Fortifying the Future: Urological Perspectives on Folic Acid and Spina Bifida Prevention

Introduction: Spina bifida affects 214,000-322,000 pregnancies globally every year. The incidence of this permanently disabling, yet preventable, neural tube defect is 1 in 500 births worldwide but disproportionately 1 in 100 births in low- and middle-income countries. Large-scale food fortification of folic acid, passed in 2023 by the World Health Assembly, provides an economically safe and equitably sustainable public health strategy to prevent the life-long urology-associated manifestations of spina bifida. Methods: A literature review was conducted to explore the role of folic acid fortification in preventing spina bifida in the context of urological care. Results: The estimated lifetime direct costs of spina bifida, as it relates to urological care, range between $500,000-$791,900. The goal of urological care in spina bifida patients is to maximize functional status. Folic acid fortification has resulted in fewer cases of spina bifida and consequently fewer pediatric and adult spina bifida-associated urology surgeries. Furthermore, folic acid fortification in the prevention of spina bifida has demonstrated better economic, psychosocial, and health outcomes. Conclusion: Through research, public health initiatives, and campaigns, widespread folic acid fortification has played a crucial role in reducing spina bifida-related urological morbidity and mortality. Spina bifida is preventable, along with its associated psychosocial, economic, medical, and financial burdens. Currently, there are no global consensus guidelines on spina bifida prevention. Hence, government and healthcare organizations are encouraged to support the World Health Assembly resolution in preventing spina bifida through large-scale folic acid fortification. Abbreviations: CIC = clean intermittent catheterization; LMIC low- and middle-income country; LUT = lower urinary tract; MMC = myelomeningocele; MOM = management of myelomeningocele; NB = neurogenic bladder; NTD = neural tube defect; SB = spina bifida; UTI = urinary tract infection; VUR = vesicoureteral reflux