0b6a245e719defeb5014f2f8219754
• Download URL:
  https://stacks.cdc.gov/view/cdc/129651/cdc_129651_DS1.pdf
• File Type:
  [PDF - 163.29 KB ]