EPIDEMIC OF NEURAL TUBE DEFECTS IN UKRAINE, OR WHY CHILDREN`S DEATH AND DISABILITIES ARE NOT PREVENTED
Ukraine suffers from the neural tube defects epidemic. According to“Omni-Net” data (“Omni-Net” is the only Ukrainian International Charitable Organization that runs population-based monitoring of birth defects according to the international standarts and is a member of EUROCAT and ICBDSR) the rates of NTD in Northen and Western regions of Ukraine in 20002014 on Polissia territories reached 21 up to 25 per 10,000 live births, and on non-Polissia territories – from 14 to 18 per 10000 live births. This data was published in the European Journal of Medical Genetics in 2016 and these rates are the highest in Europe. 75% of all NTD cases in every country can be prevented by periconceptional (during 3 months before pregnancy and ﬁ rst 2-3 months of pregnancy) intake of foic acid. Starting from 1999 USA and Canada implemented ﬂ our fortiﬁ cation with folic acid because of because of ineffectiveness of supplementation policy. Only ¼ – 1/3 of women took folic acid before pregnancy in Canada and USA, in Ukraine this number reaches only 7%. Since 1999, the prevalence of NTD decreased by 46% in Canada, and in USA there was observed a 38% reduction in prevalence for spina biﬁ da. Economic analysis showed a signiﬁ cant beneﬁ t from fortiﬁ cation: as it is estimated by experts that all direct and indirect, medical and not medical cost for one child with spina biﬁ da are 20 times higher than ﬂ our fortiﬁ cation costs. Every year after fortiﬁ cation policy was implemented, Health care system in USA saves appox. $508 mln. Ukraine already fortiﬁ es ﬂ our with folic acid and other microelemets but only for export. For example, in 2003 Ministery of Health of Indonesia implemented fortiﬁ cation standarts for all ﬂ our that is sold and consumed in their country, including mandatory folic acid fortiﬁ cation (2ppm). Ukraine is second biggest exporter of ﬂ our for Indonesia. But fortiﬁ ed ﬂ our is not sold in Ukraine… Every year in Ukraine approx. 23% of live birth children with NTD die. 99% of survivors are disabled. And this is happening while there is an effective way to prevent this tragedy. Experts estimate that 800 children born with NTD in Ukraine every year can be born healthy if ﬂ our fortiﬁ cation policy with folic acid is implemented.
Crider KS, Bailey LB, Berry RJ. Folic acid food fortification—its history, effect, concerns, and future directions. Nutrients. 2011 Mar 15;3(3):370-84.
Williams J, Mai CT, Mulinare J, Isenburg J, Flood TJ, Ethen M, Frohnert B, Kirby RS. Updated estimates of neural tube defects prevented by mandatory folic Acid fortification-United States, 1995-2011. MMWR. Morbidity and mortality weekly report. 2015 Jan;64(1):1-5.
Pfeiffer CM, Hughes JP, Lacher DA, Bailey RL, Berry RJ, Zhang M, Yetley EA, Rader JI, Sempos CT, Johnson CL. Estimation of Trends in Serum and RBC Folate in the US Population from Pre-to Postfortification Using Assay-Adjusted Data from the NHANES 1988–2010–3. The Journal of nutrition. 2012 Mar 21;142(5):886-93.
Watkins M. Mental Retardation and Developmental Delay.CDC Investigation Review 1998:282-290
Yi Y, Lindemann M, Colligs A, Snowball C. Economic burden of neural tube defects and impact of prevention with folic acid: a literature review. European journal of pediatrics. 2011 Nov 1;170(11):1391-400.
Goh YI, Koren G. Folic acid in pregnancy and fetal outcomes. Journal of Obstetrics and Gynaecology. 2008 Jan 1;28(1):3-13.
Ami N, Bernstein M, Boucher F, Rieder M, Parker L. Folate and neural tube defects: The role of supplements and food fortification. Paediatrics & child health. 2016 Apr 1;21(3):145-9.
Cortés F, Mellado C, Pardo RA, Villarroel LA, Hertrampf E. Wheat flour fortification with folic acid: changes in neural tube defects rates in Chile. American Journal of Medical Genetics Part A. 2012 Aug 1;158(8):1885-90.
Darmstadt GL, Howson CP, Walraven G, Armstrong RW, Blencowe HK, Christianson AL, Kent A, Malherbe H, Murray JC, Padilla CD, Walani SR. Prevention of congenital disorders and care of affected children: a consensus statement. JAMA pediatrics. 2016 Aug 1;170(8):790-3.
Jacob JA. Twenty years after folic acid fortification, FDA ponders expansion to corn masa flour. Jama. 2016 May 3;315(17):1821-2.
Oakley GP, Tulchinsky TH. Folic acid and vitamin B12 fortification of flour: a global basic food security requirement. Public Health Reviews. 2010 Jun;32(1):284.
Youngblood ME, Williamson R, Bell KN, Johnson Q, Kancherla V, Oakley GP. 2012 Update on global prevention of folic acid–preventable spina bifida and anencephaly. Birth Defects Research Part A: Clinical and Molecular Teratology. 2013 Oct 1;97(10):658-63.
Arth A, Kancherla V, Pachón H, Zimmerman S, Johnson Q, Oakley GP. A 2015 global update on folic acid‐preventable spina bifida and anencephaly. Birth Defects Research Part A: Clinical and Molecular Teratology. 2016 Jul 1;106(7):520-9.
Vertelec”kyj VYe, Yevtushok BA, Zymak- Zakutnya NO, Kalynka SO, Korzhyns”kyj YuS, Lapchenko SF, Sosynyuk ZO. Vrodzheni vady rozvytku, Polissya, Chornobyl”. Neonatolohiya, Xirurhiya ta Perynatal”na medycyna. 2016;6, 2(20):5-14.
Wertelecki W. Malformations in a Chornobyl-impacted region. Pediatrics. 2010 Apr 1;125(4):e836-43.
Yuskiv N, Andelin CO, Polischuk S, Shevchuk O, Sosynyuk Z, Vihovska T, Yevtushok L, Oakley GP, Wertelecki W. High rates of neural tube defects in Ukraine. Birth Defects Research Part A: Clinical and Molecular Teratology. 2004 Jun 1;70(6):400-2.
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