Public Health Nutrition


Neural tube defects in Latin America and the impact of fortification: a literature review

Jorge Rosenthala1 c1, Jessica Casasa2, Douglas Tarena2, Clinton J Alversona1, Alina Floresa1 and Jaime Friasa3

a1 National Center of Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, MS-86, Atlanta, GA 30333, USA

a2 Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, USA

a3 Carter Consulting, Atlanta, GA, USA


Objective Data on the prevalence of birth defects and neural tube defects (NTD) in Latin America are limited. The present review summarizes NTD prevalence and time trends in Latin American countries and compares pre- and post-fortification periods to assess the impact of folic acid fortification in these countries.

Design We carried out a literature review of studies and institutional reports published between 1990 and 2010 that contained information on NTD prevalence in Latin America.

Results NTD prevalence in Latin American countries varied from 0·2 to 9·6 per 1000 live births and was influenced by methods of ascertainment. Time trends from Bogota, Costa Rica, Dominican Republic, Guatemala City, Mexico and Puerto Rico showed average annual declines of 2·5 % to 21·8 %. Pre- and post-fortification comparisons were available for Argentina, Brazil, Chile, Costa Rica, Puerto Rico and Mexico. The aggregate percentage decline in NTD prevalence ranged from 33 % to 59 %.

Conclusions The present publication is the first to review data on time trends and the impact of folic acid fortification on NTD prevalence in Latin America. Reported NTD prevalence varied markedly by geographic region and in some areas of Latin America was among the lowest in the world, while in other areas it was among the highest. For countries with available information, time trends showed significant declines in NTD prevalence and these declines were greater in countries where folic acid fortification of staples reached the majority of the population at risk, such as Chile and Costa Rica.

(Received August 02 2012)

(Revised December 14 2012)

(Accepted January 04 2013)

(Online publication March 06 2013)


  • Neural tube defects;
  • Latin America;
  • NTD prevalence;
  • Time trends;
  • Folic acid fortification


c1 Corresponding author: Email