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Folic Acid to Reduce Neonatal Mortality from Neural Tube Disorders (NTD)

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Blencowe H, Cousens S, Modell B, Lawn J.  Folic acid to reduce neonatal mortality from neural tube disorders.  Int J Epidemiol. 2010 Apr; 39 (Suppl 1): i110-21.


  • Conservative estimates suggest that there are more than 300,000 new cases of Neural tube disorders (NTDs) a year (1) resulting in 41,000 deaths and 2.3 million disability-adjusted life years (DALYs) (2).
  • NTDs represent 10% of the burden of all congenital conditions. (2)
  • In low-income settings an estimated 29% of neonatal deaths related to visible congenital abnormalities are attributed to NTDs.

Intervention Effect

Folic acid supplementation for women with previous pregnancy with NTD – secondary prevention on reduction of recurrence of NTDs: 

  • High Quality Evidence / Low Public Health Program Relevance
  • 3 Randomized Controlled Trials - using folic acid tablets 0.36 mg once daily to 5 mg once a week
  • 70% (95%ci: 35-86%) reduction in recurrence of NTDs

Folic acid supplementation for women without previous pregnancy with NTD – primary prevention on reduction in NTDs:

  • Moderate Quality Evidence
  • 1 RCT and 3 cohort studies - using folic acid tablets 0.36 mg once daily to 5 mg once a week
  • 62% (95% ci: 49-71%) reduction in NTDs

Folic acid food fortification on reduction in NTD incidence:

  • Moderate Quality Evidence
  • 8 population-based observational studies with consistent findings and biological plausibility
  • 46% (95% ci: 37-54%) reduction in NTD incidence
  • Assuming NTDs constitute the cause for 29% of neonatal deaths due to visible congenital causes in low-income countries, the authors extrapolated that 13% of neonatal deaths currently attributed to congenital abnormalities in low-income countries could be prevented with folic acid food fortification.

Intervention Recommendation: STRONG

  • If folic acid food fortification achieved 100% population coverage, the number of NTDs in low-income countries could be approximately halved.
  • The evidence also support folic acid supplementation to decrease NTDs.

References from Blencowe Paper Cited Here

  1. The March of Dimes Global Report on Birth Defects, The Hidden Toll of Dying and Disabled Children.   
  2. The Global Burden of Disease.  2004 update.  2004. 

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