Decline in the incidence of neural tube defects after the national fortification of flour (1997-2005)

OBJECTIVE: To evaluate the effect of flour fortification with folic acid on the incidence of neural tube defects (NTDs) in babies. We also report the pattern of NTDs, and we compare it with those reported previously.

METHODS: All babies who were born with NTDs at King Abdul-Aziz University Hospital (KAUH), Jeddah, Kingdom of Saudi Arabia between 1997 and 2005 were included in the study. The incidence of NTDs was compared between the eras before flour fortification (1997-2000) and the eras after fortification.

RESULTS: We have observed a decline in NTD incidence in the last decade from 1.9/1000 live births (1997-2000) to 0.76/1000 live births (2001-2005). Forty-two babies were born with NTDs with a male to female ratio of 1.1:1. Sixty percent received folic acid during pregnancy, but none pre-conception. Eighty-three percent of the cases had myelomeningocele (MMC), 12% had encephalocele, 2.5% had meningocele, and another 2.5% had anencephaly. Ninety-one percent of MMC patients had severe physical disability. Thirty-two children (91%) had hydrocephalus, which required shunting in the neonatal period and 22 children (63%) had clubfeet.

CONCLUSION: After folic acid flour fortification, there was an apparent decline in the incidence of NTDs in babies born at KAUH. However, the incidence is still high and associated with serious morbidity. This stresses the need for innovative programs to increase folic acid consumption by women of childbearing age, to reduce NTDs.