Does Voluntarily Adding Folic Acid to Corn Flour Prevent Birth Defects?

A new study investigated the rate of neural tube defects in predominantly Hispanic-populated women before and after the voluntary fortification of corn masa flour with folic acid.

No significant decrease in rates of neural tube defects (NTDs) in pregnancies following voluntary corn masa folic acid fortification was demonstrated by a new study published in the journal Child’s Nervous System.

NTDs are severe congenital malformations that result from failure of neural tube closure by the 28th day of gestation. The neural tube forms the early brain and spine. The two most common NTDs are spina bifida (a spinal cord defect) and anencephaly (a brain defect) ().

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‘Mandatory rather than voluntary fortification of corn masa flour products may achieve more substantial prevention of neural tube defects in at-risk US populations.#folic acid #birth defects #pregnancy’

Well, over half of neural tube defects can be prevented with sufficient folic acid consumption before conception and in early pregnancy. Since the FDA instituted mandatory folic acid fortification of cereal grains in 1996, the Center for Disease Control and Prevention (CDC) reported a 36 percent reduction in the number of NTDs between 1996 and 2006.

This regulation resulted in a reduction of neural tube defect (NTD)–affected pregnancies for the population in the United States. The FDA approved voluntary non-mandatory fortification of corn masa flour products 20 years later, in 2016.

Why do Hispanic Communities Continue to be More Severely Affected?

In this study, researchers investigated rates of NTDs in predominantly Hispanic-populated zip codes before and after the time of voluntary fortification of corn masa flour with folic acid. They found no significant changes in rates of births with NTD in the Hispanic population.

A total of 2,584,366 pregnancies were identified among females aged 15–50 years. Of these, 365,983 took place in predominantly Hispanic zip codes. Mean quarterly NTDs per 100,000 pregnancies did not significantly differ between predominantly Hispanic zip codes and predominantly non-Hispanic zip codes pre-FDA recommendation, nor post-recommendation.

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Rates of NTDs predicted to occur if no FDA recommendation had been made were compared to the actual rate post-recommendation: no significant difference was observed in predominantly Hispanic zip codes or overall.

The results show that voluntary, but not mandatory, folic acid fortification of corn masa flour products did not work to lower the rate of congenital neural tube defects in babies born to Hispanic women in the United States ().

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Mandatory fortification of cereal grains has been much more effective in preventing congenital defects and reducing the rates of babies born with NTDs to non-Hispanic women in this country.

While this mandatory food fortification strategy is an example of a public health success, Hispanic women in the US continued to be twice as likely to give birth to a child affected by NTD compared to non-Hispanic women.

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It was not until the year 2016 that the FDA approved voluntary, but not mandatory, folic acid fortification for corn masa flour products in the US to focus on the Hispanic diet staples, such as tortillas. Since that time, the rates of Hispanic births with NTD were not significantly reduced ().

Additional research, policy initiatives, and advocacy are needed urgently. Here, let us raise awareness in all communities, especially Hispanic communities, about the impact of folic acid intake on healthy birth outcomes.

References:

The Association Between Race/Ethnicity and Major Birth Defects in the United States, 1999–2007 - (https://ajph.aphapublications.org/doi/abs/10.2105/AJPH.2014.302098)
The impact of voluntary folate fortification of corn masa flour on US pregnancies complicated by neural tube defects - (https://link.springer.com/article/10.1007/s00381-023-05945-w#Abs1)
Nation-wide failure of voluntary folic acid fortification of corn masa flour and tortillas with folic acid - (https://onlinelibrary.wiley.com/doi/abs/10.1002/bdr2.1518)

Source-Eurekalert