Draft Resolution for Folic Acid Fortification Globally

The following is a resolution for mandating folic acid fortification. The draft was written by Dr. Godfrey Oakley and has been reviewed by the Public Affairs Committee and Council. They have recommended that the resolution be put forward to the membership for your information and feedback (you may use comment feature of this blog). The draft will be available for your comments until July 21.

The revised resolution will be provided to the European Teratology Society (ETS) and the Japanese Teratology Society (JTS) for their consideration.

 

Global Total Prevention of Folic Acid-Preventable Spina Bifida and Folic Acid-Preventable Anencephaly by 2024

Whereas the mission of Teratology Society is to prevent birth defects and disorders of developmental origin,

Whereas there is unequivocal evidence that folic acid prevents all of folic acid dependent spina bifida and folic acid dependent anencephaly,1

Whereas non-folic acid preventable spina bifida and anencephaly occur at an estimated newborn prevalence of approximately 5 per 10,000 births,2

Whereas there are epidemics of spina bifida and anencephaly in many countries, with an increased prevalence above the expected non-folic acid preventable spina bifida and anencephaly occurrences of 5 per 10,000 births: 2 to 8-fold increase in several countries,3-5

Whereas mandatory folic acid fortification in the United States has prevented all or almost all of folic acid preventable spina bifida and anencephaly,6

Whereas mandatory folic acid fortification has led to near elimination of folate deficiency in the population, as well as folate deficiency anemia,7

Whereas mandatory folic acid fortification in the United States has added to everyday adult diets a uniform ~150 micrograms -- one-third the recommended daily allowance (RDA) of folic acid, in a safe manner,8

Whereas prenatal vitamins with a daily dose of 1000 microgram of folic acid have been routine in clinical care for pregnant women in the United States for decades and folic acid has been regularly and safely used in clinical medicine at 1000 to 5000 micrograms per day, and "even with doses as high as 15 milligrams (sic 15,000 micrograms) there have been no substantiated reports of side effects," it is important to be aware of and respond to any new, substantiated research that might suggest that levels of folic acid greater than 1000 micrograms a day may pose potential risk,9

Whereas governments in about 70 countries require mandatory folic acid fortification resulting in about 60,000 fewer pregnancies affected with folic acid preventable spina bifida and anencephaly,10

Whereas folic acid fortification is highly cost-effective, saving $50 for each $1 spent11

Whereas more than $10 billion dollars in direct costs have been saved in the United States since mandatory fortification began in 1996,12

Whereas 180,000 folic acid preventable spina bifida and anencephaly pregnancies occur each year because 120 countries have yet to require mandatory folic acid fortification,10

Whereas the annual occurrence of 180,000 folic acid preventable spina bifida and anencephaly pregnancies is 18-times higher than the number of children that were damaged by the drug thalidomide,13

 

The Teratology Society recommends:

All governments require mandatory folic acid fortification of a centrally produced food such as wheat flour, corn flour or meal, and maize flour or meal to provide almost all adults with an additional at least 150 micrograms of folic acid per day,

That a global strategic plan for the total prevention of folic acid dependent spina bifida and anencephaly by 2024 be written by 2017.

That members of the Teratology Society champion mandatory folic acid fortification in their countries.

 

References

1. MRC Vitamin Study Research Group. Prevention of neural tube defects: results of the Medical Research Council Vitamin Study. MRC Vitamin Study Research Group. Lancet 1991;338:131-7.

2. Berry RJ, Li Z, Erickson JD, et al. Prevention of neural-tube defects with folic acid in China. China-U.S. Collaborative Project for Neural Tube Defect Prevention. N Engl J Med 1999;341:1485-90.

3. Berry A. Focusing on folic acid. Task force organizing to promote consumption of folic acid. AWHONN Lifelines 1998;2:19-20.

4. Kondo A, Morota N, Ihara S, et al. Risk factors for the occurrence of spina bifida (a case-control study) and the prevalence rate of spina bifida in Japan. Birth Defects Res A Clin Mol Teratol 2013;97:610-5.

5. Yuskiv N, Andelin CO, Polischuk S, et al. High rates of neural tube defects in Ukraine. Birth Defects Res A Clin Mol Teratol 2004;70:400-2.

6. Mosley BS, Cleves MA, Siega-Riz AM, et al. Neural tube defects and maternal folate intake among pregnancies conceived after folic acid fortification in the United States. Am J Epidemiol 2009;169:9-17.

7. Odewole OA, Williamson RS, Zakai NA, et al. Near-elimination of folate-deficiency anemia by mandatory folic acid fortification in older US adults: Reasons for Geographic and Racial Differences in Stroke study 2003-2007. Am J Clin Nutr 2013;98:1042-7.

8. Yeung L, Yang Q, Berry RJ. Contributions of total daily intake of folic acid to serum folate concentrations. JAMA : the Journal of the American Medical Association 2008;300:2486-7.

9. Hillman RS. Hematopoietic Agents. In: Hardman JG, Gilman AG, Limbird LE, eds. Goodman and Gilman's Pharmacological Basis of Therapeutics. Nineth ed. New York: McGraw-Hill; 1996:1311-40.

10. Youngblood ME, Williamson R, Bell KN, Johnson Q, Kancherla V, Oakley GP, Jr. 2012 Update on global prevention of folic acid-preventable spina bifida and anencephaly. Birth Defects Res A Clin Mol Teratol 2013;97:658-63.

11. Grosse SD, Hopkins DP, Mulinare J, Llanos A, Hertrampf E. Folic acid fortification and birth defects prevention: lessons from the Americas. AGROFood Industry Hi-tech 2006;17.

12. Centers for Disease Control and Prevention. Ten Great Public Health Achievements --- United States, 2001--2010. Morbidity and Mortality Weekly Report (MMWR) 2011;60:619-23.

13. Stephens T, Brynner R. Dark Remedy: The Impact of Thalidomide and Its Revival as a Medicine. Cambridge, Mass: Perseus; 2001.

 

 

2 Comments

Folic acid fortification resolution

July 5, 2014 01:16 PM by Carole A. Kimmel

I think this is very good.  The only suggestion I have is to shorten and reword the 4th "Whereas" statement:


Whereas there are epidemics of spina bifida and anencephaly in many countries, with a 2 to 8-fold increased prevalence in several countries3-5 above the expected non-folic acid preventable spina bifida and anencephaly occurrences of 5 per 10,000 births 

Folic acid fortification resolution

July 6, 2014 09:58 PM by Bruce K. Beyer, PhD, DABT

This is a very good resolution.  I support Carole's suggested revision, and have no additional comments.

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