ArticleThe Journal of pediatrics2022
Changes in Spina Bifida Lesion Level after Folic Acid Fortification in the US.
Article in The Journal of pediatrics, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT05935631 (Feasibility, Acceptability and Directional Signal Effect on Blood Folate Levels of Iodized Salt Fortified With Folic Acid), which is not on this map. Cited by 15 papers, 1 of them a synthesis that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
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.
Feasibility, Acceptability and Directional Signal Effect on Blood Folate Levels of Iodized Salt Fortified With Folic Acid: Clinical Study
Who cites it
15 citing papers in PubMed, 1 synthesis or guideline pooled it, 23 citations in OpenAlex.
- A Systematic Review of Methods and Practice for Integrating Maternal, Fetal, and Child Health Outcomes, and Family Spillover Effects into Cost-Utility Analyses.PharmacoEconomics · 2024Pooled it
- Profile of individuals with full-scale intelligence quotient (FSIQ) scores in the National Spina Bifida Patient Registry (NSBPR).Journal of pediatric rehabilitation medicine · 2026Article
- Mortality Through 2021 Among Persons Born With Spina Bifida in Metropolitan Atlanta, 1981-2018.Birth defects research · 2026Article
- First 1000 Days Strategies to Prevent Childhood Obesity: A Narrative Review and Recommendations From the EndObesity Consortium.Pediatric obesity · 2026Review
- Maternal Folic Acid Supplement Use, Folate Intake, and Preterm Birth Among Infants With Spina Bifida.Birth defects research · 2025Article
- Folate Interaction With Genetic Risk for Neural Tube Defects Among Infants in Bangladesh.Birth defects research · 2025Article
- Epidemiology and morbidity of spina bifida in Hispanic Americans: a systematic review.BMJ public health · 2024Article
- Association of maternal ABO blood type with lesion level and birthweight of children with spina bifida: a descriptive study.Journal of medicine and life · 2024Article
- Folic acid supplementation use during the peri-conceptional period among professionals of a hospital in France.Preventive medicine reports · 2024Article
- Scientific impact of the National Birth Defects Prevention Network multistate collaborative publications.Birth defects research · 2024Review
- National population-based estimates for major birth defects, 2016-2020.Birth defects research · 2024Article
- Survival of neonates, infants, and children with birth defects: a population-based study in Texas, 1999-2018.Lancet regional health. Americas · 2023Article
- Training model for the fetal myelomeningocele correction with multiportal endoscopic technique.Child's nervous system : ChNS : official journal of the International Society for Pediatric Neurosurgery · 2023Article
- Pre and postnatal care characteristics and management features of children born with myelomeningocele in the post-folate fortification era of staple foods in Costa Rica (2004-2022).Child's nervous system : ChNS : official journal of the International Society for Pediatric Neurosurgery · 2023Article
- A Paternal Methylation Error in the Congenital Hydrocephalic Texas (H-Tx) Rat Is Partially Rescued with Natural Folate Supplements.International journal of molecular sciences · 2023Article
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
19 authors at 14 institutions in 2 countries.
Funding
Abstract
objectiveTo assess whether the severity of cases of spina bifida changed after the institution of mandatory folic acid fortification in the US. STUDY
designSix active population-based birth defects programs provided data on cases of spina bifida for 1992-1996 (prefortification period) and 1999-2016 (postfortification period). The programs contributed varying years of data. Case information included both a medical record verbatim text description of the spina bifida diagnosis and spina bifida codes (International Classification of Diseases, Clinical Modification, or a modified birth defects surveillance coding system). Comparing the prefortification and postfortification periods, aORs for case severity (upper-level lesions [cervical, thoracic] vs lower-level lesions [lumbar, sacral]) and prevalence ratios (PRs) were estimated.
resultsA total of 2593 cases of spina bifida (out of 7 816 062 live births) met the inclusion criteria, including 573 cases from the prefortification period and 2020 cases from the postfortification period. Case severity decreased by 70% (aOR, 0.30; 95% CI, 0.26-0.35) between the fortification periods. The decrease was most pronounced for non-Hispanic White mothers. Overall spina bifida prevalence declined by 23% (PR, 0.77; 95% CI, 0.71-0.85), with similar reductions seen across the early, mid, and recent postfortification periods. A statistically significant decrease in upper-level lesions occurred in the postfortification period compared with the prefortification period (PR, 0.28; 95% CI, 0.22-0.34), whereas the prevalence of lower-level lesions remained relatively similar (PR, 0.94; 95% CI, 0.84-1.05).
conclusionsThe severity of spina bifida cases decreased after mandatory folic acid fortification in the US. Further examination is warranted to better understand the potential effect of folic acid on spina bifida severity.
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Registered trials
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