ArticleThe American journal of clinical nutrition2018
Modeling the impact of folic acid fortification and supplementation on red blood cell folate concentrations and predicted neural tube defect risk in the United States: have we reached optimal prevention?
Article in The American journal of clinical nutrition, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 45 papers, 4 of them syntheses that pooled it.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
45 citing papers in PubMed, 4 syntheses or guidelines pooled it, 72 citations in OpenAlex.
- Comparing Folic Acid Interventions and Arsenic Reduction Strategies for Neural Tube Defect Prevention in Bangladesh: A Systematic Review and Decision Analysis.Birth defects research · 2025Pooled it
- Consumption of folic acid fortified foods among Hispanic women of reproductive age in the US: a systematic review.BMC public health · 2025Pooled it
- Effects of maternal folate and vitamin B12 on gestational diabetes mellitus: a dose-response meta-analysis of observational studies.European journal of clinical nutrition · 2022Pooled it
- Pooled it
- Folate deficiency disrupts key metabolic transitions within the developing neural ectoderm.bioRxiv : the preprint server for biology · 2026Article
- Reassessing Mandatory Folic Acid Fortification for Neural Tube Defect Prevention: Evidence, Uncertainty, and Policy Implications.Nutrients · 2026Review
- Prediabetes, diabetes, and folate status among United States women of reproductive age: NHANES 2011-March 2020.The American journal of clinical nutrition · 2026Article
- Targeting Folate Receptors for the Detection and Selective Treatment of Cancer: Advanced Precision Oncology in Practice.International journal of biological sciences · 2026Review
- Potential Contributions of Edible Oil and Wheat Flour Fortification on Reducing Inadequate Micronutrient Intake in Ethiopia.Annals of the New York Academy of Sciences · 2025Article
- Diet in Pregnancy: A Review of Current Challenges and Recommendations. A British Nutrition Foundation Briefing Paper.Nutrition bulletin · 2025Review
- Unmet needs in autoimmune liver diseases.Current opinion in immunology · 2025Review
- Folate and Vitamin B12 Status among Non-Pregnant, Non-Lactating Women of Reproductive Age and Predicted Risk for Neural Tube Defects, Morogoro Region, Tanzania.Maternal and child health journal · 2025Article
- Biological, dietetic and pharmacological properties of vitamin BNPJ science of food · 2025Review
- Artificial intelligence in food and nutrition evidence: The challenges and opportunities.PNAS nexus · 2024Article
- Improvement of serum folate status in the US women of reproductive age with fortified iodised salt with folic acid (FISFA study).Public health nutrition · 2024Article
- Combined Exposure to Folate and Lead during Pregnancy and Autistic-Like Behaviors among Canadian Children from the MIREC Pregnancy and Birth Cohort.Environmental health perspectives · 2024Article
- Bias analyses to investigate the impact of differential participation: Application to a birth defects case-control study.Paediatric and perinatal epidemiology · 2024Article
- Folate and Vitamin B12 Status in Women of Reproductive Age in Rural Haryana, India: Estimating Population-Based Prevalence for Neural Tube Defects.Birth defects research · 2024Article
- Multivitamin Use Among Hispanic Women of Reproductive Age in the United States, 2013-2022.Journal of women's health (2002) · 2024Article
- DTYMK is an essential gene in mice and heterozygosity does not cause neural tube defects.Archives of biochemistry and biophysics · 2024Article
Corrections and comments
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Authors and funding
5 authors at 1 institution in 1 country.
Funding
Abstract
Background: The US CDC and the Institute of Medicine recommend that women capable of becoming pregnant consume ≥400 µg synthetic folic acid/d to prevent neural tube defects (NTDs). The United States has 3 sources of folic acid: fortified enriched cereal grain products (ECGPs), fortified ready-to-eat (RTE) cereals, and dietary supplements. Objective: Our objectives were as follows: 1) to estimate the usual daily folic acid intake and distributions of red blood cell (RBC) folate concentrations among women consuming folic acid from different sources; 2) to assess the usual daily total folic acid intake associated with optimal RBC folate concentrations for NTD prevention; 3) to predict NTD prevalence; and 4) to estimate the number of preventable folate-sensitive NTDs. Design: NHANES data (2007-2012) for nonpregnant women of reproductive age (12-49 y) were used to estimate usual daily intakes of synthetic folic acid and natural food folate. We applied existing models of the relation between RBC folate concentrations and NTD risk to predict NTD prevalence. Results: Based on the distribution of overall RBC folate concentrations (4783 women), the predicted NTD prevalence was 7.3/10,000 live births [95% uncertainty interval (UI): 5.5-9.4/10,000 live births]. Women consuming folic acid from ECGPs as their only source had lower usual daily total folic acid intakes (median: 115 µg/d; IQR: 79-156 µg/d), lower RBC folate concentrations (median: 881 nmol/L; IQR: 704-1108 nmol/L), and higher predicted NTD prevalence (8.5/10,000 live births; 95% UI: 6.4-10.8/10,000 live births) compared with women consuming additional folic acid from diet or supplements. If women who currently consume folic acid from ECGPs only (48% of women) consumed additional folic acid sources, 345 (95% UI: 0-821) to 701 (95% UI: 242-1189) additional NTDs/y could be prevented. Conclusions: This analysis supports current recommendations and does not indicate any need for higher intakes of folic acid to achieve optimal NTD prevention. Ensuring 400 µg/d intake of folic acid prior to pregnancy has the potential to increase the number of babies born without an NTD.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.