{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,12]],"date-time":"2026-02-12T12:35:17Z","timestamp":1770899717500,"version":"3.50.1"},"reference-count":82,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2025,6,24]],"date-time":"2025-06-24T00:00:00Z","timestamp":1750723200000},"content-version":"vor","delay-in-days":23,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Birth Defects Research"],"published-print":{"date-parts":[[2025,6]]},"abstract":"<jats:title>ABSTRACT<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Maternal intake of folic acid prevents most cases of neural tube defects (NTDs), and arsenic exposure may increase NTD risk. In Bangladesh, where arsenic exposures are high, understanding the potential impacts of arsenic reduction and folic acid\u2010based interventions can guide decision\u2010making.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We conducted a systematic review and meta\u2010analysis to estimate the prevalence of NTDs in Bangladesh. We searched PubMed, Embase, Web of Science, Global Health, and Bangladesh Journals Online and extracted data using standardized forms. We used forest plots and random effects models to estimate the prevalence of all NTDs and spina bifida. Decision analysis used assumptions from the literature to compare expected NTD prevalence under strategies incorporating combinations of folic acid supplementation, fortification, and arsenic filters. Sensitivity analyses aimed to quantify the influence of adherence to supplements on estimates.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Eleven studies were included. Prevalences of NTD and spina bifida were 27.4 and 11.2 per 10,000 births, respectively; however, when estimated from population red blood cell folate concentrations, NTD prevalence was higher in both high arsenic exposure (drinking water\u2009\u2265\u200950\u2009\u03bcg\/L) and lower arsenic exposure groups (34.3 and 25.3 per 10,000 births, respectively). Folic acid fortification reduced the prevalence of NTDs to 11.1 and 9.1 per 10,000 births among high exposure and low exposure groups, respectively. Arsenic filters provided little marginal benefit. Benefits of supplements equaled those of fortification when adherence to supplements exceeded 90%.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Bangladesh has high rates of NTDs and high arsenic exposures. Folic acid fortification is projected to be the most effective strategy for NTD prevention.<\/jats:p><\/jats:sec>","DOI":"10.1002\/bdr2.2494","type":"journal-article","created":{"date-parts":[[2025,6,24]],"date-time":"2025-06-24T07:39:41Z","timestamp":1750750781000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Comparing Folic Acid Interventions and Arsenic Reduction Strategies for Neural Tube Defect Prevention in Bangladesh: A Systematic Review and Decision Analysis"],"prefix":"10.1002","volume":"117","author":[{"given":"Chih\u2010Fu","family":"Wei","sequence":"first","affiliation":[{"name":"Department of Environmental Health Harvard T.H. Chan School of Public Health  Boston Massachusetts USA"},{"name":"Department of Environmental and Occupational Medicine National Taiwan University Hospital Yunlin Branch  Huwei Township Yunlin County Taiwan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ernani F.","family":"Choma","sequence":"additional","affiliation":[{"name":"Department of Environmental Health Harvard T.H. Chan School of Public Health  Boston Massachusetts USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Xingyan","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Epidemiology Harvard T.H. Chan School of Public Health  Boston Massachusetts USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Carrie G.","family":"Wade","sequence":"additional","affiliation":[{"name":"Countway Library of Medicine Harvard Medical School  Boston Massachusetts USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ya Luan","family":"Hsiao","sequence":"additional","affiliation":[{"name":"Department of Medicine Brigham and Women's Hospital  Boston Massachusetts USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Diane","family":"Bao","sequence":"additional","affiliation":[{"name":"Department