Periconceptual Surveillance for Prevention of Anemia and Birth Defects in India

Julia Finkelstein, ScD, Cornell University (Funded 2015-2016)

Neural tube closure defects (NTDs) are among the most common and severe adverse pregnancy outcomes in the United States and globally. Women of reproductive age are a high-risk population for anemia and micronutrient deficiencies, and there is increasing evidence of the role of periconceptional vitamin B12 and folate status in the etiology of birth defects. However, there is little representative population-level data from Southern India, where the burden and consequences of these deficiencies are unacceptably high. The establishment of a periconceptional surveillance program is urgently needed to characterize the burden of anemia, micronutrient deficiencies, and adverse pregnancy outcomes in Southern India. The proposed research in this application will provide critical pre-intervention biomarker data to inform the development of a randomized efficacy trial of quadruple fortified salt (QFS) for prevention of anemia and birth defects in Southern India. We propose to conduct the first randomized efficacy trial of quadruple-fortified salt – i.e., vitamin B12, folic acid, iron, and iodine. If proven to be effective, QFS could represent a low-cost and sustainable strategy to target malnutrition, reduce the risk of anemia and adverse pregnancy outcomes, and to improve the health of women and young children.