Folic acid-preventable spina bifida and anencephaly are pandemic, affecting 225,000 children a year. These birth defects are as preventable as polio. As we near the eradication of polio, it is time to make the commitment to global prevention of all folic acid-preventable spina bifida and anencephaly (FA-P SBA) by 2010. Folic acid fortification of centrally processed foods, such as wheat and corn flour, could immediately prevent all of these birth defects for much of the world’s population. These fortification programs will also help adults by increasing serum folate concentration, eradicating folate deficiency anemia, providing human genome stability and reducing homocysteine serum concentration, which will probably prevent heart attacks and strokes, and may prevent colon cancer and Alzheimer’s disease. Where there is no centrally processed and distributed food to fortify, intense efforts must be made to increase consumption of synthetic folic acid through vitamin supplements. Geneticists can play a major role in preventing FA-P SBA by helping to create the political will in each country to implement fortification and supplement programs to eliminate disease caused by the current pandemic of folate deficiency.

Botto LD, Moore CA, Khoury MJ, Erickson JD: Neural-tube defects. N Engl J Med 1999;341:1509–1519.
Berry RJ, Li Z, Erickson JD, Li S, Moore CA, Wang H, Mulinare J, Zhao P, Wong LY, Gindler J, Hong SX, Correa A: Prevention of neural-tube defects with folic acid in China. China-US Collaborative Project for Neural Tube Defect Prevention (corrected; erratum to be published). N Engl J Med 1999;341:1485–1490.
MRC Vitamin Study Research Group: Prevention of neural tube defects: Results of the Medical Research Council Vitamin Study. Lancet 1991;338:131–137.
Czeizel AE, Dudas I: Prevention of the first occurrence of neural-tube defects by periconceptional vitamin supplementation. N Engl J Med 1992;327:1832–1835.
Blount BC, Mack MM, Wehr CM, MacGregor JT, Hiatt RA, Wang G, Wickramasinghe SN, Everson RB, Ames BN: Folate deficiency causes uracil misincorporation into human DNA and chromosome breakage: Implications for cancer and neuronal damage. Proc Natl Acad Sci USA 1997;94:3290–3295.
Lewis CA, Pancharuniti N, Sauberlich HE: Plasma folate adequacy as determined by homocysteine level. Ann NY Acad Sci 1992;669:360–362.
Jacques P, Bostom AG, Wilson PWF, Rich S, Rosenberg I, Selhub J: Determinants of plasma total homocysteine concentration in the Framingham Offspring cohort. Am J Clin Nutr 2001;73:613–621.
Selhub J, Jacques PF, Wilson PW, Rush D, Rosenberg IH: Vitamin status and intake as primary determinants of homocysteinemia in an elderly population. JAMA 1993;270:2693–2698.
Selhub J, Jacques PF, Rosenberg IH, Rogers G, Bowman BA, Gunter EW, Wright JD, Johnson CL: Serum total homocysteine concentrations in the third National Health and Nutrition Examination Survey (1991–1994): Population reference ranges and contribution of vitamin status to high serum concentrations. Ann Intern Med 1999;131:331–339.
de Bree A, Vershuren WMM, Blom HJ, Kromhout D: Association between B vitamin intake and plasma homocysteine concentration in the general Dutch population aged 20–65 years. Am J Clin Nutr 2001;73:1027–1033.
Oakley JGP: Inertia on folic acid fortification – public health malpractice. Teratology 2002, in press.
Ames BN: DNA damage from micronutrient deficiencies is likely to be a major cause of cancer. Mutat Res 2001;475:7–20.
Giovannucci E, Stampfer MJ, Colditz GA, Hunter DJ, Fuchs C, Rosner BA, Speizer FE, Willett WC: Multivitamin use, folate, and colon cancer in women in the Nurses’ Health Study. Ann Intern Med 1998;129:517–524.
Fenech M: The role of folic acid and vitamin B 12 in genomic stability of human cells. Mutat Res 2001;475:57–67.
