Skip to main content
    • Aa
    • Aa

Neural tube defects in Latin America and the impact of fortification: a literature review

  • Jorge Rosenthal (a1), Jessica Casas (a2), Douglas Taren (a2), Clinton J Alverson (a1), Alina Flores (a1) and Jaime Frias (a3)...
Abstract Objective

Data on the prevalence of birth defects and neural tube defects (NTD) in Latin America are limited. The present review summarizes NTD prevalence and time trends in Latin American countries and compares pre- and post-fortification periods to assess the impact of folic acid fortification in these countries.


We carried out a literature review of studies and institutional reports published between 1990 and 2010 that contained information on NTD prevalence in Latin America.


NTD prevalence in Latin American countries varied from 0·2 to 9·6 per 1000 live births and was influenced by methods of ascertainment. Time trends from Bogota, Costa Rica, Dominican Republic, Guatemala City, Mexico and Puerto Rico showed average annual declines of 2·5 % to 21·8 %. Pre- and post-fortification comparisons were available for Argentina, Brazil, Chile, Costa Rica, Puerto Rico and Mexico. The aggregate percentage decline in NTD prevalence ranged from 33 % to 59 %.


The present publication is the first to review data on time trends and the impact of folic acid fortification on NTD prevalence in Latin America. Reported NTD prevalence varied markedly by geographic region and in some areas of Latin America was among the lowest in the world, while in other areas it was among the highest. For countries with available information, time trends showed significant declines in NTD prevalence and these declines were greater in countries where folic acid fortification of staples reached the majority of the population at risk, such as Chile and Costa Rica.

  • View HTML
    • Send article to Kindle

      To send this article to your Kindle, first ensure is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about sending to your Kindle.

      Note you can select to send to either the or variations. ‘’ emails are free but can only be sent to your device when it is connected to wi-fi. ‘’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

      Find out more about the Kindle Personal Document Service.

      Neural tube defects in Latin America and the impact of fortification: a literature review
      Available formats
      Send article to Dropbox

      To send this article to your Dropbox account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your Dropbox account. Find out more about sending content to Dropbox.

      Neural tube defects in Latin America and the impact of fortification: a literature review
      Available formats
      Send article to Google Drive

      To send this article to your Google Drive account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your Google Drive account. Find out more about sending content to Google Drive.

      Neural tube defects in Latin America and the impact of fortification: a literature review
      Available formats
Corresponding author
*Corresponding author: Email
Linked references
Hide All

This list contains references from the content that can be linked to their source. For a full set of references and notes please see the PDF or HTML where available.

1. RE Black , S Cousens , HL Johnson et al. (2010) Global, regional, and national causes of child mortality in 2008: a systematic analysis. Lancet 375, 19691987.

3. H Blencowe , S Cousens , B Modell et al. (2010) Folic acid to reduce neonatal mortality from neural tube defects. Int J Epidemiol 39, i110i121.

5.US Preventive Services Task Force (2009) Clinical Guidelines: Folic acid supplementation for the prevention of neural tube defects: an update of the evidence for the US preventive Services Task Force. Ann Intern Med 150, 632639.

6.Medical Research Council (1991) Prevention of neural tube defects: results of the Medical Research Council Vitamin Study. MRC Vitamin Study Research Group. Lancet 338, 131137.

7. RJ Berry , Z Li , JD Erickson et al. (1999) Prevention of neural-tube defects with folic acid in China. China–US Collaborative Project for Neural Tube Defect Prevention. N Engl J Med 341, 14851490.

16. MJ Aguiar , AS Campos , RA Aguiar et al. (2003) Neural tube defects and associated factors in liveborn and stillborn infants. J Pediatr (Rio de J) 79, 129134.

17. L Daly (1992) Simple SAS macros for the calculation of exact binomial and Poisson confidence limits. Comput Biol Med 22, 351361.

18. R Price (2000) Estimating the ratio of two Poisson rates. Comput Stat Data Anal 34, 345356.

29. J Lopez-Camelo , E Castilla & IM Orioli ; INAGEMP and ECLAMC (2010) Folic acid flour fortification: impact on the frequencies of 52 congenital anomaly types in three South American countries. Am J Med Genet Part A 152A, 24442458.

