Impact of Wheat Flour Folic Acid Fortification on Neural Tube Defects in Three Cities in Peru

Abstract

Objective: The purpose of this study was to assess the impact of fortification of wheat flour with folic acid on the prevalence of neural tube defects (NTDs) in three hospitals of the three natural regions of Peru by reducing anencephaly, spina bifida or encephalocele.

Methods: In 2012, a retrospective descriptive study of NTD prevalence in three public hospitals was conducted. The data corresponded to two periods: before (2001-2005) and after (2006-2010) implementing mandatory fortification of wheat our with folic acid and other micronutrients in August 2005. Prevalence was calculated by dividing the total number of NTDs identified in the three hospitals by the total number of live newborns in the three hospitals (91.413) in 2001-2010. The 95% CI was calculated for NTD prevalence with the Poisson Test.

Results: A total of 101 newborns were found with an NTD, with mean gestational age of 37.7 weeks and mean weight of 2,808.6 grams. The prevalence of NTDs in the pre-fortification period was 12.1 per 10,000 live births and 10.1 per 10,000 live births in the post-fortification period. Pre- and post-NTD prevalences (per 10,000 live births) were 16.6 and 15.9 in Ayacucho, 12.3 and 10.1 in Tacna and 8.0 and 4.9 in Iquitos. Only the prevalence of spina bifida had a statistically significant reduction of 3.7 per 10,000 live births (p <0.05).

Conclusions: The implementation of wheat our fortification with folic acid helped reduce the prevalence of NTDs in 2 per 10,000 NB, suggesting a positive impact of the intervention in the three study hospitals.