Neural tube defects in Australia: rates before and after introduction of the mandatory folic acid standard

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Project Main Description

Information about NTD among births and termination of pregnancy between January 2007 and December 2017 has been, or will be sought from all Australian states and territories.

The study is being undertaken in two stages.  The first stage used the data available in December 2013, comprising data from January 2007 to December 2011 for New South Wales, Queensland, Western Australia, South Australia, Tasmania and the Northern Territory.   The report of the first stage of the study was produced under contract to Department of Health, who are managing the independent review of mandatory folic acid fortification [

It was anticipated at the outset that the study would need to continue to 2017 to accrue sufficient cases of NTD for sub-group analysis and confirmation of the initial findings.


Serious congenital abnormalities are rare, but can have far-reaching consequences. NTD are congenital anomalies that occur in the first four weeks of pregnancy from abnormal development of the structure that forms the brain and spinal cord.  NTD can be lethal and many who survive have lifelong serious impairment. 

Evidence emerged in the early 1990s that vitamin supplements containing folic acid (a form of the B vitamin folate) taken in the period before and immediately after conception can prevent up to 80% of NTD. Evaluation of public health interventions to increase folate and folic acid intake by women of childbearing age found these strategies to be expensive, their effects time-limited, and to have missed many women, particularly those not amenable to health education and those whose pregnancies were unplanned.  Evaluation of the program of voluntary folic acid fortification of foods found that the effectiveness criterion had not been met and that participation by the food industry had been low.

The Folate Scientific Advisory Group convened by Food Standards Australia New Zealand (FSANZ) to assess the potential benefits and risks of increasing folic acid intake within the whole population recommended mandatory folic acid fortification. Before the introduction of mandatory folic acid fortification, the Australia and New Zealand Food Regulation Ministerial Council (now the Legislative and Governance Forum on Food Regulation) committed to a comprehensive and independent review of mandatory fortification to begin two years after implementation.


The purpose of this study is to compare the rates of neural tube defects (NTD) in Australia among pregnancies conceived before and after the introduction of the mandatory folic acid fortification standard in September 2009.


Report: Neural tube defects in Australia 2007-2011: before and after implementation of the mandatory folic acid fortification standard

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