Ask an Expert: Neural Tube Defects and Fortification with Vijaya Kancherla
By Shelby Crosier
Neural tube defects (NTDs), a type of birth defect that can develop in the first weeks of pregnancy and disrupt formation of the brain and spine, affect over 2,000 babies every year in the U.S. and even more globally. Fortifying foods with folic acid is a proven way to prevent NTDs.
Vijaya Kancherla, PhD, associate professor of epidemiology at Emory University’s Rollins School of Public Health, leads global efforts to support food fortification as director of the Center for Spina Bifida Prevention.
“The evidence on the effectiveness and safety of folic acid fortification is unequivocal and strong,” she says. “Many countries are missing out on the opportunity to implement this well-established prevention program due to lack of political will. Promoting folic acid fortification is an effective intervention to prevent NTDs and reduce associated stillbirths, child mortality, and disability. There is a dire urgency to close the gap in global NTD prevention, especially in Africa, Europe, and Asia.”
Here, Kancherla breaks down what we know about folic acid fortification and why it is so important for the health of children around the world.
How do NTDs affect health and quality of life?
NTDs affect the brain and spine of the newborn. Spina bifida and anencephaly are two common types of NTDs.
Spina bifida can appear along the spine and, depending on the location of the lesion, can vary in severity, resulting in mild to severe health manifestations. The health complications can result in paralysis and disability and often require surgeries and life-long medical care.
Anencephaly, another severe type of NTD, is not compatible with life.
Tell me about the progress that has been made to prevent neural tube defects around the world.
Maternal intake of folic acid before and during early pregnancy can reduce the risk of a large proportion of NTDs. Folic acid can be acquired in the form of dietary folate, supplement pills, or staple foods that are enriched, or fortified, with the vitamin. The most efficient way of ensuring adequate folate intake in the population is through food fortification.
Over 80 countries implement food fortification policies globally, and several countries have documented reductions in the occurrence of NTDs post-fortification. However, many countries still do not implement this proven, cost-effective intervention due to lack of political will.
What types of foods do we fortify with folic acid, and why is that so important?
Commonly consumed staples such as wheat flour, maize flour, and rice are fortified with folic acid around the world. Studies have also recently shown that salt is a good vehicle for fortification due to its universal reach through salt iodization programs.
Staple food fortification ensures that the majority of the population has access to folic acid in a cost-effective way, regardless of their ability to purchase foods rich in folate (like green leafy vegetables or lentils) or supplements. Once a country implements sustained food fortification of staple foods, the benefits are seen immediately in terms of improved folate status in the population.
How is the Center for Spina Bifida Prevention supporting neural tube defect prevention around the world?
The Center for Spina Bifida Prevention engages in science-based advocacy for food fortification with folic acid. Our goal is to engage with countries and provide needed scientific assistance in food fortification policy development, implementation, and evaluation. We work with various implementation partners globally to promote improved folate status in the population and prevent NTDs where possible.
