Global birth prevalence of spina bifida by folic acid fortification status: A systematic review and meta-analysis

C.A.M. Atta, K.M. Fiest, A.D. Frolkis, N. Jette, T. Pringsheim, C. St Germaine-Smith, T. Rajapakse, G.G. Kaplan and A. Metcalfe

American Journal of Public Health, 2016, vol. 106, issue 1, e24-e34

Abstract: Background. Birth defects remain a significant source of worldwide morbidity and mortality. Strong scientific evidence shows that folic acid fortification of a region's food supply leads to a decrease in spina bifida (a birth defect of the spine). Still, many countries around the world have yet to approve mandatory fortification through government legislation. Objectives. Wesought to performa systematic reviewandmeta-analysis of period prevalence of spina bifida by folic acid fortification status, geographic region, and study population. Search methods. An expert research librarian used terms related to neural tube defects and epidemiology from primary research from 1985 to 2010 to search in EMBASE and MEDLINE. We searched the reference lists of included articles and key review articles identified by experts. Selection criteria. Inclusion criteria included studies in English or French reporting on prevalence published between January 1985 and December 2010 that (1) were primary research, (2) were population-based, and (3) reported a point or period prevalence estimate of spina bifida (i.e., prevalence estimate with confidence intervals or case numerator and population denominator). Two independent reviewers screened titles and abstracts for eligible articles, then2authorsscreenedfull texts induplicate forfinal inclusion. Disagreements were resolved through consensus or a third party. Data collection and analysis. We followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses, or PRISMA, abstracting data related to case ascertainment, study population, folic acid fortification status, geographic region, and prevalence estimate independently and in duplicate. We extracted overall data and any subgroups reported by age, gender, time period, or type of spina bifida. We classified each period prevalence estimate as mandatory or voluntary folic acid fortification according to each country's folic acid fortification status at the time data were collected (as determined by a well-recognized fortification monitoring body, Food Fortification Initiative).We determined study quality on the basis of sample representativeness, standardization of data collection and birth defect assessment, and statistical analyses. We analyzed study-level period prevalence estimates by using a random effects model (a level of

Keywords: folic acid; vitamin B complex, female; fortified food; health; human; legislation and jurisprudence; meta analysis; physiology; pregnancy; prevalence; spinal dysraphism; standards; statistics and numerical data, Female; Folic Acid; Food, Fortified; Global Health; Humans; Pregnancy; Prevalence; Spinal Dysraphism; Vitamin B Complex (search for similar items in EconPapers)
Date: 2016
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Citations: View citations in EconPapers (3)

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Persistent link: https://EconPapers.repec.org/RePEc:aph:ajpbhl:10.2105/ajph.2015.302902_4

DOI: 10.2105/AJPH.2015.302902

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