EFFECTIVENESS OF FOLIC ACID FORTIFICATION AND SUPPLEMENTATION IN NEURAL TUBE DEFECTS: A CALL FOR CONTINUED EFFORTS AND FUTURE RESEARCH. A SYSTEMATIC REVIEW

Abstract

Neural tube defects (NTDs), including spina bifida, anencephaly, and encephalocele, remain among the most common and preventable congenital anomalies worldwide. This systematic review aims to evaluate the effectiveness of folic acid fortification and supplementation in reducing the prevalence of NTDs, while also highlighting the urgent need for targeted interventions in countries such as Pakistan. A total of 37 studies were selected through a systematic literature review using databases such as PubMed, Sci-Hub, and Google Scholar. The review includes prevalence data from both global and Pakistani studies, as well as analyses of public health interventions involving folic acid. Globally, NTD prevalence remains high in many low- and middle-income countries, with studies showing reductions in NTD incidence of up to 85% with adequate folic acid intake. In Pakistan, several hospital-based studies reported a high burden of NTDs, often associated with poor maternal folic acid intake and high rates of consanguinity. Despite overwhelming global evidence supporting the efficacy of folic acid in preventing NTDs, Pakistan has yet to implement nationwide folic acid fortification. Findings from countries like Canada, the United States, and Chile demonstrate significant reductions in NTD prevalence following food fortification policies. This review concludes that mandatory folic acid fortification and enhanced peri-conceptional supplementation programs are crucial to reducing the burden of NTDs. There is a pressing need for national policies, public health education, and surveillance systems to support folic acid interventions and improve maternal and neonatal health outcomes.