SARAH ZIMMERMAN 
Flour Fortification Initiative, 1599 Clifton Road, NE, Mailstop: 1599-001-1BX (SPH: Global Health),
Atlanta, GA 30322, USA

Abstract

The March of Dimes estimates that worldwide more than 300,000 infants are born every year with a neural tube defect. These permanently disabling or fatal birth defects are largely preventable if the mother has at least 400 micrograms of folic acid daily before conception and in the early days of pregnancy. Flour in some countries has been fortified for more than 15 years as a means of preventing neural tube defects; now 63 countries require adding this B vitamin to their wheat flour. Countries which measure the results report 30 to 70 percent declines in neural tube defects after fortification begins.

SERIOUS BIRTH DEFECTS PREVENTED

In 1991, folic acid, a form of vitamin B9, was confirmed to prevent serious birth defects known as NTDs (neural tube defects) (1). Five years later, a few countries began adding folic acid to wheat flour along with the traditional mix of iron and other B vitamins used in flour fortification since the 1940s. The addition of folic acid has proven to be a cost-effective means of significantly lowering the prevalence of these permanently disabling or fatal birth defects.
The most common NTD is spina bifida in which the baby’s spine does not form correctly (i.e. Figure 1. Spina Bifida Illustration). In mild cases, permanent loss of some sensation or movement occurs. Severe cases include paralysis and varying degrees of loss of bowel and bladder control. Children born with spina bifida will undergo a lifetime of surgeries and face many health issues. Spina bifida can be treated, but it cannot be cured.
Another NTD is anencephaly in which the brain does not form properly. Pregnancies affected by anencephaly are often miscarried. Babies born with anencephaly die shortly after birth. A third type of NTD is encepha ...