Document Detail

Incidence of open neural tube defects in Nova Scotia after folic acid fortification.
MedLine Citation:
PMID:  12186168     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: With the goal of preventing open neural tube defects (NTDs), recommendations for folic acid supplementation before conception were introduced in Canada in 1994, and by November 1998 Canadian grain products were being fortified with folic acid. We wished to determine whether the annual incidence of open NTDs in Nova Scotia, including those in stillbirths and terminated pregnancies, changed after the introduction of either folic acid supplementation or fortification.
METHODS: For the 10-year period from Jan. 1, 1991, to Dec. 31, 2000, we retrospectively extracted the total number of births in Nova Scotia and the number of live births and stillbirths with open NTDs from the Nova Scotia Atlee Perinatal Database as well as the number of terminated pregnancies affected by NTDs from the Fetal Anomaly Database. We determined the total annual incidence of all open NTDs, and of the subgroups spina bifida and anencephaly, per 1000 births in the province during the periods before (1991-1994) and after (1995-1998) folic acid supplementation initiatives were begun but before folic acid fortification of grain products was implemented, and during the periods before (1991-1997) and after (1998-2000) fortification.
RESULTS: In the period after supplementation initiatives were begun but before fortification was implemented, the incidence of open NTDs did not change significantly: the mean annual rate was 2.55 per 1000 births during 1991-1994 and 2.61 per 1000 births during 1995-1997 (relative risk [RR] 1.02, 95% confidence interval [CI] 0.77-1.35). After the fortification was implemented the incidence of open NTDs decreased by more than 50%: the mean annual rate was 2.58 per 1000 births during 1991-1997 and 1.17 per 1000 births during 1998-2000 (relative risk 0.46, 95% CI 0.32-0.66).
INTERPRETATION: The recommendations for folic acid supplementation alone did not appear to succeed in reducing the incidence of open NTDs in Nova Scotia, whereas the fortification of grain products with folic acid did result in a significant reduction in the incidence.
Vidia L Persad; Michiel C Van den Hof; Johanne M Dubé; Pamela Zimmer
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne     Volume:  167     ISSN:  0820-3946     ISO Abbreviation:  CMAJ     Publication Date:  2002 Aug 
Date Detail:
Created Date:  2002-08-20     Completed Date:  2002-08-27     Revised Date:  2013-04-18    
Medline Journal Info:
Nlm Unique ID:  9711805     Medline TA:  CMAJ     Country:  Canada    
Other Details:
Languages:  eng     Pagination:  241-5     Citation Subset:  AIM; IM    
Department of Obstetrics and Gynaecology, Dalhousie University, Halifax, NS.
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MeSH Terms
Dietary Supplements
Folic Acid / pharmacology*
Guideline Adherence*
Hematinics / pharmacology*
Infant, Newborn
Neural Tube Defects / epidemiology*,  prevention & control*
Nova Scotia / epidemiology
Practice Guidelines as Topic*
Pregnancy Outcome
Prenatal Care
Retrospective Studies
Reg. No./Substance:
0/Hematinics; 59-30-3/Folic Acid
Comment In:
CMAJ. 2002 Aug 6;167(3):255-6   [PMID:  12186171 ]
CMAJ. 2002 Oct 15;167(8):848; author reply 848-9   [PMID:  12406938 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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