NCHR Comment On USPSTF Draft Recommendation On Folic Acid Supplementation To Prevent Neural Tube Defects

March 20, 2023

We are pleased to have the opportunity to express our views regarding the USPSTF draft recommendation statement on folic acid supplementation to prevent neural tube defects.

The National Center for Health Research (NCHR) is a nonprofit think tank that conducts, analyzes, and scrutinizes research on a range of health issues, with a particular focus on which prevention strategies and treatments are most effective for which patients and consumers. We do not accept funding from companies that make products that are the subject of our work, so we have no conflicts of interest.

Worldwide, about 300,000 infants are born yearly with a neural tube defect. These complications account for as many as 29% of newborn deaths associated with congenital abnormalities in low-income settings.¹ In addition, neural tube defects are among the most common causes of childhood mortality and disability.² Since 1992, when the U.S. Public Health Service first recommended folic acid supplementation for reproductive-aged women to reduce the risk of neural tube defects, multiple agencies and professional organizations have made similar recommendations.¹ In this current draft recommendation, USPSTF reaffirms that, for women who plan to or could become pregnant, there is high certainty that folic acid supplementation has a substantial net benefit. The current recommendation is consistent with recommendations of the American College of Obstetricians and Gynecologists, American Academy of Family Physicians, American Academy of Pediatrics, and March of Dimes.

We appreciate USPSTF highlighting areas that require further study, including disparities in the prevalence of neural tube defects. For example, in the U.S., Hispanic women are more likely to have a child born with a neural tube defect compared to non-Hispanic white and non-Hispanic black women.³ More research on the causes of this disparity may help further reduce the number of families affected by these serious complications.

NCHR is grateful for the opportunity to comment on this USPSTF draft recommendation. National Center for Health Research can be reached at info@center4research.org or (202) 223-4000.

1. Practice Bulletin No. 187: Neural Tube Defects. Obstetrics & Gynecology. 2017;130(6):e279-e290. doi:10.1097/AOG.0000000000002412
2. Estevez-Ordonez D, Davis MC, Hopson B, et al. Reducing inequities in preventable neural tube defects: the critical and underutilized role of neurosurgical advocacy for folate fortification. Neurosurgical Focus. 2018;45(4):E20. doi:10.3171/2018.7.FOCUS18231
3. Williams J, Mai CT, Mulinare J, et al. Updated Estimates of Neural Tube Defects Prevented by Mandatory Folic Acid Fortification — United States, 1995–2011. MMWR Morb Mortal Wkly Rep. 2015;64(1):1-5.

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