Evidence map›Paper›PMID 40552686›Full record

SynthesisBirth defects research2025

Comparing Folic Acid Interventions and Arsenic Reduction Strategies for Neural Tube Defect Prevention in Bangladesh: A Systematic Review and Decision Analysis.

Chih-Fu Wei, Ernani F Choma, Xingyan Wang, Carrie G Wade, Ya Luan Hsiao, Diane Bao, Sudipta K Mukherjee, David C Christiani, Marc G Weisskopf, Liming Liang and 1 more

Abstract readMeta-AnalysisSystematic Review
In one paragraph

Synthesis in Birth defects research, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 4 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
4citing papers in PubMed, 1 pooled it
–field-weighted citation impact
1 · What the graph read from 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.

2 · The registry

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.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

4 citing papers in PubMed, 1 synthesis or guideline pooled it.

  1. Pooled it
  2. Article
  3. Review
  4. Maternal Nutrition, Toxicants, and Epigenetic Programming of Obesity Across Generations.Diabetes, metabolic syndrome and obesity : targets and therapy · 2025
    Review
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

11 authors.

Chih-Fu WeiDepartment of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA.
Ernani F ChomaDepartment of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA.
Xingyan WangDepartment of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA.
Carrie G WadeCountway Library of Medicine, Harvard Medical School, Boston, Massachusetts, USA.
Ya Luan HsiaoDepartment of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA.
Diane BaoDepartment of Neurology, Boston Children's Hospital, Boston, Massachusetts, USA.
Sudipta K MukherjeeDepartment of Paediatric Neurosurgery, National Institute of Neurosciences & Hospital, Dhaka, Bangladesh.
David C ChristianiDepartment of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA.
Marc G WeisskopfDepartment of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA.
Liming LiangDepartment of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA.
Maitreyi MazumdarDepartment of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA.ORCID 0000-0003-0380-2407

Funding

Translational Research Support CoreP30ES000002 · NIEHS · HARVARD UNIVERSITY (SCH OF PUBLIC HLTH) · PI JAIME ELIZABETH HART · 1985 to 2026
$44.6M
Genetic Analysis and Manipulation Core (GAEC)P50HD105351 · NICHD · BOSTON CHILDREN'S HOSPITAL · PI Hisashi Umemori · 2021 to 2026
$9.4M
Interdisciplinary approaches for understanding how arsenic and micronutrients affect the epigenome to influence spina bifida riskR01ES034713 · NIEHS · BOSTON CHILDREN'S HOSPITAL · PI MAZUMDAR, MAITREYI · 2023 to 2025
$2.3M
Does arsenic increase risk of neural tube defects in a highly-exposed population?R01ES026317 · NIEHS · BOSTON CHILDREN'S HOSPITAL · PI MAZUMDAR, MAITREYI · 2016 to 2020
$2.2M
National Institutes of Environmental Health Sciences P30ES000002NICHD NIH HHS P50 HD105351NIEHS NIH HHS P30 ES000002NIEHS NIH HHS R01 ES026317NIEHS NIH HHS R01 ES034713
6 · The paper itself

Abstract

backgroundMaternal intake of folic acid prevents most cases of neural tube defects (NTDs), and arsenic exposure may increase NTD risk. In Bangladesh, where arsenic exposures are high, understanding the potential impacts of arsenic reduction and folic acid-based interventions can guide decision-making.

methodsWe conducted a systematic review and meta-analysis to estimate the prevalence of NTDs in Bangladesh. We searched PubMed, Embase, Web of Science, Global Health, and Bangladesh Journals Online and extracted data using standardized forms. We used forest plots and random effects models to estimate the prevalence of all NTDs and spina bifida. Decision analysis used assumptions from the literature to compare expected NTD prevalence under strategies incorporating combinations of folic acid supplementation, fortification, and arsenic filters. Sensitivity analyses aimed to quantify the influence of adherence to supplements on estimates.

resultsEleven studies were included. Prevalences of NTD and spina bifida were 27.4 and 11.2 per 10,000 births, respectively; however, when estimated from population red blood cell folate concentrations, NTD prevalence was higher in both high arsenic exposure (drinking water ≥ 50 μg/L) and lower arsenic exposure groups (34.3 and 25.3 per 10,000 births, respectively). Folic acid fortification reduced the prevalence of NTDs to 11.1 and 9.1 per 10,000 births among high exposure and low exposure groups, respectively. Arsenic filters provided little marginal benefit. Benefits of supplements equaled those of fortification when adherence to supplements exceeded 90%.

conclusionsBangladesh has high rates of NTDs and high arsenic exposures. Folic acid fortification is projected to be the most effective strategy for NTD prevention.

Indexed as

ArsenicFolic AcidNeural Tube DefectsBangladeshDecision Support TechniquesDietary SupplementsFemaleHumansMaternal ExposurePregnancyPrevalenceSpinal DysraphismArsenicFolic Acidarsenicdecision analysisfolic acidneural tube defectsspina bifida

Identifiers

PMID40552686
PMCPMC12186471

What OpenQuestion holds

Textmetadata
LicenceCC BY-NC-ND
Read underepoch 390

Registered trials

None linked

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.