[Effects of wheat flour fortification with folic acid on the prevalence of neural tube defects in Chile]. / Resultados del Programa de Prevención de Defectos de Tubo Neural en Chile mediante la fortificación de la harina con ácido fólico: Período 2001-2010.

BACKGROUND: Congenital malformations (CMF) have an important role in infant mortality. Neural tube defects (NTD) have great relevance from both social and public health points of view. The ECLAMC (Collaborative Latin American Study of Congenital Malformations) maintains in Chile an epidemiological surveillance of CMF prevalence rate at birth since 1969. AIM: To assess the effect of wheat flour folic acid fortification on the prevalence of NTD. PATIENTS AND METHODS: Only Anencephaly, Spina bifida and Cephalocele were considered as NTD. All children born in the maternities incorporated to ECLAMC between 1969 and 1999 were considered as belonging to the pre folic acid fortification period and those who were born from 2001 to 2010 were considered as belonging to the post fortification period. RESULTS: The NTD prevalence rate at birth in the pre fortification period was 17.03/10,000. In the second period, there were 291,996 births and among them, 280 newborns were affected by a form of NTD (9.59 in 10,000 births). This represents a 44% decrease (p < 0.01). Anencephaly rate fell from 7.16/10,000 to 3.67/10,000, representing a 49% lower rate (p < 0.01). Spina bifida rate decreased from 8.61/10,000 to 4.49/10,000, representing a 48% lower rate (p < 0.01). Cephalocele had a 20% non-significant reduction. CONCLUSIONS: Wheat flour fortification with folic acid reduced by 44% the prevalence rate of NTD at birth. This means that NTDs were prevented in 185 Chilean newborns each year.

Resultados del Programa de Prevención de Defectos de Tubo Neural en Chile mediante la fortificación de la harina con ácido fólico: Período 2001-2010 / Effects of wheat flour fortification with folic acid on the prevalence of neural tube defects in Chile

Background: Congenital malformations (CMF) have an important role in infant mortality. Neural tube defects (NTD) have great relevance from both social and public health points of view. The ECLAMC (Collaborative Latin American Study of Congenital Malformations) maintains in Chile an epidemiological surveillance of CMF prevalence rate at birth since 1969. Aim: To assess the effect of wheat flour folic acid fortification on the prevalence of NTD. Patients and Methods: Only An encephaly, Spina bifida and Cephalocele were considered as NTD. All children born in the maternities incorporated to ECLAMC between 1969 and 1999 were considered as belonging to the pre folic acid fortification period and those who were born from 2001 to 2010 were considered as belonging to the post fortification period. Results: The NTD prevalence rate at birth in the pre fortification period was 17.03/10,000. In the second period, there were 291,996 births and among them, 280 newborns were affected by a form of NTD (9.59 in 10,000 births). This represents a 44% decrease (p < 0.01). Anencephaly rate fell from 7.16/10,000 to 3.67/10,000, representing a 49% lower rate (p < 0.01). Spina bifida rate decreased from 8.61/10,000 to 4.49/10,000, representing a 48% lower rate (p < 0.01). Cephalocele had a 20% non-significant reduction. Conclusions: Wheat flour fortification with folic acid reduced by 44% the prevalence rate of NTD at birth. This means that NTDs were prevented in 185 Chilean newborns each year.

[Effects of folic acid fortification in the rates of malformations at birth in Chile]. / Efecto de la fortificación de la harina con ácido fólico sobre la evolución de las tasas de prevalencia al nacimiento de malformaciones congénitas en los hospitales chilenos del ECLAMC.

