Table Salt Fortified With Folic Acid is A Cheap, Effective Way to Prevent Fatal Birth Defects
Fortification with folic acid may be especially beneficial in countries that do not have mandated folic acid fortification regulations.
Iodized table salt that is fortified with folic acid can prevent birth defects in women who are pregnant, according to investigators at Emory University (in conjunction with investigators at the University of Central Florida [UCF] and other institutions in India) who published their research in JAMA Network Open.
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“Salt fortification is cheap and it's really easy to add in the amount of folic acid needed to save lives,” said lead study author Jogi Pattisapu, MD, a neurosurgeon with UCF's College of Medicine, in the press release.
According to World Health Organization recommendations, women who are planning to conceive should start supplementing with 400 micrograms of folic acid—this supplementation regimen should continue until 3 months of pregnancy. They recommend folic acid because it can prevent spina bifida and anencephaly, leading contributors of stillbirths, elective pregnancy terminations, and death in infants.
In the United States, grain food must be fortified with folic acid, as fortification is cost-effective, safe, and equitable health measure. However, more than 100 countries around the world do not require food fortification. Thus, more than 260,000 births were affected by spina bifida and anencephaly globally.
Investigators conducted a trial, during which they fortified commercially available iodized table salt with folic acid to evaluate the feasibility and efficacy of fortification to prevent birth defects including spina bifida and anencephaly. The cohort included 83 non-pregnant women (likely between ages 18 to 45) from southern India, where the rate of birth defects is high.
The investigators observed that the pregnant women who consumed fortified salt for 4 months had a 3.7-times reduced risk in these birth defects, according to the study authors. Additionally, the authors noted that, if existing iodized salt companies fortified their products with folic acid, 50% of all spina bifida cases could be prevented.
Once a fetus contracts spina bifida or anencephaly, there is no curing it, explains Vijaya Kancherla, an associate professor in the Department of Epidemiology at Rollins, in the press release. In low- and middle-income countries, where folate deficiency is a prevalent issue, people often do not have enough resources to receive clinical care, which often leads to infant mortality.
“It is a human rights issue that everyone should be worried about and should strive to find alternate solutions that prevent these conditions from occurring in the first place, no matter where one is born,” Kancherla said in the press release.
However, the authors noted that their research does not promote higher salt consumption; rather, it shows that adding folic acid to salt that is already consumed could prove to be globally beneficial.
“Hopefully countries that have not already implemented fortification programs can now look at their infrastructures,” Pattisapu said in the press release. “What we need now is action."
