Inositol for the Prevention of Neural Tube Defects: A Potential Opportunity for Advocacy in Global Pediatric Neurosurgery

Abstract

Objective: Approximately 70-80% of neural tube defects (NTDs) are responsive to folate. Myo-inositol has increasingly been identified as a potential solution to address folate-unresponsive NTDs. We provide a brief background of existing evidence regarding the role of myo-inositol in NTD prevention and describe its role in advocacy efforts focused on NTD prevention.

Methods: A narrative review was performed.

Results: Existing data regarding the efficacy of inositol supplementation is limited by low sample sizes and primarily observational study designs. Although advocacy efforts regarding NTDs have focused on folate fortification and supplementation, examining the data for inositol intake is worthwhile. After reviewing the data, we put forth that a series of criteria would need to be met even before considering advocacy and policy. First, the weight of evidence must favor increasing inositol intake. Second, the cost-effectiveness of inositol policy must be demonstrated. Third, the policy must be politically viable. Fourth, political priority for the policy must be generated. Fifth, synergy between existing folate policy efforts and inositol policy efforts must be generated. After that series of criteria are examined, advocacy may occur through neurosurgery-specific organizations, combined approaches with other surgical disciplines, and advocacy through collaborations of various clinical and research personnel.

Conclusion: Inositol may represent an avenue for reducing the birth prevalence of folate-unresponsive neural tube defects. Given their clinical roles in treatment of spina bifida and neural tube defects, neurosurgeons are central to advocacy efforts in prevention as well.