30. A Guardiola , V Koltermann , PM Aguilar et al. (2009) Neurological congenital malformations in a tertiary hospital in South Brazil. Arq Neuropsiquiatr 67, 807811.

31. LF Nascimiento (2008) Prevalencia de defeitos de fechamento de tubo neural no Vale do Paraiba, Sao Paulo. Rev Paul Pediatr 26, 372377.

34. J David (2004) Fortificacion de harina de trigo en América Latina y región del Caribe. Rev Chil Nutr 31, 336347.

39. RS Olney & J Mulinare (2002) Trends in neural tube defects, folic acid fortification, and vitamin supplement use. Semin Perinatol 26, 277285.

41. LJ Williams , SA Rasmussen , A Flores et al. (2005) Decline in the prevalence of spina bifida and anencephaly by race/ethnicity: 1995–2002. Pediatrics 116, 580586.

45. BS Mosley , CJ Simmons , MA Cleves et al. (2002) Regional bias in birth defect prevalence rates for Arkansas: influence of incomplete ascertainment along surveillance system borders. Teratology 66, Suppl. 1, S36S40.

46. AC Hexter & JA Harris (1991) Bias in congenital malformations information from the birth certificate. Teratology 44, 177180.

50. P De Wals , F Tairou , M Van Allen et al. (2007) Reduction in neural tube defects after folic acid fortification in Canada. N Engl J Med 357, 135142.

53. E Hertrampf & F Cortés (2004) Folic acid fortification of wheat flour: Chile. Nutr Rev 62, 6 Pt 2, S44S48.

54. MA Honein , LJ Paulozzi , TJ Mathews et al. (2001) Impact of folic acid fortification of the US food supply on the occurrence of neural tube defects. JAMA 285, 29812986.

55. JG Ray , C Meier , MJ Vermeulen et al. (2002) Association of neural tube defects and folic acid fortification. Lancet 360, 20472048.

56. BH Chen , SI Carmichael , S Selvin et al. (2008) NTD prevalence in central California before and after folic acid fortification. Birth Defects Res A Clin Mol Teratol 82, 547552.

57. A Llanos , E Hertrampf , F Cortes et al. (2007) Cost-effectiveness of a folic acid fortification program in Chile. Health Policy 83, 295303.

62. CMDS Costa (2006) Profile of the congenital malformations in a sample of births in city of Rio de Janeiro, 1999–2001. Cad Saude Publica (Rio de J) 22, 24232431.

63. FA Ramos-Guerra , JC Llerena , SG Nogueira de Nava et al. (2008) Defeitos congênitos no Municipio do Rio de Janeiro, Brasil: uma avaliação através do SINASC (2000–2004). Cad Saude Publica (Rio de J) 24, 140149.

65. R Monteleone-Neto & EE Castilla (1994) Apparently normal frequency of congenital anomalies in the highly polluted town of Cubatao, Brazil. Am J Med Genet 52, 319323.

71. E Hertrampf & F Cortes (2008) National food-fortification program with folic acid in Chile. Food Nutr Bull 29, 1 Suppl., S231S237.

73. H Garcia , A Salguero , J Moreno et al. (2003) Frecuencia de anomalías congénitas en el Instituto Materno Infantil de Bogotá. Biomédica (Bogotá) 23, 161172.

74. I Zarante , L Franco , C Lopez et al. (2010) Frecuencia de malformaciones congénitas: evaluacion y pronostico de 52,744 nacimientos en tres ciudades colombianas. Biomédica (Bogotá) 30, 6571.

76. H Ostos , G Astaiza , F Garcia et al. (2000) Disminución de la incidencia de defectos de cierre del tubo neural en un hospital Universitario de Neiva: posible efecto de la promoción del consumo de acido fólico. Biomédica (Bogotá) 20, 1824.

Recommend this journal

Email your librarian or administrator to recommend adding this journal to your organisation's collection.

Public Health Nutrition
  • ISSN: 1368-9800
  • EISSN: 1475-2727
  • URL: /core/journals/public-health-nutrition
Please enter your name
Please enter a valid email address
Who would you like to send this to? *



Altmetric attention score

Full text views

Total number of HTML views: 17
Total number of PDF views: 126 *
Loading metrics...

Abstract views

Total abstract views: 295 *
Loading metrics...

* Views captured on Cambridge Core between September 2016 - 24th July 2017. This data will be updated every 24 hours.