Pregnancy

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Neural tube defects, folic acid

Africa

• BMC Pediatrics
  • Birth prevalence of neural tube defects and associated risk factors in Africa: a systematic review and meta-analysis [2021]

• BMC Pregnancy and Childbirth
  • Magnitude and determinants of neural tube defect in Africa: a systematic review and meta-analysis [2021]

• Scientific Reports
  • Prevalence of anencephaly in Africa: a systematic review and meta-analysis [2021]

• Scientifica
  • Prevalence of Spina Bifida among Newborns in Africa: A Systematic Review and Meta-Analysis [2020]

Argentina

• Journal of Community Genetics
  • The use of a Toolkit for health needs assessment on neural tube defects in Argentina [2013]

Australia

• Australian Institute of Health and Welfare
  • Monitoring the health impacts of mandatory folic acid and iodine fortification 2016 [2016]
  • Folic acid & iodine fortification [2016]

• WA Health
  • Myelomenigocele: Infant Care

Australia, Canada, United States

• Nutrients
  • Women Taking a Folic Acid Supplement in Countries with Mandatory Food Fortification Programs May Be Exceeding the Upper Tolerable Limit of Folic Acid: A Systematic Review [2022]

Brazil

• Cadernos de Saúde Pública
  • Recommendations for folate intake in women: implications for public health strategies [2010]

Cameroon

• Advances in Nutrition
  • Review of Existing Models to Predict Reductions in Neural Tube Defects Due to Folic Acid Fortification and Model Results Using Data from Cameroon [2021]

Canada

• American Journal of Clinical Nutrition
  • Periconceptional intake of folic acid among low-risk women in Canada: summary of a workshop aiming to align prenatal folic acid supplement composition with current expert guidelines [2018]

• Public Health Agency of Canada
  • Effect of Folic Acid Food Fortification in Canada on Congenital Heart Disease Subtypes [2016]
  • Folic Acid Use among Pregnant Women in Canada

• Society of Obstetricians and Gynaecologists of Canada
  • Folic Acid and Multivitamin Supplementation for Prevention of Folic Acid–Sensitive Congenital Anomalies [2022]
  • Prevention, Screening, Diagnosis, and Pregnancy Management for Fetal Neural Tube Defects [2021]

Canada, United States

• North American Fetal Therapy Network
  • Mode of Delivery and Subsequent Motor Function in Children With Myelomeningocele Without In Utero Repair [2025]

China

• BMC Medicine
  • Initiation and duration of folic acid supplementation in preventing congenital malformations [2023]

• BMC Pregnancy and Childbirth
  • Socioeconomic inequality in periconceptional folic acid supplementation in China: a census of 0.9 million women in their first trimester of pregnancy [2017]

• China CDC Weekly
  • Folic Acid Status and Associated Factors for Pregnant Chinese Women — China, 2015 [2021]

Costa Rica

• Child's Nervous System
  • Integrated surveillance strategy to support the prevention of neural tube defects through food fortification with folic acid: the experience of Costa Rica [2023]

• Maternal and Child Health Journal
  • Neural Tube Defects in Costa Rica, 1987–2012: Origins and Development of Birth Defect Surveillance and Folic Acid Fortification [2015]

Denmark, Norway

• Journal of the American Heart Association
  • Association Between Maternal Folic Acid Supplementation and Congenital Heart Defects in Offspring in Birth Cohorts From Denmark and Norway [2019]

Denmark, Sweden

• BioMed Research International
  • Ultrasound in Prenatal Diagnostics and Its Impact on the Epidemiology of Spina Bifida in a National Cohort from Denmark with a Comparison to Sweden [2018]

East Africa

• BMC Neurology
  • Birth prevalence of neural tube defects in eastern Africa: a systematic review and meta-analysis [2022]

Ethiopia

• BMJ Open
  • Birth prevalence and risk factors of neural tube defects in Ethiopia: a systematic review and meta-analysis [2023]

• Global Pediatric Health
  • Magnitude and Associated Factors of Neural Tube Defects in Ethiopia: A Systematic Review and Meta-Analysis [2020]

• PLoS ONE
  • Birth prevalence and determinants of neural tube defects among newborns in Ethiopia: A systematic review and meta-analysis [2025]
  • Folate deficiency among women of reproductive age in Ethiopia: A systematic review and meta-analysis [2023]

