Article
Effects of Folic Acid Fortification on Spina Bifida Prevalence in Brazil
Registro en:
ORIOLI, Iêda Maria; et al. Instituto Nacional de Ciência e Tecnologia Genética Médica Populacional (INAGEMP). Rio de Janeiro, Brasil.
2472-1727
Autor
Orioli, Iêda Maria
Nascimento, Ricardo Lima do
López-Camelo, Jorge Santiago
Castilla, Eduardo Enrique
Resumen
To assess spina bifida birth prevalence changes after folic acid fortification of wheat and
maize flours began in Brazil in June 2004. METHODS: Cross-sectional study of Brazilian live births in 2004
and 2006. Spina bifida birth prevalence from the Live Births Information System (SINASC: Sistema de Informac
¸o˜es sobre Nascidos Vivos) in a prefortified period was compared to a period fortified with folic acid in
each state. Observed prevalence rates in 2004 were used to calculate the expected prevalence rates in 2006
under the null hypothesis that both were similar. The observed/expected (O/E) ratios were tested by twotailed
Z-test. To minimize ascertainment differences among states, the O/E ratio of each one of the 27 Brazilian
states was adjusted for the number of births with the Mantel-Haenszel statistic. RESULTS: The reduction
in spina bifida birth prevalence in 2006 was 39% (O/E 5 0.61; 95% confidence interval [CI], 0.55-0.67), and
40% (O/E 5 0.60; 95% CI, 0.53 0.68), after adjusting for state birth number. This reduction was significant
(p < 0.0001), and heterogeneous among states (v2 5 72.96; p < 0.0001). CONCLUSIONS: Using SINASC data,
there was a significant reduction in spina bifida birth prevalence in Brazil, probably related to the folic acid
food fortification program. 2030-01-01