of Neurology Boston Children's Hospital  Boston Massachusetts USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sudipta K.","family":"Mukherjee","sequence":"additional","affiliation":[{"name":"Department of Paediatric Neurosurgery National Institute of Neurosciences &amp; Hospital  Dhaka Bangladesh"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"David C.","family":"Christiani","sequence":"additional","affiliation":[{"name":"Department of Environmental Health Harvard T.H. Chan School of Public Health  Boston Massachusetts USA"},{"name":"Division of Pulmonary and Critical Care Medicine Massachusetts General Hospital  Boston Massachusetts USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Marc G.","family":"Weisskopf","sequence":"additional","affiliation":[{"name":"Department of Environmental Health Harvard T.H. Chan School of Public Health  Boston Massachusetts USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Liming","family":"Liang","sequence":"additional","affiliation":[{"name":"Department of Epidemiology Harvard T.H. Chan School of Public Health  Boston Massachusetts USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0380-2407","authenticated-orcid":false,"given":"Maitreyi","family":"Mazumdar","sequence":"additional","affiliation":[{"name":"Department of Environmental Health Harvard T.H. Chan School of Public Health  Boston Massachusetts USA"},{"name":"Department of Neurology Boston Children's Hospital  Boston Massachusetts USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2025,6,24]]},"reference":[{"issue":"4","key":"e_1_2_9_2_1","first-page":"662","article-title":"Varieties of Foetal Congenital Abnormality","volume":"21","author":"Akhtar N.","year":"2012","journal-title":"Mymensingh Medical Journal"},{"key":"e_1_2_9_3_1","doi-asserted-by":"publisher","DOI":"10.3329\/ssmcj.v30i1.59375"},{"key":"e_1_2_9_4_1","doi-asserted-by":"publisher","DOI":"10.3329\/jhpn.v28i1.4527"},{"key":"e_1_2_9_5_1","doi-asserted-by":"publisher","DOI":"10.3329\/bjch.v44i1.49679"},{"key":"e_1_2_9_6_1","doi-asserted-by":"publisher","DOI":"10.2105\/AJPH.2015.302902"},{"key":"e_1_2_9_7_1","unstructured":"Bangladesh Bureau of Statistics (BBS) andUNICEF Bangladesh.2019.\u201c\u201dProgotir Pathey Bangladesh Multiple Indicator Cluster Survey 2019 \u201dSurvey Findings Report (978\u2013984\u20108969\u201034\u20102).https:\/\/www.unicef.org\/bangladesh\/media\/3281\/file\/Bangladesh%202019%20MICS%20Report_English.pdf."},{"key":"e_1_2_9_8_1","doi-asserted-by":"publisher","DOI":"10.3390\/nu14153114"},{"key":"e_1_2_9_9_1","doi-asserted-by":"publisher","DOI":"10.1093\/ije\/dyq028"},{"key":"e_1_2_9_10_1","doi-asserted-by":"publisher","DOI":"10.1111\/nyas.13548"},{"key":"e_1_2_9_11_1","doi-asserted-by":"publisher","DOI":"10.1093\/ajcn\/nqy148"},{"key":"e_1_2_9_12_1","doi-asserted-by":"publisher","DOI":"10.1146\/annurev\u2010nutr\u2010082117\u2010051757"},{"key":"e_1_2_9_13_1","doi-asserted-by":"publisher","DOI":"10.1007\/bf00310189"},{"key":"e_1_2_9_14_1","doi-asserted-by":"publisher","DOI":"10.1002\/14651858.CD012150.pub2"},{"key":"e_1_2_9_15_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jtemb.2015.01.003"},{"key":"e_1_2_9_16_1","volume-title":"March of Dimes Global Report on Birth Defects. The Hidden Toll of Dying and Disabled Children: Executive Summary","author":"Christianson A.","year":"2006"},{"key":"e_1_2_9_17_1","doi-asserted-by":"publisher","DOI":"10.1016\/S1474\u20104422(13)70110\u20108"},{"issue":"31","key":"e_1_2_9_18_1","first-page":"980","article-title":"CDC Grand Rounds: Additional Opportunities to Prevent Neural Tube Defects With Folic Acid Fortification","volume":"59","author":"Cordero A.","year":"2010","journal-title":"Morbidity and Mortality Weekly Report"},{"issue":"15","key":"e_1_2_9_19_1","first-page":"421","article-title":"Optimal Serum and Red Blood Cell Folate Concentrations in Women of Reproductive Age for Prevention of Neural Tube Defects: World Health Organization Guidelines","volume":"64","author":"Cordero A. M.","year":"2015","journal-title":"MMWR. Morbidity and Mortality Weekly