PEDIATRICS Vol. 116 No. 3 September 2005, pp. 580-586 (doi:10.1542/peds.2005-0592)
Decline in the Prevalence of Spina Bifida and Anencephaly by Race/Ethnicity: 1995–2002
* National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia
Department of Maternal and Child Health, School of Public Health, University of Alabama, Birmingham, Alabama
Objective. In an effort to reduce the occurrence of neural tube defects (NTDs), folic acid fortification of US enriched grain products was authorized by the Food and Drug Administration in March 1996 and required by January 1998. Fortification has been shown to result in an important decline in the prevalence of spina bifida and anencephaly in the general US population; however, fortification's impact on specific racial/ethnic groups has not been well described. We sought to characterize the decline in the prevalence of spina bifida and anencephaly among specific racial/ethnic groups during the transition to mandatory folic acid fortification in the United States.
Methods. Data from 21 population-based birth defects surveillance systems were used to examine trends in prevalence of spina bifida and anencephaly for specific racial/ethnic groups for the years 1995–2002. These years were divided into 3 periods: prefortification, optional fortification, and mandatory fortification. Race/ethnicity was defined as Hispanic, non-Hispanic white, and non-Hispanic black. Prevalence ratios were calculated for each racial/ethnic group by dividing the prevalence from the mandatory fortification period by the prevalence in the prefortification period.
Results. The study included data on 4468 cases of spina bifida and 2625 cases of anencephaly. The prevalence of spina bifida and anencephaly was highest among Hispanic births, followed by non-Hispanic white births, with the lowest prevalence among non-Hispanic black births. Significant declines in spina bifida and anencephaly were observed among Hispanic births and non-Hispanic white births. The prevalence ratio for non-Hispanic black births was of borderline significance for spina bifida and was not significant for anencephaly.
Conclusions. The results of this study suggest that folic acid fortification is associated with significant decreases in the prevalence of spina bifida and anencephaly among non-Hispanic white and Hispanic births. The magnitude of the reduction was similar between these 2 groups and was more pronounced for spina bifida than for anencephaly. The decline in the prevalence of spina bifida and anencephaly among non-Hispanic black births did not reach statistical significance. Efforts to increase folic acid consumption for the prevention of NTDs in pregnancies among women of all races/ethnicities should be continued, and studies to identify and elucidate other risk factors for NTDs are warranted.
Key Words: spina bifida • anencephaly • folic acid • fortification • race-ethnicity • neural tube defects
Abbreviations: NTD, neural tube defect • FDA, Food and Drug Administration • PR, prevalence ratio • CI, confidence interval • MTHFR, methylenetetrahydrofolate reductase
Accepted May 10, 2005.
CiteULike 
Connotea 
Del.icio.us 
Digg 
Facebook 
Reddit 
Technorati 
Twitter What's this?