Europe

• EUROCAT
  • Prevention of Neural Tube Defects in Europe: A Public Health Failure [2021]
  • Folic Acid and Neural Tube Defects

• Reproductive Health
  • Folic acid supplementation in European women of reproductive age and during pregnancy with excessive weight: a systematic review [2025]

France

• Nutrients
  • Prevention of Neural Tube Defects by Folic Acid Supplementation: A National Population-Based Study [2020]
  • Social Inequalities in Prenatal Folic Acid Supplementation: Results from the ELFE Cohort [2019]

Germany

• Archives of Gynecology and Obstetrics
  • Recommendation and intake of dietary supplements periconceptional and during pregnancy: results of a nationwide survey of gynaecologists [2023]

• Deutsches Ärzteblatt International
  • The mandatory fortification of staple foods with folic acid: a current controversy in Germany [2011]

High-income countries

• PLoS ONE
  • Neonatal and infant mortality associated with spina bifida: A systematic review and meta-analysis [2021]

India

• Child's Nervous System
  • Burden of neural tube defects in India: a systematic review and meta-analysis [2024]

• Journal of Obstetrics and Gynaecology of India
  • Indian Perspective on Clinical Aspects, Usage, and Guidelines of Folic Acid [2014]

International

• American Journal of Epidemiology
  • Food Fortification With Folic Acid for Prevention of Spina Bifida and Anencephaly: The Need for a Paradigm Shift in Evidence Evaluation for Policy-Making [2021]

• Annals of the New York Academy of Sciences
  • Estimates of global and regional prevalence of neural tube defects for 2015: a systematic analysis [2018]

• Birth Defects Research
  • A 2019 global update on folic acid-preventable spina bifida and anencephaly [2021]

• Child's Nervous System
  • Barriers and facilitators to the implementation of mandatory folate fortification as an evidence-based policy to prevent neural tube defects [2023]

• EUROCAT
  • Analysis of Mortality among Neonates and Children with Spina Bifida: An International Registry-Based Study, 2001-2012 [2019]

• Journal of Clinical Pharmacology
  • Folic acid supplementation for pregnant women and those planning pregnancy: 2015 update [2015]

• Lancet Global Health
  • Preventing birth defects, saving lives, and promoting health equity: an urgent call to action for universal mandatory food fortification with folic acid [2022]

• Nutrients
  • Folate Supplementation in Women with Pre-Existing Diabetes [2023]
  • Folic Acid Fortification and Neural Tube Defect Risk: Analysis of the Food Fortification Initiative Dataset [2020]

• PLoS ONE
  • Cost-effectiveness of mandatory folic acid fortification of flours in prevention of neural tube defects: A systematic review [2021]

• Preventive Medicine Reports
  • Maternal folic acid and multivitamin supplementation: International clinical evidence with considerations for the prevention of folate-sensitive birth defects [2021]

• Reproductive Health
  • Global prevalence of congenital anencephaly: a comprehensive systematic review and meta-analysis [2022]

Ireland

• Department of Health
  • Folic Acid Supplementation [2019]

• Ireland's Health Services
  • The folate status of pregnant women in the Republic of Ireland; the current position [2017]

Israel

• BMJ Nutrition, Prevention & Health
  • Parity and the use of folic acid supplementation during pregnancy [2019]

Japan

• Congenital Anomalies
  • Preconceptional folic acid supplementation in Japan [2017]

Latin America

• PLoS ONE
  • Neural tube defects: Sex ratio changes after fortification with folic acid [2018]

• Public Health Nutrition
  • Neural tube defects in Latin America and the impact of fortification: a literature review [2014]

Low and middle income countries

• Child's Nervous System
  • Spina bifida management in low- and middle-income countries - a comprehensive policy approach [2023]

• Maternal & Child Nutrition
  • Maternal folic acid supplementation and infant birthweight in low- and middle-income countries: A systematic review [2020]

New Zealand

• Health New Zealand
  • Folate and Folic Acid

• Starship
  • Neural Tube Defects - management of infant

Norway

• BMC Pregnancy and Childbirth
  • Folic acid supplementation, dietary folate intake during pregnancy and risk for spontaneous preterm delivery: a prospective observational cohort study [2014]

Poland

• Ginekologia Polska
  • Folate supplementation during the preconception period, pregnancy and puerperium. Polish Society of Gynecologists and Obstetricians Guidelines [2017]