Food and Nutrition Board Institute of Medicine: Dietary reference intakes for thiamin, riboflavin, niacin, folate, vitamin B12, pantothenic acid, biotin, and coline. A report of the Standing Committee on the Scientific Evaluation of Dietary Rererence Intakes and its Panel on Folate, Other B Vitamins and Choline and Subcommittee on Upper Reference Levels of Nutrients. Washington, National Academy Press, 1998.
Food and Drug Administration. Food Standards: amendment of standards of identity for enriched grain products to require addition of folic acid. Fed Regist 1996;61:8781–8807.
Folic acid and the prevention of disease. Report of the Committee on Medical Aspects of Food and Nutrition Policy. Rep Health Soc Subj (Lond) 2000;50:i-xv, 1–101.
Centers for Disease Control and Prevention. Recommendations for the use of folic acid to reduce the number of cases of spina bifida and other neural tube defects. MMWR – Morbidity & Mortality Weekly Report 1992;41:1–7.
Dickinson CJ: Does folic acid harm people with vitamin B12 deficiency? QJM 1995;88:357–364.
Daly LE, Kirke PN, Molloy A, Weir DG, Scott JM: Folate levels and neural tube defects. Implications for prevention. JAMA 1995;274:1698–1702.
Wald NJ, Law MR, Morris JK, Wald DS: Quantifying the effect of folic acid. Lancet 2001;358:2069–2073.
Huber A, Wallins L, DeRusso P: Folate nutriture in pregnancy. J Am Diet Assoc 1988;88:791–795.
Bostom AG, Silbershatz H, Rosenberg IH, Selhub J, D’Agostino RB, Wolf PA, Jacques PF, Wilson PW: Nonfasting plasma total homocysteine levels and all-cause and cardiovascular disease mortality in elderly Framingham men and women. Arch Intern Med 1999;159:1077–1080.
Bostom AG, Rosenberg IH, Silbershatz H, Jacques PF, Selhub J, D’Agostino RB, Wilson PW, Wolf PA: Nonfasting plasma total homocysteine levels and stroke incidence in elderly persons: The Framingham Study. Ann Intern Med 1999;131:352–355.
Centers for Disease Control and Prevention: Folate status in women of childbearing age – United States, 1999. MMWR Morb Mortal Wkly Report 2000;49:962–965.
Lawrence JM, Petitti DB, Watkins M, Umekubo MA: Trends in serum folate after food fortification. Lancet 1999;354:915–916.
Ray JG, Vermeulen MJ, Boss SC, Cole DEC: Increased red cell folate concentration in women of reproductive age after Canadian folic acid food fortification. Epidemiology 2002;13:238–240.
Honein MA, Paulozzi LJ, Mathews TJ, Erickson JD, Wong LY: Impact of folic acid fortification of the US food supply on the occurrence of neural tube defects. JAMA 2001;285:2981–2986.
Jacques PF, Selhub J, Bostom AG, Wilson PW, Rosenberg IH: The effect of folic acid fortification on plasma folate and total homocysteine concentrations. N Engl J Med 1999;340:1449–1454.
Martin JA, Smith BL, Mathews TJ, Ventura MA: Births and deaths: Preliminary data for 1998. Natl Vital Stat Rep 1999;47:1–45; Table E.
Oakley JG: Delay in folic acid fortification. BMJ 2002;324:1348–1349.
Willett WC, Stampfer MJ: What vitamins should I be taking? N Engl J Med 2002;346:1915.
Freire WB, Hertrampf E, Cortes F: Effect of folic acid fortification in Chile: Preliminary Results. Eur J Pediatr Surg 2000;10(suppl 1):42–43.
Raats M, Thorpe L, Hurren C, Elliott K: Changing Preconceptions: The HEA Folic Acid Campaign, 1995–1998. London, Health Education Authority, 1998, p. 2.
de Walle HEK, de Jong-van den Berg LTW, Cornel MC: Periconceptional folic acid intake in the northern Netherlands. Lancet 1999;353:1187.
de Walle HEK, de Jong-van den Berg LTW: Insufficient folic acid intake in the Netherlands. What about the future? Teratology 2002;66:44–54.
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.