This article has been cited by other articles:
|
|
 |
|
  Racial/Ethnic Differences in the Birth Prevalence of Spina Bifida--United States, 1995-2005 JAMA, June 3, 2009; 301(21): 2203 - 2204. [Full Text] [PDF]
|
|
|
|
 |
|
 J. Robitaille, H. C Hamner, M. E Cogswell, and Q. Yang Does the MTHFR 677C->T variant affect the Recommended Dietary Allowance for folate in the US population? Am. J. Clinical Nutrition, April 1, 2009; 89(4): 1269 - 1273. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 A. M. Molloy, P. N. Kirke, J. F. Troendle, H. Burke, M. Sutton, L. C. Brody, J. M. Scott, and J. L. Mills Maternal Vitamin B12 Status and Risk of Neural Tube Defects in a Population With High Neural Tube Defect Prevalence and No Folic Acid Fortification Pediatrics, March 1, 2009; 123(3): 917 - 923. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 J. M. Tilford, S. D. Grosse, A. C. Goodman, and Kemeng Li Labor Market Productivity Costs for Caregivers of Children with Spina Bifida: A Population-Based Analysis Med Decis Making, January 1, 2009; 29(1): 23 - 32. [Abstract] [PDF]
|
|
|
|
|
|
H. C Hamner, J. Mulinare, M. E Cogswell, A. L Flores, C. A Boyle, C. E Prue, C.-Y. Wang, A. L Carriquiry, and O. Devine Predicted contribution of folic acid fortification of corn masa flour to the usual folic acid intake for the US population: National Health and Nutrition Examination Survey 2001-2004 Am. J. Clinical Nutrition, January 1, 2009; 89(1): 305 - 315. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 L. N Borrell Commentary: Health policies in the US: can they increase or decrease the gap between subgroups of the population? The case of folic acid Int. J. Epidemiol., October 1, 2008; 37(5): 1067 - 1068. [Full Text] [PDF]
|
|
|
|
 |
|
 C. M. Pfeiffer, J. D. Osterloh, J. Kennedy-Stephenson, M. F. Picciano, E. A. Yetley, J. I. Rader, and C. L. Johnson Trends in Circulating Concentrations of Total Homocysteine among US Adolescents and Adults: Findings from the 1991-1994 and 1999-2004 National Health and Nutrition Examination Surveys Clin. Chem., May 1, 2008; 54(5): 801 - 813. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
L. B Bailey The rise and fall of blood folate in the United States emphasizes the need to identify all sources of folic acid Am. J. Clinical Nutrition, September 1, 2007; 86(3): 528 - 530. [Full Text] [PDF]
|
|
|
|
|
|
S. M. Dolan and C. Moore Linking Family History in Obstetric and Pediatric Care: Assessing Risk for Genetic Disease and Birth Defects Pediatrics, September 1, 2007; 120(SUPPLEMENT_2): S66 - S70. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
P. A. Romitti Utility of Family History Reports of Major Birth Defects as a Public Health Strategy Pediatrics, September 1, 2007; 120(SUPPLEMENT_2): S71 - S77. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
Q.-H. Yang, H. K Carter, J. Mulinare, R. Berry, J. Friedman, and J D. Erickson Race-ethnicity differences in folic acid intake in women of childbearing age in the United States after folic acid fortification: findings from the National Health and Nutrition Examination Survey, 2001-2002 Am. J. Clinical Nutrition, May 1, 2007; 85(5): 1409 - 1416. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
K. D Stark, R. J Pawlosky, R. J Sokol, J. H Hannigan, and N. Salem Jr Maternal smoking is associated with decreased 5-methyltetrahydrofolate in cord plasma Am. J. Clinical Nutrition, March 1, 2007; 85(3): 796 - 802. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. M. Robbins, J. M. Tilford, T.M. Bird, M. A. Cleves, J. A. Reading, and C. A. Hobbs Hospitalizations of Newborns With Folate-Sensitive Birth Defects Before and After Fortification of Foods With Folic Acid Pediatrics, September 1, 2006; 118(3): 906 - 915. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. I. Rader and B. O. Schneeman Prevalence of Neural Tube Defects, Folate Status, and Folate Fortification of Enriched Cereal-Grain Products in the United States Pediatrics, April 1, 2006; 117(4): 1394 - 1399. [Full Text] [PDF]
|
|
|
|
 |
|
 Q. Yang, L. D. Botto, J. D. Erickson, R. J. Berry, C. Sambell, H. Johansen, and J.M. Friedman Improvement in Stroke Mortality in Canada and the United States, 1990 to 2002 Circulation, March 14, 2006; 113(10): 1335 - 1343. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
R. L. Brent and G. P. Oakley Jr Triumph and/or Tragedy: The Present Food and Drug Administration Program of Enriching Grains With Folic Acid Pediatrics, March 1, 2006; 117(3): 930 - 932. [Full Text] [PDF]
|
|
eLetters:
Read all eLetters
- Reason for lower rates of NTDs in "black" populations
- Katherine A. Dettwyler
- Pediatrics Online, 17 Jan 2008 [Full text]