Report"},{"key":"e_1_2_9_20_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.g4554"},{"key":"e_1_2_9_21_1","doi-asserted-by":"publisher","DOI":"10.3390\/nu11010071"},{"key":"e_1_2_9_22_1","doi-asserted-by":"publisher","DOI":"10.1093\/ajcn\/nqy065"},{"key":"e_1_2_9_23_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10995\u2010014\u20101542\u20108"},{"key":"e_1_2_9_24_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.cdnut.2023.100070"},{"key":"e_1_2_9_25_1","doi-asserted-by":"publisher","DOI":"10.1002\/14651858.CD007950.pub3"},{"key":"e_1_2_9_26_1","doi-asserted-by":"publisher","DOI":"10.3329\/jhpn.v28i4.6040"},{"key":"e_1_2_9_27_1","doi-asserted-by":"publisher","DOI":"10.1289\/EHP11872"},{"key":"e_1_2_9_28_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.315.7109.629"},{"key":"e_1_2_9_29_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamapsychiatry.2018.1381"},{"issue":"3","key":"e_1_2_9_30_1","first-page":"658","article-title":"Frequency, Distribution of Congenital Anomaly and Associated Maternal Risk Factors","volume":"26","author":"Fatema K.","year":"2017","journal-title":"Mymensingh Medical Journal"},{"key":"e_1_2_9_31_1","doi-asserted-by":"publisher","DOI":"10.1530\/jrf.0.0170199"},{"key":"e_1_2_9_32_1","doi-asserted-by":"publisher","DOI":"10.1093\/cdn\/nzab069"},{"key":"e_1_2_9_33_1","doi-asserted-by":"publisher","DOI":"10.1093\/ajcn\/84.5.1093"},{"key":"e_1_2_9_34_1","doi-asserted-by":"publisher","DOI":"10.1093\/ajcn\/86.4.1202"},{"key":"e_1_2_9_35_1","unstructured":"Global Fortification Data Exchange.2025. \u201cProviding Actionable Food Fortification Data.\u201d Accessed April 15 2025.https:\/\/fortificationdata.org."},{"key":"e_1_2_9_36_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.amepre.2015.10.012"},{"key":"e_1_2_9_37_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijdevneu.2011.06.006"},{"key":"e_1_2_9_38_1","doi-asserted-by":"publisher","DOI":"10.1002\/bdrb.20142"},{"key":"e_1_2_9_39_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0250098"},{"key":"e_1_2_9_40_1","doi-asserted-by":"publisher","DOI":"10.1111\/nyas.13527"},{"issue":"3","key":"e_1_2_9_41_1","first-page":"656","article-title":"Pattern of Fetal Congenital Anomalies and Its Relation With Maternal Factors","volume":"31","author":"Jahan U. R.","year":"2022","journal-title":"Mymensingh Medical Journal"},{"key":"e_1_2_9_42_1","doi-asserted-by":"publisher","DOI":"10.1155\/2022\/1359572"},{"key":"e_1_2_9_43_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00381\u2010023\u201005910\u20107"},{"key":"e_1_2_9_44_1","doi-asserted-by":"publisher","DOI":"10.1016\/S2214\u2010109X(22)00213\u20103"},{"key":"e_1_2_9_45_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0188726"},{"key":"e_1_2_9_46_1","doi-asserted-by":"publisher","DOI":"10.3945\/jn.108.101022"},{"key":"e_1_2_9_47_1","doi-asserted-by":"publisher","DOI":"10.1093\/ajcn\/80.5.1123"},{"issue":"2","key":"e_1_2_9_48_1","first-page":"190","article-title":"Arsenic in Drinking\u2010Water and Reproductive Health Outcomes: A Study of Participants in the Bangladesh Integrated Nutrition Programme","volume":"24","author":"Kwok R. K.","year":"2006","journal-title":"Journal of Health, Population, and Nutrition"},{"key":"e_1_2_9_49_1","doi-asserted-by":"publisher","DOI":"10.1016\/S2214\u2010109X(23)00191\u20102"},{"key":"e_1_2_9_50_1","doi-asserted-by":"publisher","DOI":"10.1093\/ajcn\/nqaa259"},{"key":"e_1_2_9_51_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12940\u2010015\u20100020\u20100"},{"key":"e_1_2_9_52_1","doi-asserted-by":"publisher","DOI":"10.1002\/bdra.23399"},{"key":"e_1_2_9_53_1","doi-asserted-by":"publisher","DOI":"10.1002\/jrsm.1547"},{"key":"e_1_2_9_54_1","volume-title":"National Health and Nutrition Examination Survey Data","author":"National Center for Health