Saudi Arabia

• Nutrients
  • Knowledge and Practice of Childbearing Women in Saudi Arabia towards Folic Acid Supplement-Evidence from a Cross-Sectional Study [2022]

Slovenia

• Nutrients
  • Dietary Intake of Folate and Assessment of the Folate Deficiency Prevalence in Slovenia Using Serum Biomarkers [2021]

South-East Asia, Sub-Saharan Africa

• Lancet Global Health
  • Neural tube defects as a cause of death among stillbirths, infants, and children younger than 5 years in sub-Saharan Africa and southeast Asia: an analysis of the CHAMPS network [2023]

Spain

• Nutrients
  • The Use of Lower or Higher Than Recommended Doses of Folic Acid Supplements during Pregnancy Is Associated with Child Attentional Dysfunction at 4–5 Years of Age in the INMA Project [2021]

Sub-Saharan Africa

• PLoS ONE
  • Folic acid supplementation during preconception period in sub-Saharan African countries: A systematic review and meta-analysis [2025]

Switzerland

• Nutrients
  • Inadequate Status and Low Awareness of Folate in Switzerland—A Call to Strengthen Public Health Measures to Ensure Sufficient Intakes [2020]

Turkey

• BMC Pregnancy and Childbirth
  • Evaluation of neural tube defects from 2014 to 2019 in Turkey [2022]

United Kingdom

• Birth Defects Research
  • Maternal ethnicity and the prevalence of British pregnancies affected by neural tube defects [2021]

• HSC Public Health Agency
  • Folic acid and Vitamin D guidelines for health professionals [2017]

• JRSM Open
  • Folates, folic acid and preconception care – a review [2021]

• Public Health England
  • Update on folic acid [2017]

• UK National Screening Committee
  • Neural tube defect

United States

• Agency for Healthcare Research and Quality
  • Folic Acid Supplementation to Prevent Neural Tube Defects: Updated Evidence Report and Systematic Review for the US Preventive Services Task Force [2023]
  • Folic Acid Supplementation to Prevent Neural Tube Defects: A Limited Systematic Review Update for the U.S. Preventive Services Task Force [2023]

• American College of Medical Genetics and Genomics
  • Focused Revision: Policy statement on folic acid and neural tube defects [2021]
  • Laboratory screening and diagnosis of open neural tube defects, 2019 revision: a technical standard of the American College of Medical Genetics and Genomics (ACMG) [2020]
  • Technical standards and guidelines: prenatal screening for open neural tube defects [2005]

• Annals of the New York Academy of Sciences
  • Fortification of corn masa flour with folic acid in the United States: an overview of the evidence [2014]

• Centers for Disease Control and Prevention
  • Periconceptional intakes of methyl donors and other micronutrients involved in one-carbon metabolism may further reduce the risk of neural tube defects in offspring: a United States population-based case-control study of women meeting the folic acid recommendations [2023]
  • Neighborhood Deprivation and Neural Tube Defects [2023]
  • Neural Tube Defects in Pregnancies Among Women With Diagnosed HIV Infection — 15 Jurisdictions, 2013–2017 [2020]
  • Survival of infants with spina bifida and the role of maternal prepregnancy body mass index [2019]
  • Folic Acid

• National Institute of Child Health and Human Development
  • Neural Tube Defects (NTDs)

• Nutrients
  • Impact of Voluntary Folic Acid Fortification of Corn Masa Flour on RBC Folate Concentrations in the U.S. (NHANES 2011–2018) [2021]

• Topics in Spinal Cord Injury Rehabilitation
  • Demystifying Spina Bifida Guidelines Using a Periodicity Schedule [2022]

• U.S. Preventive Services Task Force
  • Folic Acid Supplementation to Prevent Neural Tube Defects: Preventive Medication [2023]

Vietnam

• Nutrients
  • Low Prevalence of Folic Acid Supplementation during Pregnancy: A Multicenter Study in Vietnam [2019]

WHO

• World Health Organization
  • Monitoring flour fortification to maximize health benefits: a manual for millers, regulators, and programme managers [2021]
  • Guideline: optimal serum and red blood cell folate concentrations in women of reproductive age for prevention of neural tube defects [2015]
  • Serum and red blood cell folate concentrations for assessing folate status in populations [2014]
  • Periconceptional folic acid supplementation to prevent neural tube defects

{Related topics}

• Topic
  • Prenatal screening and diagnosis
  • Obstetrics, perinatology
  • Fetal therapy