BACKGROUND: The effects of folic acid fortification on neural tube defects is well known. Other reports show a beneficial effect of the fortification on orofacial clefts, urinary malformations and defects caused by limb reduction. AIM: To determine the changes in prevalence of congenital malformations after the start of flour folic acid fortification in Chile. MATERIAL AND METHODS: The rates of 22 malformations occurring in the maternity of the University of Chile Clinical Hospital and other Chilean hospitals participating in the Latin American Collaborative Study of Congenital Malformations (ECLAMC) were compared before and after the start of flour folic acid fortification. RESULTS: After the start of folic acid fortification a significant reduction in the rates of anencephalia, spina bifida and diaphragmatic hernia, was observed. The rates of all other malformations remained stable or increased. The rates of all malformations at the University of Chile Clinical Hospital had a steady increase until 2005 and were significantly higher than in the rest of hospitals participating in ECLAMC. CONCLUSIONS: Folic acid fortification was associated with an expected reduction in rates of spina bifida and anencephalia and an unexpected reduction in the rates of diaphragmatic hernia.

Efecto de la fortificación de la harina con ácido fólico sobre la evolución de las tasas de prevalencia al nacimiento de malformaciones congénitas en los hospitales chilenos del ECLAMC / Effects of folic acid fortification in the rates of malformations at birth in Chile

Background: The effects of folic acid fortification on neural tube defects is well known. Other reports show a beneficial effect of the fortification on orofacial clefts, urinary malformations and defects caused by limb reduction. Aim: To determine the changes in prevalence of congenital malformations after the start of flour folic acid fortification in Chile. Material and methods: The rates of 22 malformations occurring in the maternity of the University of Chile Clinical Hospital and other Chilean hospitals participating in the Latin American Collaborative Study of Congenital Malformations (ECLAMC) were compared before and after the start of flour folic acid fortification. Results: After the start of folic acid fortification a significant reduction in the rates of anencephalia, spina bifida and diaphragmatic hernia, was observed. The rates of all other malformations remained stable or increased. The rates of all malformations at the University of Chile Clinical Hospital had a steady increase until 2005 and were significantly higher than in the rest of hospitals participating in ECLAMC. Conclusions: Folic acid fortification was associated with an expected reduction in rates of spina bifida and anencephalia and an unexpected reduction in the rates of diaphragmatic hernia.

[The frequency of twin pregnancies increased in a Chilean hospital associated with periconceptional flour folic acid supplementation]. / La frecuencia de nacimientos de gemelos aumentó en un hospital chileno coincidiendo con el consumo periconcepcional de harina fortificada con ácido fólico.

BACKGROUND: A significant increase in the frequency of twins has been described in the literature as a secondary effect of perinatal supplementation with folic acid. AIM: To verify if the frequency of twins increased in a Chilean hospital, after the start of flour folic acid supplementation. MATERIAL AND METHODS: The frequency of twins was compared in the University of Chile Clinical Hospital, before and after the start of flour fortification with folic acid. RESULTS: There was a 34% increase in the frequency of twins during the post fortification period (2001-2004) as compared with the previous period (1998-2000). A decrease in the frequency of male twins, when compared with single newborns, was also observed in the post fortification period. There was a higher frequency of stillborns among twins, when compared with single newborns. CONCLUSIONS: The frequency of twin pregnancies increased after flour folic acid supplementation in sample of Chilean population.

La frecuencia de nacimientos de gemelos aumentó en un hospital chileno coincidiendo con el consumo periconcepcional de harina fortificada con ácido fólico / The frequency of twin pregnancies increased in a Chilean hospital associated with periconceptional flour folic acid supplementation

Background: A significant increase in the frequency of twins has been described in the literature as a secondary effect of perinatal supplementation with folic acid. Aim: To verify if the frequency of twins increased in a Chilean hospital, after the start of flour folic acid supplementation. Material and methods: The frequency of twins was compared in the University of Chile Clinical Hospital, before and after the start of flour fortification with folic acid. Results: There was a 34% increase in the frequency of twins during the post fortification period (2001-2004) as compared with the previous period (1998-2000). A decrease in the frequency of male twins, when compared with single newborns, was also observed in the post fortification period. There was a higher frequency of stillborns among twins, when compared with single newborns. Conclusions: The frequency of twin pregnancies increased after flour folic acid supplementation in sample of Chilean population.