Association of neural tube defects and folic acid food fortification in Canada

Lancet. 2002 Dec;360(9350):2047-8. doi: 10.1016/S0140-6736(02)11994-5.


Many women do not receive folic acid supplements before conception. In response, most of Canada's cereal grain products were being fortified with folic acid by January, 1998, thereby providing an additional 0.1-0.2 mg per day of dietary folate to the Canadian population. We assessed the effect of supplementation on prevalence of open neural tube defects in the province of Ontario. Among 336 963 women who underwent maternal serum screening over 77 months, the prevalence of open neural tube defects declined from 1.13 per 1000 pregnancies before fortification to 0.58 per 1000 pregnancies thereafter (prevalence ratio 0.52, 95% CI 0.40-0.67, p<0.0001). At a population level, folic acid food fortification is associated with a pronounced reduction in open neural tube defects.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Female
  • Folic Acid / administration & dosage
  • Folic Acid / blood
  • Folic Acid / therapeutic use*
  • Food, Fortified*
  • Humans
  • Infant, Newborn
  • Neural Tube Defects / epidemiology
  • Neural Tube Defects / prevention & control*
  • Ontario / epidemiology
  • Poisson Distribution
  • Pregnancy
  • Prevalence
  • Spinal Dysraphism / epidemiology
  • Spinal Dysraphism / prevention & control


  • Folic Acid