{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,17]],"date-time":"2026-07-17T15:03:39Z","timestamp":1784300619161,"version":"3.55.0"},"reference-count":40,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2026,5,27]],"date-time":"2026-05-27T00:00:00Z","timestamp":1779840000000},"content-version":"vor","delay-in-days":26,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,5,1]],"date-time":"2026-05-01T00:00:00Z","timestamp":1777593600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Birth Defects Research"],"published-print":{"date-parts":[[2026,5]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Spina bifida and anencephaly are major birth defects, and the majority of them can be prevented through maternal intake of folic acid (vitamin B9) during early pregnancy. We estimated the proportion of folic acid\u2010preventable spina bifida and anencephaly (FAP SBA) prevented globally through mandatory folic acid fortification policy in the year 2024 for cereal grains (i.e., wheat flour, maize flour, and rice).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We used country\u2010specific fortification data from the Food Fortification Initiative for year 2024. Seventy countries had mandatory cereal grain fortification adding folic acid, and of them, 69 had complete data for analysis. Our prevention model assumed &gt;\u2009150\u2009mcg\/day of folic acid protects against FAP SBA, and post\u2010fortification prevalence was assumed to reach the prevention target of 0.5 cases per 1000 births.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>We estimated 63,600 cases of FAP SBA were prevented in the year 2024 in the 69 countries with mandatory fortification of cereal grains with folic acid worldwide. The prevention percent was 24%, indicating only a quarter of all preventable FAP SBA was prevented globally. About 200,000 preventable FAP SBA cases occurred in over 100 countries without fortification policies.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>The 76th World Health Assembly resolution (76.19) passed in 2023 urges countries to implement folic acid fortification of staple foods to prevent FAP SBA. However, a large global disparity in FAP SBA prevention persists in 2024 despite proven fortification effectiveness. Fortification can swiftly and cost\u2010effectively help countries achieve health equity by preventing disability and mortality associated with FAP SBA.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/bdr2.70065","type":"journal-article","created":{"date-parts":[[2026,5,28]],"date-time":"2026-05-28T03:29:58Z","timestamp":1779938998000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["A Global Update on the Status of Prevention of Folic Acid\u2010Preventable Spina Bifida and Anencephaly in Year 2024"],"prefix":"10.1002","volume":"118","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":"Department of Population Health Sciences School of Public Health of Georgia State University  Atlanta Georgia USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Helena","family":"Pach\u00f3n","sequence":"additional","affiliation":[{"name":"Food Fortification Initiative  Atlanta Georgia USA"},{"name":"Hubert Department of Global Health Rollins School of Public Health of Emory University  Atlanta Georgia USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,5,27]]},"reference":[{"key":"e_1_2_9_2_1","doi-asserted-by":"publisher","DOI":"10.1002\/bdra.23100"},{"key":"e_1_2_9_3_1","doi-asserted-by":"publisher","DOI":"10.1002\/bdra.23529"},{"key":"e_1_2_9_4_1","doi-asserted-by":"publisher","DOI":"10.2105\/AJPH.2015.302902"},{"key":"e_1_2_9_5_1","doi-asserted-by":"publisher","DOI":"10.1002\/bdra.20304"},{"key":"e_1_2_9_6_1","doi-asserted-by":"publisher","DOI":"10.1002\/bdra.20504"},{"key":"e_1_2_9_7_1","doi-asserted-by":"publisher","DOI":"10.1177\/15648265100311S103"},{"key":"e_1_2_9_8_1","doi-asserted-by":"publisher","DOI":"10.1111\/nyas.13548"},{"key":"e_1_2_9_9_1","doi-asserted-by":"publisher","DOI":"10.1056\/nejm199911113412006"},{"key":"e_1_2_9_10_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00381\u2010021\u201005191\u2010y"},{"key":"e_1_2_9_11_1","doi-asserted-by":"publisher","DOI":"10.1002\/14651858.CD012150.pub2"},{"key":"e_1_2_9_12_1","volume-title":"March of Dimes Global Report on Birth Defects: The Hidden Toll of Dying and Disabled Children","author":"Christianson A.","year":"2006"},{"key":"e_1_2_9_13_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.g4554"},{"key":"e_1_2_9_14_1","doi-asserted-by":"publisher","DOI":"10.1093\/ajcn\/nqy065"},{"key":"e_1_2_9_15_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamapediatrics.2016.0388"},{"key":"e_1_2_9_16_1","doi-asserted-by":"publisher","DOI":"10.1111\/nyas.13499"},{"key":"e_1_2_9_17_1","volume-title":"Knowledge Brief\u2014The Policy Environment for Folic Acid Interventions to Prevent NTDs","author":"Folate Task Team, & International Federation for Spina Bifida and Hydrocephalus","year":"2020"},{"key":"e_1_2_9_18_1","unstructured":"Global Fortification Data Exchange.2025a.