Mandatory folic acid fortification could tackle child morbidity and mortality in Bangladesh: Population study
Neural tube defects comprise one of the causes of severe morbidity and mortality for both children and adults, but can usually be prevented by women’s folic acid intake before and during pregnancy.
Researchers from Bangladesh Medical College, Atlanta’s Emory University, Boston’s Tufts University, and Harvard — as well as several Bangladeshi and US hospitals — assessed the relationship between maternal prenatal folic acid supplementation and the risk of myelomeningocele (a common and severe kind of neural tube defect) in their offspring.
Higher intake, lower risk
They used data from a case-control study conducted from April to November 2013 at Dhaka Community Hospital in Bangladesh; the cases were children with myelomeningocele, while the controls were children without myelomeningocele, and all their mothers were included in the study.
The cases and controls were matched equally by age and sex (106 participants in total), and a paediatrician specialising in neural tube defect classification identified myelomeningocele in the children.
The researchers reported that 51% of the cases’ mothers had taken folic acid supplements while pregnant, compared with 72% of the controls’ mothers.
They added that “maternal prenatal folic acid use significantly decreased the odds of myelomeningocele in the offspring”, even though the association between prenatal folic acid intake and myelomeningocele risk was slightly weakened after the results were adjusted for maternal age during pregnancy.
Fortify for folate
They also stated there was a confirmed ‘protective association’ between maternal prenatal folic acid supplementation and myelomeningocele in children born in Bangladesh, whose women of reproductive age tend to have low folic acid supplementation and therefore, low plasma folate concentrations.
To tackle this, they suggested mandatory folic acid fortification of “widely eaten and centrally processed” foods (such as rice or wheat), which could reverse the low folate status of Bangladeshi women of childbearing age, and prevent myelomeningocele-induced child morbidity and mortality.
They further suggested that supplementation programmes be introduced in areas where mandatory food fortification cannot reach the Bangladeshi population.
They concluded: “In combination, the two interventions would provide a complementary and fast-paced solution in addressing neural tube defect reduction in Bangladesh.
“Preventing the mortality and morbidity associated with neural tube defects through folic acid fortification has the potential to help Bangladesh to move towards achieving the 2030 Sustainable Development Goals.”
Source: PLOS ONE
“Prenatal folic acid use associated with decreased risk of myelomeningocele: A casecontrol study offers further support for folic acid fortification in Bangladesh”
Authors: Vijaya Kancherla, et al.