Postfolate spina bifida lesion level change

Background: Spina bifida accounts for a large proportion of birth defects in the United States. Studies have evaluated the decrease in prevalence at birth after folate fortification of food grains, but little is known about neurologic functional changes related to fortification. This study assesses the functional level of lesions in the prefortification and postfortification eras. Methods: Data were collected through retrospective review of medical records from a regional multispecialty clinic in Arizona. This study included individuals born between 1981–1995 (prefortification) and 1999–2013 (postfortification). Patients were included if they had a primary diagnosis of spina bifida with or without hydrocephalus. Results: There was a significant difference in functional lesion level with an 85% reduction in thoracic level lesions in the postfortification era (p <.005). There were no differences in gender or ethnicity across eras; however, Hispanic ethnicity had a higher number of cases overall (51.7%). The most common lesion level in both eras was mid-lumbar, accounting for 35.7 and 34.4% of cases in the prefolate and postfolate eras, respectively. Conclusions: This study demonstrates a significant difference in the distribution of lesion level of spina bifida patients born in the postfortification era, based on neurologic function. Further research with a larger sample size is needed to determine if this observation holds true nationally.