\u201cNutrient Levels\u201dRetrieved February 19 2025.https:\/\/www.fortificationdata.org\/nutrient\u2010levels\u2010in\u2010fortification\u2010standards\/."},{"key":"e_1_2_9_19_1","unstructured":"Global Fortification Data Exchange.2025b.\u201cMap: Daily Food Intake\/Availability per Capita\u201dRetrieved February 19 2025.https:\/\/fortificationdata.org\/map\u2010availability\/."},{"key":"e_1_2_9_20_1","unstructured":"Global Fortification Data Exchange.2026.\u201cQuantity and Proportion of Food Vehicle That is Fortified.\u201dRetrieved April 28 2026.https:\/\/www.fortificationdata.org\/quantity\u2010and\u2010proportion\u2010of\u2010food\u2010vehicle\u2010that\u2010is\u2010fortified\/."},{"key":"e_1_2_9_21_1","doi-asserted-by":"publisher","DOI":"10.1111\/nyas.13527"},{"key":"e_1_2_9_22_1","unstructured":"International Federation of Spina Bifida and Hydrocephalus.2005.\u201cPolicy Statement on Prevention of Neural Tube Defects and Mandatory Food Fortification.\u201dRetrieved June 1 2025.https:\/\/www.ifglobal.org\/publications\/if\u2010policy\u2010statement\u2010on\u2010prevention\u2010of\u2010neural\u2010tube\u2010defects\u2010and\u2010mandatory\u2010food\u2010fortification\/."},{"key":"e_1_2_9_23_1","doi-asserted-by":"publisher","DOI":"10.1002\/bdr2.1366"},{"key":"e_1_2_9_24_1","doi-asserted-by":"publisher","DOI":"10.1002\/bdr2.1835"},{"key":"e_1_2_9_25_1","doi-asserted-by":"publisher","DOI":"10.1002\/bdr2.2115"},{"key":"e_1_2_9_26_1","doi-asserted-by":"publisher","DOI":"10.1093\/ajcn\/nqz023"},{"key":"e_1_2_9_27_1","doi-asserted-by":"publisher","DOI":"10.9745\/GHSP\u2010D\u201015\u201000171"},{"key":"e_1_2_9_28_1","doi-asserted-by":"publisher","DOI":"10.3389\/fnut.2026.1765596"},{"key":"e_1_2_9_29_1","doi-asserted-by":"publisher","DOI":"10.9745\/GHSP\u2010D\u201017\u201000427"},{"key":"e_1_2_9_30_1","unstructured":"Millers Fortification Index.2026.\u201cMicronutrient Fortification Index \u2010 Nigeria\u201d. Retrieved April 28 2026.https:\/\/mfi\u2010ng.org\/."},{"key":"e_1_2_9_31_1","doi-asserted-by":"publisher","DOI":"10.3390\/nu14183837"},{"key":"e_1_2_9_32_1","doi-asserted-by":"publisher","DOI":"10.1177\/0379572118774229"},{"key":"e_1_2_9_33_1","doi-asserted-by":"publisher","DOI":"10.1098\/rstb.2010.0126"},{"key":"e_1_2_9_34_1","doi-asserted-by":"publisher","DOI":"10.1002\/bdra.23339"},{"key":"e_1_2_9_35_1","volume-title":"The State of the World's Children 2024\u2014The Future of Childhood in the Changing World","author":"United Nations Children's Fund","year":"2025"},{"key":"e_1_2_9_36_1","doi-asserted-by":"publisher","DOI":"10.1002\/bdr2.2343"},{"issue":"1","key":"e_1_2_9_37_1","first-page":"1","article-title":"Updated Estimates of Neural Tube Defects Prevented by Mandatory Folic Acid Fortification\u2014United States, 1995\u20132011","volume":"64","author":"Williams J.","year":"2015","journal-title":"Morbidity and Mortality Weekly Report"},{"key":"e_1_2_9_38_1","unstructured":"World Health Organization.2010.\u201c63rd World Health Assembly. Agenda Item 11.7: Birth Defects.\u201dRetrieved June 1 2025.https:\/\/apps.who.int\/gb\/ebwha\/pdf_files\/WHA63\/A63_R17\u2010en.pdf."},{"key":"e_1_2_9_39_1","unstructured":"World Health Organization.2023.\u201c76th World Health Assembly. Agenda Item 152. Accelerating Efforts for Preventing Micronutrient Deficiencies and Their Consequences Including Spina Bifida and Other Neural Tube Defects Through Safe and Effective Food Fortification.\u201dRetrieved June 1 2025.https:\/\/apps.who.int\/gb\/ebwha\/pdf_files\/EB152\/B152_CONF5\u2010en.pdf."},{"key":"e_1_2_9_40_1","doi-asserted-by":"publisher","DOI":"10.3945\/ajcn.2009.28401"},{"key":"e_1_2_9_41_1","doi-asserted-by":"publisher","DOI":"10.1002\/bdra.23166"}],"container-title":["Birth Defects Research"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/bdr2.70065","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1002\/bdr2.70065","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/bdr2.70065","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,17]],"date-time":"2026-07-17T14:13:55Z","timestamp":1784297635000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/bdr2.70065"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,5]]},"references-count":40,"journal-issue":{"issue":"5","published-print":{"date-parts":[[2026,5]]}},"alternative-id":["10.1002\/bdr2.70065"],"URL":"https:\/\/doi.org\/10.1002\/bdr2.70065","archive":["Portico"],"relation":{},"ISSN":["2472-1727","2472-1727"],"issn-type":[{"value":"2472-1727","type":"print"},{"value":"2472-1727","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,5]]},"assertion":[{"value":"2025-09-13","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-05-12","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-05-27","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e70065"}}