2012 Update on global prevention of folic acid-preventable spina bifida and anencephaly

Birth Defects Res A Clin Mol Teratol. 2013 Oct;97(10):658-63. doi: 10.1002/bdra.23166. Epub 2013 Sep 2.


Background: Folic acid was proven in 1991 to prevent most cases of spina bifida and anencephaly. In 2008, less than 10% of folic acid-preventable spina bifida and anencephaly (FAPSBA) was prevented through folic acid fortification programs. This study updates the global estimates of the proportion of FAPSBA prevented with various types of folic acid fortification as of 2012.

Methods: For each country, we estimated the annual birth prevalence of FAPSBA and the daily amount of folic acid consumed from mandatory folic acid fortification programs. Assuming in Model I (our original Bell and Oakley model) that it required 400 μg, and in Model II (a new model), 200 μg of folic acid daily for total prevention of FAPSBA, we estimated the percentage of FAPSBA being prevented in each country by fortification.

Results: Using the original model, we estimate that 15% of FAPSBA is being prevented in 2012, compared with 2006 (6.8%) and 2008 (9.1%). We estimate in our new model that 25% of FAPSBA is being prevented.

Conclusion: We estimate an increasing prevention of FAPSBA in the world through folic acid fortification, yet the pace is slow. Our new model estimates that only 25% prevention and reminds us that there remains a lot of work to do in countries that do not implement mandatory fortification, which is key to achieving global and total prevention. If we are to prevent all FAPSBA, there is an urgent need to build the global political will to find sufficient resources to aid in this effort.

Keywords: anencephaly; epidemiology; flour fortification; folic acid; prevention; spina bifida.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Anencephaly / epidemiology
  • Anencephaly / prevention & control*
  • Flour / analysis
  • Folic Acid / administration & dosage*
  • Food, Fortified*
  • Global Health
  • Humans
  • Infant
  • Models, Statistical*
  • Nutritional Requirements / physiology
  • Prevalence
  • Spinal Dysraphism / epidemiology
  • Spinal Dysraphism / prevention & control*


  • Folic Acid