{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,21]],"date-time":"2026-02-21T11:30:17Z","timestamp":1771673417029,"version":"3.50.1"},"reference-count":35,"publisher":"Wiley","issue":"7","license":[{"start":{"date-parts":[[2016,3,24]],"date-time":"2016-03-24T00:00:00Z","timestamp":1458777600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Birth Defects Research"],"published-print":{"date-parts":[[2016,7]]},"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>The World Health Organization recently released recommendations stating that red blood cell (RBC) folate concentrations should be above 400 ng\/L (906 nmol\/L) for optimal prevention of folate\u2010sensitive neural tube defects (NTDs). The objective of this study was to determine the distribution of folate insufficiency (FI) (&lt;906 nmol\/L) and potential risk of NTDs based on RBC folate concentrations among nonpregnant women of child\u2010bearing age in Guatemala.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>A national and regional multistage cluster probability survey was completed during 2009 to 2010 among Guatemalan women of child\u2010bearing age 15 to 49 years of age. Demographic and health information and blood samples for RBC folate analyses were collected from 1473 women. Prevalence rate ratios of FI and predicted NTD prevalence were estimated based on RBC folate concentrations comparing subpopulations of interest.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>National FI prevalence was 47.2% [95% confidence interval, 43.3\u201351.1] and showed wide variation by region (18\u201381%). In all regions, FI prevalence was higher among indigenous (27\u201389%) than among nonindigenous populations (16\u201344%). National NTD risk based on RBC folate concentrations was estimated to be 14 per 10,000 live births (95% uncertainty interval, 11.1\u201318.6) and showed wide regional variation (from 11 NTDS in the Metropolitan region to 26 NTDs per 10,000 live births in the Norte region).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>FI remains a common problem in populations with limited access to fortified products, specifically rural, low income, and indigenous populations. However, among subpopulations that are most likely to have fortified food, the prevalence of FI is similar to countries with well\u2010established fortification programs. Birth Defects Research (Part A) 106:587\u2013595, 2016. \u00a9 2016 Wiley Periodicals, Inc.<\/jats:p><\/jats:sec>","DOI":"10.1002\/bdra.23499","type":"journal-article","created":{"date-parts":[[2016,3,24]],"date-time":"2016-03-24T11:05:46Z","timestamp":1458817546000},"page":"587-595","source":"Crossref","is-referenced-by-count":26,"title":["Red Blood Cell Folate Insufficiency among nonpregnant Women of Childbearing age in Guatemala 2009 to 2010: Prevalence and predicted Neural Tube Defects risk"],"prefix":"10.1002","volume":"106","author":[{"given":"Jorge","family":"Rosenthal","sequence":"first","affiliation":[{"name":"National Center on Birth Defects and Developmental Disabilities Centers for Disease Control and Prevention Atlanta Georgia USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mary\u2010Elizabeth","family":"Reeve","sequence":"additional","affiliation":[{"name":"Consultant Global Maternal and Preconception Health Healdsburg CA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nicte","family":"Ramirez","sequence":"additional","affiliation":[{"name":"Instituto de Nutrici\u00f3n de Centroam\u00e9rica y Panam\u00e1 Guatemala"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Krista S.","family":"Crider","sequence":"additional","affiliation":[{"name":"National Center on Birth Defects and Developmental Disabilities Centers for Disease Control and Prevention Atlanta Georgia USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Joe","family":"Sniezek","sequence":"additional","affiliation":[{"name":"National Center on Birth Defects and Developmental Disabilities Centers for Disease Control and Prevention Atlanta Georgia USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Claudia","family":"Vellozzi","sequence":"additional","affiliation":[{"name":"National Center on Birth Defects and Developmental Disabilities Centers for Disease Control and Prevention Atlanta Georgia USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Owen","family":"Devine","sequence":"additional","affiliation":[{"name":"Carter Consulting, Inc Atlanta Georgia USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Eunice","family":"Lopez\u2010Pazos","sequence":"additional","affiliation":[{"name":"Guatemala Ministerio de Salud P\u00fablica y Asistencia P\u00fablica Guatemala"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2016,3,24]]},"reference":[{"key":"e_1_2_6_2_1","volume-title":"Prevalencia de Anomalias Congenitas Mayores Externas de Recien Nacidos en Hospitales Nacionales y Regionales de Guatemala 2001\u20132003","author":"Acevedo CR","year":"2004"},{"key":"e_1_2_6_3_1","first-page":"1","article-title":"Impacto de la fortificaci\u00f3n de alimentos con \u00e1cido f\u00f3lico en los defectos del tubo neural en Costa Rica","volume":"30","author":"Arguello MP","year":"2011","journal-title":"Rev Panam Salud P\u00fablica"},{"key":"e_1_2_6_4_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM199911113412001"},{"key":"e_1_2_6_5_1","doi-asserted-by":"publisher","DOI":"10.1093\/aje\/kwp440"},{"key":"e_1_2_6_6_1","first-page":"1","article-title":"Recommendations for the use of folic acid to reduce the number of cases of spina bifida and other neural tube defects","volume":"41","author":"Centers for Disease Control and Prevention","year":"1992","journal-title":"MMWR"},{"key":"e_1_2_6_7_1","unstructured":"Chua LopezCA.2006.Anomalias del tubo neural en Guatemala. 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