Michiel Van den Hof Dalhousie University Halifax, Nova Scotia.

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Presentation transcript:

Michiel Van den Hof Dalhousie University Halifax, Nova Scotia

History of Folate Research Numerous small studies suggesting benefit of folic acid supplementation “Landmark” paper on benefit of folic acid supplementation to reduce the recurrence of NTDs* * MRC Vitamin Study Research Group: Lancet 1991

History of Folate Research Research shows that folic acid supplementation reduces open NTDs in low-risk women* * Czeizel AE, Dudas I: N Engl J Med 1992

History of Folate Research Canadian recommendations about folic acid supplementation issued: -Health Canada -SOGC -Canadian Task Force on the Periodic Health Examination

Incidence of ONTD’S per 1000 births in Nova Scotia

Total Incidence of ONTD’S per 1000 Pregnancies

History of Folate Research < 45% of pregnant women taking folic acid before conception

History of Folate Research March US-FDA orders all enriched grain products to be fortified (.14/100gm) starting January 1, 1998

History of Folate Research November 1, Health Canada endorses similar fortification

Questions? Did recommendations for folic acid supplementation work? Did the “small” amount of fortification work?

Folic Acid Supplementation/Fortification Methods: Nova Scotia Perinatal Database plus Nova Scotia Fetal Anomaly Database combined have information on all births and birth defects that occur in this province.

Folic Acid Supplementation/Fortification Open neural tube defects: -spina bifida -anencephaly -other

Folic Acid Supplementation/Fortification Pre-supplementation Post-supplementation but pre-fortification Pre-fortification Post-fortification

Folic Acid Supplementation/Fortification Risks for Folic Acid Fortification: Delay diagnosis of vitamin B12 deficiency which may result in neurologic effects.

Folic Acid Supplementation/Fortification Spina Total Anencephaly* Bifida** NTDs*** Pre-supplementation Post-supplementation Pre-fortification *RR0.82,95%CI ; p=0.49 **RR1.11,95%CI ; p=0.64 ***RR1.02,95%CI ; p=0.87

Incidence of ONTD’S per 1000 Pregnancies

Folic Acid Supplementation/Fortification Spina Total Anencephaly* Bifida** NTDs*** Pre-fortification Post-fortification * RR 0.41, 95% CI ; p=0.004 ** RR 0.40, 95% CI ; p<0.001 ***RR 0.46, 95% CI ; p<0.001

Incidence of ONTD’S per 1000 Pregnancies

Folic Acid Supplementation/Fortification With the introduction of folic acid fortification, there was a 59% reduction in anencephaly 59% reduction in spina bifida and a54% reduction in all NTDs. Calculated reduction ~ 20%

Folic Acid Supplementation/Fortification Can prevention be further reduced? Chinese study suggested ~.6/1000 in both high and low-risk population. Thus, further reduction may be possible, 1.0 .6 (40%).

Incidence of Anencephaly and Spina Bifida per 1000 Pregnancies in Nova Scotia