6 However, folic acid supplementation before pregnancy is a challenging public health intervention in many countries, 7 and mandatory staple food fortification strategies have been more effective. 5 The US Preventive Services Task Force recommends all women planning to or who could become pregnant take a daily folic acid supplement containing 400 to 800 µg at least 1 month prior to anticipated conception and through the first 2 to 3 months of pregnancy. 5 Water-soluble folic acid is a crucial micronutrient required before and during early pregnancy for proper fetal DNA synthesis and complete neural tube closure. Spina bifida and anencephaly occur due to incomplete closure of the fetal neural fold during embryogenesis around day 28 after conception. 3 Limited surveillance studies in India suggest the prevalence is higher, at approximately 40 to 50 per 10 000 births, and contributes to a high number of stillbirths, elective pregnancy terminations, and deaths among neonates, infants, and children younger than 5 years. 2 Approximately 260 000 SBA-affected births occur worldwide annually, with a global prevalence rate of 20 per 10 000 births. 1 Anencephaly is not compatible with life, and spina bifida can lead to a stillbirth or postpartum death, with significant health complications and permanent neurological disabilities in survivors. Trial Registration Identifier: NCT06174883įolic acid (vitamin B 9) prevents severely disabling and life-threatening neural tube defects, such as spina bifida and anencephaly (SBA). This novel evidence can inform public health policy to accelerate SBA prevention. The participants found the salt acceptable in color and taste.Ĭonclusions and Relevance Use of folic acid–fortified iodized salt was associated with increased serum folate concentrations in women of reproductive age. Two-tailed Wilcoxon signed rank test showed the median difference in preintervention and postintervention serum folate concentrations to be highly significant ( P < .001). The median serum folate concentration increased from 14.6 (IQR, 11.2-20.6) nmol/L at baseline to 54.4 (IQR, 43.5-54.4) nmol/L at end of study, a 3.7-fold increase from baseline to study end point. Results A total of 83 nonpregnant nonlactating women aged 20 to 44 years (mean age, 30.9 years) were eligible for the study and provided serum samples for analysis at baseline and the end point of the intervention. Main Outcomes and Measures Change in median serum folate levels between baseline and study end point as the primary outcome of the study. Median serum folate concentrations were assessed at baseline and 4 months. Intervention Consumption of approximately 300 µg/d of folic acid using double fortified salt (folic acid plus iodine). Preintervention and postintervention serum folate levels were analyzed among study participants at baseline and after 4 months, respectively. All households in the villages agreed to participate in the study. Objective To determine the association of folic acid–fortified iodized salt with serum folate concentrations among nonpregnant and nonlactating women of reproductive age.ĭesign, Setting, and Participants This nonrandomized controlled trial using a preintervention and postintervention design was conducted in 4 rural villages in Southern India from July 1 to November 30, 2022. Thirty years after folic acid was shown to be effective in reducing SBA prevalence, only about one-quarter of such births are prevented globally through cereal grain fortification. Importance India has a disproportionately high prevalence of neural tube defects, including spina bifida and anencephaly (SBA), causing a high number of stillbirths, elective pregnancy terminations, and child mortality India contributes a large proportion of the global burden of SBA. Shared Decision Making and Communication.Scientific Discovery and the Future of Medicine.Health Care Economics, Insurance, Payment.Clinical Implications of Basic Neuroscience.Challenges in Clinical Electrocardiography.
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