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