domingo, 6 de enero de 2013

CDC - About Us, Folic Acid - NCBDDD

January 4, 2013

Taking folic acid before and during early pregnancy can help prevent many neural tube defects (major birth defects of a baby’s brain and spine).
In the US, neural tube defects affect 3,000 pregnancies every year, with higher rates among Hispanic women.
CDC has folic acid resources in English and Spanish for use during National Folic Acid Awareness Week in January and all through the year.

Please share this e-mail with others interested in improving public health practice through evidence-based strategies. Past "Did You Know?" information is available online.

About Us

Taking folic acid before and during pregnancy can help reduce neural tube defects (NTDs), which are major birth defects of a baby’s brain and spine (including anencephaly and spina bifida), by up to 70%.
The Centers for Disease Control and Prevention (CDC) monitors NTDs, conducts research in why they occur and how to prevent them, and develops programs to prevent them from occurring.

Prevention Programs and Evaluation

CDC promotes the use of folic acid among all women who can get pregnant by creating, testing, and sharing free, easy-to-read, and useful educational materials in English and Spanish and other tools. CDC leads efforts to identify and disseminate effective messages for those planning a pregnancy and those not planning a pregnancy. CDC also promotes folic acid use by developing effective educational programs that target women who appear to have a greater chance of having a baby born with an NTD. For example, CDC is evaluating whether using promotoras (lay health outreach workers) is effective in communicating to Latinas that taking folic acid before and during pregnancy can help prevent NTDs.

Global Initiative to Eliminate Folic Acid-Preventable Neural Tube Defects

CDC provides the scientific and programmatic expertise to prevent neural tube defects, build upon and strengthen global neural tube defect surveillance, and expand the reach of global folic acid fortification. Learn more about CDC’s Global Initiative to Eliminate Folic Acid-Preventable Neural Tube Defects.

Tracking

Ten Significant Public Health Achievements ― United States, 2001-2010: Folic Acid

If a woman has enough folic acid in her body before and during pregnancy, it can help prevent neural tube defects (NTDs). The past decade has seen significant reductions in the number of infants born with NTDs.

Learn More

CDC works with state birth defects programs to track the number of babies with spina bifida and other birth defects in the United States and reports these numbers annually. This way, we can find out if the number is rising, dropping, or staying the same. We can also evaluate the prevalence according to where people live and by other factors. This information can help us evaluate the effectiveness of folic acid promotion efforts, and conduct research related to identifying risk factors for birth defects. It can also lead to opportunities for additional prevention.

Research

National Birth Defects Prevention Study (NBDPS)

NBDPS is the largest population-based U.S. study looking at risk factors for and potential causes of birth defects. Current folic acid research activities of the NBDPS include assessing:

How a woman's intake of nutrients, including folic acid, could affect the risk for specific birth defects.
Why Hispanics have higher rates of NTDs.
Women's behaviors related to preventing birth defects, including folic acid use and alcohol use.

Did You Know?

In the United States, there are 3,000 pregnancies affected by spina bifida or anencephaly each year.
Hispanic/Latina women have a higher rate of NTD-affected pregnancies than non-Hispanic white and non-Hispanic black women.
The total lifetime cost of care for a child born with spina bifida is estimated to be $560,000.

National Health and Nutrition Examination Survey (NHANES)

NHANES is an annual survey designed to assess the health and nutritional status of adults and children in the United States. The survey is unique in that it combines interviews and physical examinations. CDC uses information from NHANES to look at how much folic acid people are getting from the foods they eat and dietary supplements or vitamins they take. The survey also provides information on the actual levels of folate circulating in the blood. We look at both folic acid intake and blood folate levels among many individuals including pregnant women, non-pregnant women of childbearing age, adults, children, and people with certain conditions, such as diabetes or obesity.

Behavioral Risk Factor Surveillance Survey (BRFSS)

The BRFSS is the world’s largest, on-going telephone health survey system, tracking health conditions and risk behaviors in the United States annually since 1984. CDC uses information from BRFSS to assess levels of folic acid supplement use among women who may become pregnant, and other health behaviors related to having a healthy pregnancy.

Pregnancy Risk Assessment Monitoring System (PRAMS)

PRAMS is a surveillance project of CDC and state health departments. PRAMS collects state-specific data on maternal attitudes and experiences before, during, and shortly after pregnancy.

Global Initiative to Eliminate Folic Acid-Preventable Neural Tube Defects

Neural tube defects are serious birth defects of the spine and brain, and are a significant cause of infant mortality and childhood morbidity worldwide.

