-
Healthier Babies Worldwide Partnership for Neural Tube Defect
Prevention
Alina L. Flores, MPH, CHES
Aliki Pappas Weakland, MPH, MSW
National Center on Birth Defects and Developmental Disabilities
Centers for Disease Control and Prevention
World Health Organization Geneva, Switzerland
22 October 2012
National Center on Birth Defects and Developmental
Disabilities
Division of Birth Defects and Developmental Disabilities
Disclaimer: The findings and conclusions in this presentation
have not been formally disseminated by the Centers for Disease
Control and Prevention and should not be construed to represent any
agency determination or policy.
-
Serious birth defects of the brain and spine that form in the
first month of pregnancy
Most common are anencephaly and spina bifida
Majority of neural tube defects are preventable with folic acid
before and during early pregnancy
Neural Tube Defects
(The “other” NTD)
-
Global Burden of Neural Tube Defects
Neural tube defects affect more than 300,000 babies each year
worldwide1
Occur widely In different geographical areas
In countries of varying levels of economic development
Among diverse populations
Remain a significant, preventable cause of mortality and
morbidity
1 Christianson A, Howson CP, Model B. March of Dimes Global
Report on Birth Defects: the hidden toll of dying and disabled
children. 2006. March of Dimes Birth Defects Foundation, New
York.
-
Folic Acid and Neural Tube Defect Prevention
Role of folic acid in preventing neural tube defects is well
known
The majority can be prevented with 400 micrograms (mcg) of folic
acid daily before and during early pregnancy
Globally many women of reproductive age do not consume enough
folic acid to prevent neural tube defects
Folic acid fortification is a cost effective public health
intervention to ensure more babies are born without these birth
defects
CDC. www.cdc.gov/mmwr/mmwrrhtml/mmm5931a2.htm. CDC Grand Rounds:
Additional Opportunities to Prevent NTD with Folic Acid
Fortification
-
Factors that might increase risk for NTDS
Folic acid deficiency
Previous pregnancy affected by an NTD
Certain medications
Certain medical conditions such as pre-existing diabetes,
obesity, and vitamin B12 deficiency
Race/ethnic origin
Exposure to high temperatures early in pregnancy
Genetics - MTHFR
-
Fortification: Cost Effectiveness South Africa and Chile
Folic acid fortification has been proven to be effective
South Africa In 2003 South Africa fortified wheat flour and
maize meal
Reduction in neural tube defects (through June 2005): 31%
Return on investment of 46 to 1
Chile In 1998 Chile fortified wheat flour
Reduction in neural tube defects (through 2001): 41%
Return on investment of 11 to 1
South Africa – Sayed AR, Bourne D, Pattinson R, Nixon J,
Henderson B. Decline in the prevalence of neural tube defects
following folic acid fortification and its cost-benefit in South
Africa. Birth Defects Research Part a-Clinical and Molecular
Teratology2008 Apr;82(4):211-6. Chile – Llanos A, Hertrampf E,
Cortes F, Pardo A, Grosse SD, Uauy R. Cost-effectiveness of a folic
acid fortification program in Chile. Health
Policy2007;83(2-3):295-303.
-
Fortification: Cost Effectiveness United States
Since mandatory folic acid fortification of cereal grain
products labeled as enriched in the US:
36% reduction in NTDs (1998-2006)
10,000 more babies born without NTDs in the past decade
More than 4 billion dollars in direct costs saved over the past
decade
MMWR Ten Great Public Health Achievements—United States
2001-2010, May 20, 2011 60(19); 619-623
-
Healthier Babies Worldwide Partnership for Neural Tube Defect
Prevention
CDC is working with partners to advance neural tube defect
prevention globally
Goal: Increase the intake of folic acid among women of
reproductive age
-
Healthier Babies Worldwide Partnership for Neural Tube Defect
Prevention
Preventing NTDs through increased intake of folic acid would
Reduce infant and child mortality and childhood morbidity
Contribute to the achievement of the Millennium Development Goal
4 (reduce under-5 mortality)
Support the 63rd World Health Assembly resolution on birth
defects
-
Healthier Babies Worldwide Partnership for Neural Tube Defect
Prevention
Key components of the Initiative:
Build the science base (surveillance, epidemiology, laboratory
and prevention capacity) to support neural tube defect
prevention
Educate and inform on the benefits of fortification policies for
neural tube defect prevention
Establish programs and strategic partnerships to advance
prevention
-
Platforms for Capacity Building and Integration of Birth Defect
Surveillance
Strengthen national capacity for surveillance Conduct workshops
and trainings for:
• Healthcare workforce
• Field Epidemiology Training Programs
• Epidemiologists
Strengthen the existing vital registration systems and other
health information systems and develop surveillance mechanisms for
birth defects Conduct pilot surveillance projects
Integrate into existing HIV, Immunization and Maternal and Child
Health efforts
-
Healthier Babies Worldwide Partnership for Neural Tube Defect
Prevention
Collaboration with WHO (HQ and SEARO)
Supporting fortification guidelines for food staples
Determining a target range of blood folate concentrations to
maximize prevention of neural tube defects
Developing regional and country level approaches for birth
defect prevention
-
Healthier Babies Worldwide Partnership for Neural Tube Defect
Prevention
Working with partners
Monitoring effectiveness of fortification efforts
Improving surveillance to evaluate impact of prevention
efforts
Strengthening laboratory capacity to measure blood folates and
support quality control
Identifying new strategies to increase folic acid intake to
reach women of reproductive age not reached by fortification
-
Key Points
Neural tube defects are life-threatening and cause life-long
disabilities
Majority of neural tube defects are preventable with folic
acid
Globally many women of reproductive age do not consume enough
folic acid to prevent neural tube defects
Fortification of foods with folic acid is a feasible,
economical, safe and effective public health policy to prevent
neural tube defects
-
Acknowledgements
• World Health Organization/Headquarters
– Dr Juan Pablo Pena- Rosas
– Dr Luz Maria de Regil
– Ms Paule Pillard
• World Health Organization/Regional Office for South-East
Asia
– Dr Neena Raina
– Dr Rajesh Mehta
-
For more information please contact Centers for Disease Control
and Prevention
1600 Clifton Road NE, Atlanta, GA 30333
Telephone: 1-800-CDC-INFO (232-4636)/TTY: 1-888-232-6348
E-mail: [email protected] Web: http://www.cdc.gov
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.
National Center on Birth Defects and Developmental
Disabilities
Division of Birth Defects and Developmental Disabilities
Thank you!
www.cdc.gov/folicacid