In June 2014, the Teratology Society (now the Society for Birth Defects Research and Prevention) met in Bellevue, Washington. During the previous years (2010–2013), there was a cluster of neural tube defects (NTDs) in central Washington that was getting national attention as the etiology for these birth defects in this specific region was not known. The Program Committee for the annual meeting saw this as an opportunity for our program to have a “hot topics” session and emphasize how our Society and the annual meeting was relevant to a global and local problem. In this session, Sara Baron and Mandy Stahre were local speakers who described how the cluster was first recognized and investigated, David Erickson from the centers for disease control and prevention explained cluster investigations, Mark Canfield from the Texas Department of State Health Services spoke on environmental and occupational exposures and NTDs, and Janee Gelineau‐van Waes described her research on fumonisin exposure as a risk for NTDs. In addition, our Teratology Society/European Teratology Society Exchange Lecture focused on Is Lack of Mandatory Folic Acid Fortification Public Health Malpractice ? Margo Whiteford presented the impact of spina bifida on individuals and families, not only describing statistics for the economic and physical stresses but expressing, in a very personal way, her experience as a person with spina bifida. Godfrey Oakley, a long‐time proponent of fortifying food with folic acid as a prevention for spina bifida F, presented data on the effects of folic acid fortification in the United States.

After these excellent presentations describing the difficulties associated with NTDs on the personal, community, scientific, and society levels, the Teratology Society, at the suggestion of Godfrey Oakley, drafted a resolution recommending that all governments institute mandatory fortification of a centrally produced food. In addition, the Society recommended that a global strategic plan be developed for the total prevention of folic acid‐preventable spina bifida and folic acid‐preventable anencephaly by 2024. This resolution was published as an editorial in Birth Defects Research (MA Smith and C Lau on behalf of the Teratology Society. A resolution on folic acid fortification. Birth Defects Research A 103 (1):1–2. 2015). This resolution has been cited 17 times and was published by the Japanese Teratology Society in their journal. The resolution is reprinted below to remind us that many countries still do not fortify with folic acid, resulting in many preventable cases of spina bifida.

Preamble to the Teratology Society Resolution on Folic Acid Fortification

The North American Teratology Society is committed to the prevention of birth defects and disorders of developmental origin globally. The United States, like several other countries, requires mandatory fortification of enriched cereal grains with folic acid. Since fortification was required in 1998, the United States has seen a 26% decrease in neural tube defects, including spina bifida and anencephaly (Centers for Disease Control and Prevention, 2004). In Canada, the reductions by province varied 85% in Newfoundland and 40% in Ontario. In general, the percent reduction will be a function of how high the rate of spina bifida and anencephaly are before fortification (De Wals et al., 2007). If all countries would require fortification of folic acid, we believe it would substantially decrease the global incidence of these severe to life threatening birth defects. While each country will have to determine the best strategy for implementing such a plan considering cultural preferences, cost/benefit, and quality of life concerns, the Teratology Society has developed the following resolution to support mandatory fortification efforts and hope that it can be used by fortification advocates worldwide to reduce the number of folic acid‐preventable birth defects.

Resolution: Global Total Prevention of Folic Acid‐Preventable Spina Bifida and Folic Acid‐Preventable Anencephaly by 2024

Whereas, the mission of the Teratology Society is to prevent birth defects and disorders of developmental origin,

Whereas, there is unequivocal evidence that folic acid prevents a large proportion of spina bifida and anencephaly (MRC Vitamin Study Research Group, 1991),

Whereas, there are epidemics of spina bifida and anencephaly in many countries, with prevalence that exceeds the expected prevalence of nonfolic acid‐preventable spina bifida and anencephaly of approximately 5 per 10,000 births (Berry, 1998; Berry et al., 1999; Kondo et al., 2013; Yuskiv et al., 2004),