The two most common neural tube defects are spina bifida and anencephaly.
In the U.S., 3,000 pregnancies are affected by neural tube defects every year (1), and Hispanic women have a higher rate of neural tube defect-affected pregnancies than non-Hispanic women.(2)
Globally there are more than 300,000 babies born with neural tube defects each year. (3)
The total lifetime cost of care for a child born with spina bifida is estimated to be $560,000. (4)

CDC has made a significant contribution in neural tube defects prevention over the past two decades and led the way in establishing that every woman who can get pregnant should consume 400 mcg of folic acid daily to prevent neural tube defects.

What has been done?

In 1996, the Food and Drug Administration (FDA) established regulations requiring that by 1998 all standardized enriched cereal grain products sold in the U. S. include 140 micrograms folic acid/100 grams and allowed for the addition of folic acid to breakfast cereals, corn grits, infant formulas, medical foods, and foods for special dietary use.
Before fortification, about 4,130 babies had neural tube defects each year in the U. S., and nearly 1,200 died. After folic acid fortification, the yearly number of pregnancies affected by neural tube defects dropped to about 3,000, and the related deaths declined to 840. (1)

Expanding Global Efforts

Expansion of global folic acid fortification efforts can have a significant impact on infant mortality and childhood morbidity worldwide. CDC’s National Center on Birth Defects and Developmental Disabilities (NCBDDD) has developed the Global Initiative to Eliminate Folic Acid-Preventable Neural Tube Defects (GIENTD) to significantly reduce infant mortality and childhood morbidity resulting from the more than 300,000 neural tube defect-affected births worldwide each year, contribute to the achievement of United Nations Millennium Development Goal 4

, and help to meet the Global Health Initiative Child Health Goal

.
The initiative builds on CDC’s expertise and experience in neural tube defect prevention and aims to expand the number of low and middle income countries with mandatory folic acid fortification of staple foods consumed by a large proportion of the population (such as wheat flour and maize flour) and provide support for long-term sustainable interventions to eliminate folic acid-preventable neural tube defects worldwide. Key components of the initiative are to provide needed technical expertise for surveillance of neural tube defects, monitor fortification efforts and improve laboratory capacity. The GIENTD strategic objectives are centered on policy, program and science, and underscore the importance of effective partnerships to reach countries with the most need and where the health impact would be greatest.

The GIENTD strategic objectives are to:

Work with the World Health Organization (WHO) and others to establish a global policy to support and advance country-level fortification efforts
Strengthen and expand global folic acid fortification and other intervention efforts, and fill scientific and technical gaps by engaging in strategic partnerships
Strengthen the public health capacity for blood folate and neural tube defect surveillance, epidemiology and laboratory capacity globally, including determining biomarkers for optimal blood folate concentrations for neural tube defect prevention

Public Health Impact

With an annual prevalence of more than 300,000 neural tube defects, expanding the reach of global folic acid fortification in low and middle income countries can lead to the prevention of 150,000-210,000 neural tube defects worldwide each year. (5)
Many countries currently do not have the surveillance systems that can accurately monitor prevalence of neural tube defects and other observable birth defects. Through this initiative, CDC can provide needed technical expertise for surveillance of neural tube defects, monitoring of fortification efforts and improvement of laboratory capacity.

References

CDC. Spina Bifida and Anencephaly Before and After Folic Acid Mandate --- United States, 1995--1996 and 1999—2000. MMWR 2004; 53(17): 362-365.
Williams LJ, Rasmussen SA, Flores A, Kirby ES, Edmonds LD. Decline in the prevalence of spina bifida and anencephaly by race/ethnicity: 1995-2002. Pediatrics. 2005 Sep:116(3):580-6.
Shibuya K, Murray CJ. Congenital anomalies. In: Health dimensions of sex and reproduction: the global burden of sexually transmitted diseases, HIV, maternal conditions, perinatal disorders, and congenital anomalies. Murray CJ, Lopez AD, eds. Boston, Massachusetts: the Harvard School of Public Health on behalf of the World Health Organization and the World Bank; 1998:455-512.
Grosse SD, Oyang L, Collins JS, Green D, Dean JH, Stevenson RE. Economic Evaluation of a Neural Tube Defect Recurrence–Prevention Program. Am J Prev Med. 2008 Dec:35(6):572-7.
CDC. CDC Grand Rounds: Additional Opportunities to Prevent Neural Tube Defects with Folic Acid Fortification. MMWR 2010; 59(31);980-984.

Free Materials

Brochures, Booklets, Posters, and Fact Sheets

CDC has FREE folic acid brochures, booklets, posters, and fact sheets in English and Spanish. The materials were designed, tested, refined, and produced for their specific audiences and are available for personal use or use in community activities.
To view, print, or order materials go to the order form. Questions? Please contact flo@cdc.gov.
Go to online order form »

Go to order form (in Spanish) »