Objective The periconceptional use of folic acid reduces the risk of neural tube defects (NTD) considerably. Since 1998 the USA and many other countries adopted the policy of fortification of cereal grain. In the Kingdom of Saudi Arabia, the national flour mills organisation ordered fortification of flour as a mandatory procedure policy, starting from 2001. The aim of our study was to evaluate the effect of the implementation of the above policy on the incidence of NTD in babies born at King Abdul Aziz University Hospital (KAUH).
Methods All babies who were born with NTD at KAUH between 1997 and 2005 were included in the study. The incidence of NTD was compared between the eras before flour fortification (1997–2000) and the eras after fortification.
Results We have observed a decline in recent years from 1.9/1000 live births (1997–2000) to 0.76/1000 live births (2001–5). 42 babies were born with NTD with a male : female ratio of 1.1 : 1. 60% received folic acid during pregnancy but none preconception. 83% of the cases had myelomeningocele, 12% encephalocele and only 2.5% had meningococcal and another 2.5% had anencephaly. 91% of myelomeningocele patients had severe physical disability.
Conclusion After folic acid flour fortification, there was an apparent decline in the incidence of NTD in babies born at KAUH. However, the incidence is still high and is associated with serious morbidity. This emphasises the need for innovative programmes to increase folic acid consumption by women of childbearing age, to reduce NTD further.
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