Statistics","year":"2024"},{"key":"e_1_2_9_55_1","doi-asserted-by":"publisher","DOI":"10.1289\/ehp.1409396"},{"key":"e_1_2_9_56_1","doi-asserted-by":"publisher","DOI":"10.1007\/s12403\u2010022\u201000487\u2010z"},{"key":"e_1_2_9_57_1","doi-asserted-by":"publisher","DOI":"10.3329\/bsmmcj.v3i1.71956"},{"key":"e_1_2_9_58_1","doi-asserted-by":"publisher","DOI":"10.1126\/science.aba1510"},{"key":"e_1_2_9_59_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.eclinm.2023.102366"},{"key":"e_1_2_9_60_1","doi-asserted-by":"publisher","DOI":"10.1177\/146642400212200116"},{"key":"e_1_2_9_61_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0258488"},{"key":"e_1_2_9_62_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2011.1433"},{"key":"e_1_2_9_63_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.scitotenv.2016.04.112"},{"key":"e_1_2_9_64_1","doi-asserted-by":"publisher","DOI":"10.1007\/978-3-319-21416-0"},{"key":"e_1_2_9_65_1","doi-asserted-by":"publisher","DOI":"10.3171\/2020.7.PEDS20442"},{"key":"e_1_2_9_66_1","doi-asserted-by":"publisher","DOI":"10.3329\/dujps.v14i2.28514"},{"issue":"4","key":"e_1_2_9_67_1","first-page":"805","article-title":"Pattern and Risk Factors of Congenital Anomaly in Newborn in a Tertiary Level Private Medical College Hospital, Bangladesh","volume":"27","author":"Siddika M.","year":"2018","journal-title":"Mymensingh Medical Journal"},{"key":"e_1_2_9_68_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.taap.2004.07.006"},{"key":"e_1_2_9_69_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ypmed.2018.05.023"},{"key":"e_1_2_9_70_1","unstructured":"United Nations Department of Economic and Social Affairs Population Division.2022. \u201cWorld Population Prospects 2022: Data Sources.\u201d Accessed August 23 2024.https:\/\/population.un.org\/wpp\/."},{"key":"e_1_2_9_71_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2023.9864"},{"key":"e_1_2_9_72_1","doi-asserted-by":"publisher","DOI":"10.3390\/nu8030152"},{"key":"e_1_2_9_73_1","doi-asserted-by":"publisher","DOI":"10.1186\/s13229\u2010017\u20100170\u20108"},{"key":"e_1_2_9_74_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12940\u2010024\u201001091\u20101"},{"key":"e_1_2_9_75_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.envres.2024.119714"},{"key":"e_1_2_9_76_1","doi-asserted-by":"publisher","DOI":"10.1002\/sim.4780101105"},{"key":"e_1_2_9_77_1","volume-title":"Optimal Serum and Red Blood Cell Folate Concentrations in Women of Reproductive Age for Prevention of Neural Tube Defects","author":"WHO","year":"2015"},{"key":"e_1_2_9_78_1","volume-title":"Guidelines for Drinking\u2010Water Quality: Fourth Edition Incoporating the First and Second Addenda","author":"WHO","year":"2022"},{"key":"e_1_2_9_79_1","unstructured":"WHO.2023.\u201cAccelerating Efforts for Preventing Micronutrient Deficiencies and Their Consequences Including Spina Bifida and Other Neural Tube Defects Through Safe and Effective Food Fortification. (EB152\/CONF.\/5).\u201dhttps:\/\/apps.who.int\/gb\/ebwha\/pdf_files\/EB152\/B152_CONF5\u2010en.pdf."},{"issue":"1","key":"e_1_2_9_80_1","first-page":"1","article-title":"Updated Estimates of Neural Tube Defects Prevented by Mandatory Folic Acid Fortification \u2010 United States, 1995\u20102011","volume":"64","author":"Williams J.","year":"2015","journal-title":"MMWR. Morbidity and Mortality Weekly Report"},{"key":"e_1_2_9_81_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0890-6238(96)00131-1"},{"key":"e_1_2_9_82_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00431\u2010011\u20101492\u20108"},{"key":"e_1_2_9_83_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0151586"}],"container-title":["Birth Defects Research"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/bdr2.2494","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,8,11]],"date-time":"2025-08-11T12:52:12Z","timestamp":1754916732000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/bdr2.2494"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,6]]},"references-count":82,"journal-issue":{"issue":"6","published-print":{"date-parts":[[2025,6]]}},"alternative-id":["10.1002\/bdr2.2494"],"URL":"https:\/\/doi.org\/10.1002\/bdr2.2494","archive":["Portico"],"relation":{},"ISSN":["2472-1727","2472-1727"],"issn-type":[{"value":"2472-1727","type":"print"},{"value":"2472-1727","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,6]]},"assertion":[{"value":"2024-12-18","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-05-28","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-06-24","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e2494"}}