{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,16]],"date-time":"2026-10-16T22:14:38Z","timestamp":1792188878717,"version":"4.4.0"},"reference-count":40,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2020,10,30]],"date-time":"2020-10-30T00:00:00Z","timestamp":1604016000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Birth Defects Research"],"published-print":{"date-parts":[[2021,1]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Mandatory folic acid fortification of staples is a proven intervention to prevent spina bifida and anencephaly, two life\u2010threatening and disabling neural tube defects. We estimated the global proportion of folic acid\u2010preventable spina bifida and anencephaly (FAP SBA) prevented through mandatory folic acid fortification of wheat and\/or maize flour in 2019.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Using data from the Global Fortification Data Exchange, we identified countries with mandatory fortification policies that required at least 1.0 ppm folic acid be added to wheat and\/or maize flour and had information on percentage of industrially milled flour that is fortified. We built FAP SBA prevention models assuming mandatory folic acid fortification at 200\u2009\u03bcg\/day of folic acid fully protects against FAP SBA and would lower the prevalence neural tube defects to 0.5 per 1,000 live births.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>In 2019, 56 countries met our criteria for mandatory folic acid fortification of wheat (<jats:italic>n<\/jats:italic> =\u200956 countries) and\/or maize (<jats:italic>n<\/jats:italic> =\u200915 countries) flour and with complete data for our modeling. Overall, our prevention model estimated that 65,380 FAP SBA cases were prevented in 2019 through folic acid fortification of wheat and\/or maize flour. We estimated the current global prevention proportion of all preventable FAP SBA cases worldwide to be at 23% of total possible prevention.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Global prevention efforts for FAP SBA are slow and have stalled. Mandatory fortification should be urgently implemented in all countries to prevent epidemics of FAP SBA, and to achieve health\u2010related Sustainable Development Goals for year 2030 by reducing child mortality due to preventable FAP SBA.<\/jats:p><\/jats:sec>","DOI":"10.1002\/bdr2.1835","type":"journal-article","created":{"date-parts":[[2020,10,30]],"date-time":"2020-10-30T12:19:28Z","timestamp":1604060368000},"page":"77-89","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":47,"title":["A 2019 global update on folic <scp>acid\u2010preventable<\/scp> spina bifida and anencephaly"],"prefix":"10.1002","volume":"113","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2803-8030","authenticated-orcid":false,"given":"Vijaya","family":"Kancherla","sequence":"first","affiliation":[{"name":"Center for Spina Bifida Prevention, Department of Epidemiology Rollins School of Public Health of Emory University  Atlanta Georgia USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kaustubh","family":"Wagh","sequence":"additional","affiliation":[{"name":"Hubert Department of Global Health Rollins School of Public Health of Emory University  Atlanta Georgia USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Helena","family":"Pach\u00f3n","sequence":"additional","affiliation":[{"name":"Hubert Department of Global Health Rollins School of Public Health of Emory University  Atlanta Georgia USA"},{"name":"Food Fortification Initiative  Atlanta Georgia USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2185-3929","authenticated-orcid":false,"suffix":"Jr.","given":"Godfrey P.","family":"Oakley","sequence":"additional","affiliation":[{"name":"Center for Spina Bifida Prevention, Department of Epidemiology Rollins School of Public Health of Emory University  Atlanta Georgia USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2020,10,30]]},"reference":[{"key":"e_1_2_9_2_1","doi-asserted-by":"publisher","DOI":"10.1002\/bdra.23529"},{"key":"e_1_2_9_3_1","doi-asserted-by":"publisher","DOI":"10.2105\/AJPH.2015.302902"},{"key":"e_1_2_9_4_1","doi-asserted-by":"publisher","DOI":"10.1002\/bdra.20304"},{"key":"e_1_2_9_5_1","doi-asserted-by":"publisher","DOI":"10.1002\/bdra.20504"},{"key":"e_1_2_9_6_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0206212"},{"issue":"1","key":"e_1_2_9_7_1","doi-asserted-by":"crossref","first-page":"S22","DOI":"10.1177\/15648265100311S103","article-title":"Fortification of flour with folic acid","volume":"31","author":"Berry R. 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