Whereas, governments in approximately 70 countries require mandatory folic acid fortification, resulting in approximately 60,000 fewer pregnancies affected with folic acid‐preventable spina bifida and folic acid‐preventable anencephaly each year (Youngblood et al., 2013), Whereas, mandatory folic acid fortification has led to marked reductions in folate deficiency and folate deficiency anemia in the U.S. population (Odewole et al., 2013),

Whereas, while there is no evidence demonstrating that folic acid fortification causes adverse health effects at a daily dose of 1,000 μg (the current Tolerable Upper Intake Level (UL) set by the U.S. Food and Nutrition Board for synthetic forms of folate (i.e., folic acid) available in dietary supplements and fortified foods (Institute of Medicine, 1998), it is important to respond to any new, substantiated research suggesting that levels of folic acid higher than 1,000 μg a day pose a potential risk,

Whereas, folic acid fortification is highly cost‐effective, saving approximately $5 billion dollars in direct costs in the United States alone in a 10‐year span (1996–2006) (Centers for Disease Control and Prevention, 2011),

Whereas, approximately 180,000 spina bifida and anencephaly pregnancies occur in 120 countries each year that may be preventable through mandatory folic acid fortification (Odewole et al., 2013),

The Teratology Society recommends

All governments institute mandatory folic acid fortification of a centrally produced food (such as, but not limited to, wheat flour, corn flour or meal, rice, and maize flour or meal) to provide almost all adults with at least an additional 150 μg of folic acid per day.

That a global strategic plan for the total prevention of folic acid‐preventable spina bifida and folic acid‐preventable anencephaly by 2024 be written by 2015.

That members of the Teratology Society champion mandatory folic acid fortification in their home countries.

The content of this document has been reviewed and fully approved by the Council and the Public Affairs Committee of Teratology Society.

Submitted on behalf of the Teratology Society,

Public Affairs Committee

Mary Alice Smith¹, Christopher Lau²

¹President, Teratology Society, Reston, Virginia

²Chair, Public Affairs Committee, Teratology Society, Reston, Virginia

2014年6月，畸形学学会（现为出生缺陷研究与预防学会）在华盛顿州贝尔维尤举行会议。在过去的几年中（2010-2013年），华盛顿中部出现了一系列神经管畸形（NTD），这引起了全国的关注，因为在该特定区域内这些先天性缺陷的病因尚不清楚。年度会议的程序委员会将其视为我们的程序召开“热门话题”会议的机会，并强调学会和年度会议如何与全球和本地问题相关。在本次会议中，萨拉·巴伦（Sara Baron）和曼迪·斯塔赫（Mandy Stahre）是当地人，他们描述了该群是如何被首次识别和调查的，疾病控制和预防中心的David Erickson解释了群的调查，得克萨斯州州卫生服务部的马克·坎菲尔德（Mark Canfield）就环境和职业暴露与NTD进行了演讲，珍妮·吉琳娜·凡·韦斯（Janet Gelineau-van Waes）描述了她对伏马菌素暴露作为NTD风险的研究。此外，我们的术语学会/欧洲术语学会交流讲座的重点是是否缺乏强制性叶酸强化公共卫生的弊端？玛戈·怀特福德（Margo Whiteford）介绍了脊柱裂对个人和家庭的影响，不仅描述了经济和身体压力的统计数据，而且以非常个人化的方式表达了她作为脊柱裂的人的经历。长期支持用叶酸强化食物以预防脊柱裂F的戈弗雷·奥克利（Godfrey Oakley）提出了有关美国强化叶酸影响的数据。

在这些精彩的演讲在个人，社区，科学和社会各级描述了与NTD相关的困难之后，在戈弗雷·奥克利（Godfrey Oakley）的建议下，畸变学学会起草了一项决议，建议所有政府对集中生产的食品实行强制性设防。此外，学会建议制定一项全球战略计划，以在2024年之前全面预防可预防叶酸的脊柱裂和防止可预防叶酸的无脑。该决议作为社论发表在《出生缺陷研究》（MA Smith和C Lau）上。代表Teratology Society。关于叶酸强化的决议。出生缺陷研究A103（1）：1-2。2015）。该决议已被引用了17次，并由日本畸形学会在其期刊上发表。该决议在下面重印，以提醒我们，许多国家仍未使用叶酸进行强化，导致许多可预防的脊柱裂病例。

