Folic Acid Reducing Birth Defects
Grain products fortified

From the National Post, Canada

Efforts by government and doctors to get Canadian women of childbearing age to consume folic acid have significantly reduced the rate of spina bifida and other neurobiological defects.

Two new studies show the occurrence of neural tube defects was halved between the early and the late 1990s. The studies show the change came after Health Canada ordered that grain products be fortified with folic acid. They say a public awareness campaign did not have a significant impact.

The studies, published today in the Canadian Medical Association Journal, plot the incidence of the defects along a timeline that tracks developments in the public health campaign and food fortification. The findings are a significant justification of the push by the medical community in favour of folic acid supplementation.

"Our results help to validate the decision to have food fortified with folic acid and may encourage the implementation of fortification in countries that have not yet implemented such strategies," says one of the studies, conducted by researchers from the department of obstetrics and gynecology at Dalhousie University in Halifax.

Fortifying food, which caused some early controversy among those worried about the safety of such a widespread application, has been shown to be beneficial and justifiable, according to a commentary that accompanies the studies in the journal.

"It is an effective and inexpensive way to ensure adequate folate levels in all prospective mothers and maximizes the effect of folic acid in preventing neural tube defects," said Dr. Demetrios Economides and Dr. Rezan Kadir of the obstetrics department at the Royal Free Hospital School of Medicine in London, England.

Folate, which is a B vitamin, is naturally found in nuts, liver and dark green, leafy vegetables, such as spinach. Folic acid refers to the synthetic form of the vitamin.

The vitamin's significance in the development of unborn children was first suggested in the late 1960s, when researchers found folate deficiencies might contribute to neural tube defects.

These defects, which occur when the central nervous system does not fully form in the developing fetus, occur in one to two per 1,000 births.

The Nova Scotia study says neural tube defects are the most significant fetal anomalies leading to long-term morbidity: "The lifetime medical and financial costs of a patient with spina bifida are very high and the effect on the family is incalculable."

The study, which analyzed a decade's worth of provincial data on live births, stillbirths and terminated pregnancies, found the incidence of neural tube defects dropped by at least 54% after grain products began being fortified.

The rate dropped from 2.58 per 1,000 births during 1991 to 1997, to 1.17 per 1,000 births during 1998 to 2000, the study found.

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