School of Medicine, Koç University, Istanbul, Turkey.
Department of Neurosurgery, University of Texas Southwestern Medical Center, Dallas, TX, USA.
Neurosurg Rev. 2024 Oct 4;47(1):724. doi: 10.1007/s10143-024-02959-z.
Neural tube defects (NTDs), such as spina bifida and anencephaly, are severe congenital anomalies affecting the development of the brain and spine. These conditions are often linked to folic acid deficiency during early pregnancy, a modifiable risk factor. While high-income countries have implemented mandatory folic acid fortification in staple foods, resulting in significant reductions in NTD prevalence, low- and middle-income countries (LMICs) continue to experience disproportionately high rates of these birth defects. Folic acid supplementation and fortification are proven interventions for preventing NTDs, but many LMICs face political, financial, and logistical barriers to implementing these programs. This paper highlights the importance of mandatory folic acid fortification as a cost-effective public health intervention and advocates for its expansion in LMICs. It reviews the successes of fortification programs in high-income countries, explores alternative food vehicles like rice for regions with different dietary staples, and discusses the potential of multi-nutrient fortification strategies. Additionally, this paper emphasizes the need for global collaboration, enhanced monitoring and evaluation, and public health education campaigns to ensure that women of reproductive age, especially in LMICs, receive adequate folic acid. By addressing these challenges, the global health community can significantly reduce the incidence of NTDs, improve maternal and child health, and promote health equity worldwide. The time to act is now, as the benefits of folic acid fortification far outweigh the costs of inaction.
神经管缺陷（NTDs），如脊柱裂和无脑畸形，是严重的先天性畸形，影响大脑和脊柱的发育。这些情况通常与妊娠早期叶酸缺乏有关，这是一个可以改变的风险因素。虽然高收入国家已经在主食中实施了强制性叶酸强化，从而显著降低了 NTD 的患病率，但中低收入国家（LMICs）仍然面临着这些出生缺陷的不成比例的高发病率。叶酸补充和强化是预防 NTDs 的已证实干预措施，但许多 LMICs 在实施这些方案时面临着政治、财务和后勤方面的障碍。本文强调了强制性叶酸强化作为一种具有成本效益的公共卫生干预措施的重要性，并主张在 LMICs 中扩大其应用。它回顾了高收入国家强化计划的成功经验，探讨了针对不同主食地区的替代食物载体，如大米，并讨论了多营养素强化策略的潜力。此外，本文还强调了全球合作、加强监测和评估以及公共卫生教育运动的必要性，以确保育龄妇女，特别是在 LMICs 中，获得足够的叶酸。通过应对这些挑战，全球卫生界可以显著降低 NTD 的发病率，改善母婴健康，并在全球范围内促进健康公平。现在是采取行动的时候了，因为叶酸强化的益处远远超过了不采取行动的代价。
