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Articles & Key Findings

Key Findings: Population Red Blood Cell Folate Concentrations for the Prevention of Neural Tube Defects

Mom holding baby

British Medical Journal has published a new study about the association between the amount of folate in women’s blood (“blood folate concentrations”) and the risk of having a baby affected by a neural tube defect, such as spina bifida or anencephaly. In this study, CDC researchers and other scientists found that blood folate concentrations can predict the risk of neural tube defects in a population. These findings will be useful for public health officials interested in understanding the risk of folate-sensitive neural tube defects in their communities and planning prevention programs. You can read the article’s abstract here.

About This Article

This study uses data from two large studies and applies a mathematical model to describe the relationship between women’s blood folate concentrations and the risk of having a baby affected by a neural tube defect.

Main Findings From This Article

Through mathematical modeling of information collected from two large studies in China, this study shows a link between blood folate concentrations in early pregnancy and the risk of neural tube defects. A similar relationship was found in a previous study conducted in an Irish population, and together the results suggest that blood folate concentrations can reasonably predict neural tube defect risk in other populations.

This study found:

What are neural tube defects?

  • Neural tube defects are serious birth defects of the brain and spine.
  • The two most common neural tube defects are spina bifida (affects the spine) and anencephaly (affects the brain).
  • Neural tube defects happen during the first month of pregnancy.

What is folate?

  • Folate is a B vitamin that is present naturally in foods. Folic acid is a synthetic form of folate that is added to vitamins and some foods.
  • Many, but not all, neural tube defects can be prevented by consuming enough folic acid daily. These birth defects are called folate-sensitive neural tube defects.
  • It is important that women of reproductive age consume 400 mcg of folic acid daily by taking a daily vitamin with folic acid in it, by eating food that is fortified with folic acid (such as some breakfast cereals and other cereal grain products), or both, in addition to eating a diet rich in natural folate.
  • If a woman has enough folate in her blood before and during early pregnancy, from synthetic and natural sources, it can help prevent neural tube defects.
  • Lower blood folate concentrations are associated with a higher risk of neural tube defects.
  • For the prevention of neural tube defects, the optimal blood folate concentration within a population is 1000 nanomoles per liter (nmol/L) or greater.
  • Blood folate concentrations alone (without having information on folate intake or other factors) can be used as a tool to determine the need for and the effectiveness of neural tube defects prevention programs, such as the fortification of staple foods with folic acid.

Paper Reference

Crider KS, Devine O, Hao L, Dowling NF, Li S, Molloy AM, Li Z, Zhu J, Berry RJ. Population Red Blood Cell Folate Concentrations for the Prevention of Neural Tube Defects: A Bayesian Model. Brit Med J. 2014 [epub ahead of print].

Neural Tube Defects: Centers for Disease Control and Prevention (CDC) Activities

CDC’s National Center on Birth Defects and Developmental Disabilities is working with the World Health Organization and other partners on a global initiative, Birth Defects COUNT (Countries and Organizations United for Neural Tube Defects Prevention), to reduce death and lifelong disability due to neural tube defects. The three focus areas of Birth Defects COUNT are science, partnerships, and public health policy.

  1. Science. Develop and strengthen regional and in-country abilities to monitor birth defects, as well as develop and strengthen laboratory capacity to measure the amount of folate present in the blood (or blood folate concentration).
  2. Partnership. Engage a global network of partners who are experts in conducting birth defects prevention programs, tracking birth defects rates, monitoring blood folate concentrations, and developing interventions to increase the amount of folic acid consumed by women of childbearing age.
  3. Policy. Educate and inform decision makers on the benefits of fortification policies for preventing neural tube defects.

CDC’s activities support United Nations Millennium Development Goal 4, to reduce the mortality rate of children under-five, and improve global efforts to prevent neural tube defects.

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