术语学会关于叶酸强化的决议的序言

北美畸形病学会致力于在全球范围内预防出生缺陷和发育起源的疾病。与其他几个国家一样，美国要求对富含谷物的叶酸进行强制性强化。自1998年要求加强防御以来，美国的神经管缺陷（包括脊柱裂和无脑畸形）减少了26％（疾病控制与预防中心，2004年）。在加拿大，纽芬兰省和安大略省的省份减少幅度分别为85％和40％。通常，减少的百分比将取决于设防前脊柱裂和无脑症的发生率（De Wals等，2007）。）。如果所有国家都要求强化叶酸，我们相信它将大大降低这些严重威胁生命的出生缺陷的全球发病率。虽然每个国家都必须考虑文化偏好，成本/收益以及生活质量来确定实施此类计划的最佳策略，但畸形学协会已经制定了以下决议，以支持强制性设防工作，并希望可以将其用于全世界的防御工事倡导者减少了可预防叶酸的出生缺陷的数量。

解决方案：到2024年全球全面预防叶酸可预防的脊柱裂和叶酸可预防的无脑

鉴于Teratology Society的使命是预防先天缺陷和发育起源的障碍，

鉴于有明确的证据表明叶酸可预防大部分的脊柱裂和无脑症（MRC维生素研究小组，1991年），

鉴于在许多国家中存在脊柱裂和无脑疟疾的流行，其流行率超过了非叶酸可预防的脊柱裂的预期患病率，每10,000例婴儿中约有5发生无脑畸形（Berry，1998； Berry等，1999； Kondo等）等人，2013年；尤斯基夫等人，2004年），

鉴于约有70个国家/地区的政府要求进行叶酸强制性强化，因此，每年因叶酸可预防的脊柱裂和叶酸可预防性无脑而受孕的人数减少了约60,000（Youngblood等人，2013），而叶酸的强制性强化已导致美国人群的叶酸缺乏症和叶酸缺乏症贫血明显减少（Odewole等，2013），

鉴于没有证据表明叶酸强化会导致每天1000μg的剂量对健康产生不利影响（美国食品和营养委员会为合成叶酸（即叶酸）设定的当前可耐受的最高摄入量水平（UL）膳食补充剂和强化食品中含有的硫酸（Institute of Medicine，1998年），重要的是应对任何新的，有根据的研究表明，每天叶酸含量超过1,000μg构成潜在风险，

叶酸强化具有很高的成本效益，仅在美国的十年（1996-2006年）内，就节省了约50亿美元的直接成本（疾病控制与预防中心，2011年），

鉴于每年有120,000个国家发生约18万脊柱裂和无脑妊娠，这可以通过强制性叶酸强化来预防（Odewole等，2013），

术语学会推荐

所有政府都对集中生产的食品（例如但不限于小麦粉，玉米粉或粗粉，大米和玉米粉或粗粉）实施强制性叶酸强化，以向几乎所有成年人提供至少150μg的叶酸。每天叶酸。

到2015年，制定一项到2024年全面预防叶酸可预防的脊柱裂和叶酸可预防的无脑的全球战略计划。

术语学会的会员在其本国拥护强制性叶酸防御工事。

该文件的内容已经理事会和Teratology Society公共事务委员会审查并完全批准。

代表Teratology Society提交，

公共事务委员会

玛丽·爱丽丝·史密斯¹，克里斯托弗·刘²

¹弗吉尼亚州雷斯顿市畸形学会会长

²弗吉尼亚州雷斯顿市畸变学会公共事务委员会主席