Ann. N.Y. Acad. Sci. ISSN 0077-8923
ANNALS OF THE NEW YORK ACADEMY OF SCIENCES
Special Issue: Folate Status in Women and Neural Tube Defect Risk Reduction
Improving maternal folate status to prevent infant neural
tube defects: working group conclusions and a framework
Aliki P. Weakland,
Lynn B. Bailey,
Lorenzo D. Botto,
Luz Maria De-Regil,
and Kenneth H. Brown
Micronutrient Forum, Ottawa, Ontario, Canada.
Core Engagement LLC, Fort Collins, Colorado.
Department of Foods and
Nutrition, University of Georgia, Athens, Georgia.
Department of Pediatrics, University of Utah, Salt Lake City, Utah.
International, Ottawa, Ontario, Canada.
Bill & Melinda Gates Foundation, Fairﬁeld, California
Address for correspondence: Homero Martinez, Nutrition International, 180 Elgin Street – Suite 1000, Ottawa, ON K2P 2K3,
As infectious disease control programs achieve increasing success, further reductions in child mortality in low- and
middle-income countries (LMICs) will require focused prevention strategies for birth defects and other noninfectious
diseases. Neural tube defects (NTDs) can cause early death or lifelong disability. Preventing NTDs provides a feasible,
signiﬁcant opportunity to decrease the toll of birth defects and contribute to further reducing child mortality globally.
The Micronutrient Forum convened a technical consultation on Folate Status in Women and Neural Tube Defects
Prevention to develop a roadmap to inform and prioritize investments in NTD prevention in LMICs; help guide
implementation efforts in terms of the feasibility of interventions and the potential for acceleration; and identify
research and knowledge gaps. Here, we describe the impetus for and approach to the consultation and present the
conclusions and a framework for developing a roadmap for action to accelerate NTD prevention in LMICs. The
framework (1) provides options for action on folate status assessment; (2) outlines a way forward to develop and
implement a time-bound global action plan for NTD prevention; and (3) identiﬁes common impediments to NTD
prevention, broad strategies to overcome or minimize these impediments, and basic building blocks necessary to
Keywords: neural tube defects; folic acid; birth defects
Many countries have made great progress in reduc-
ing under-ﬁve mortality from infectious diseases
like malaria and HIV and from vaccine-preventable
diseases like measles and polio. As a result, the
prevention of other causes of child mortality has
taken on even greater signiﬁcance to achieve further
improvements in child survival. In many countries,
birth defects are on the rise as a leading cause of
and must be considered in
strategies for reaching the health outcomes targeted
in the Sustainable Development Goals—Year 2030.
Neural tube defects (NTDs) include a group of
common and serious congenital anomalies char-
acterized by incomplete closure of the embryonic
neural tube, leading to brain and spine anomalies
that can lead to death or lifelong disability.
forms of NTD (anencephaly, craniorachischisis, and
iniencephaly) are lethal in the newborn period or
prenatally. Others (spina biﬁda and encephalocele)
allow for survival but require aggressive multidis-
ciplinary medical and surgical care and impose a
heavy toll on the quality of life of the individuals
affected and their families. Anencephaly and spina
biﬁda are among the most common NTDs, (each
accounting for about 40–45% of all NTDs), with
encephalocele constituting the remaining 5–10%.
NTDs develop during the ﬁrst 28 days of
pregnancy, often before women are aware they are
pregnant. Importantly, folate status in women of
reproductive age (WRA) is a key determinant of
Ann. N.Y. Acad. Sci. 1414 (2018) 5–19
2018 The Authors. Annals of the New York Academy of Sciences
published by Wiley Periodicals, Inc. on behalf of New York Academy of Sciences.
This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in
any medium, provided the original work is properly cited.