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Folic acid intake is extremely important before and during pregnancy. Insufficiency of folic acid in the mother’s body can cause severe malformations in the baby, such as neural tube defects (NTDs). These NTD’s can include anencephaly, when a baby’s brain does not fully develop, and spina bifida, where the tube enclosing the spinal cord is open at birth. In order to overcome these NTD’s, fortifications were put in place in the 1990’s. Foods such as cereals and flour became fortified with folic acid, so that unsuspecting pregnant mothers could have sufficient folic acid intake while eating everyday foods, and their babies would remain unaffected by NTDs.

Recently, a study conducted by scientists at Stanford University has challenged fortification and its effectiveness. The study examined newborns and reports of pregnancies by birth defects in eight Central California counties from 1989 to 2010 (pre-fortification). The results indicated that the total reported NTDs for the study period were 87.8 cases per 100,000 births per year. From 1989 to 1996, before fortification started, NTDs were declining by 8.7 cases per 100,000 births per year. After fortification was fully implemented, between years 1999 and 2010, NTDs declined more slowly, by 1.7 cases per 100,000 births per year. These changes before and after fortification indicate a needed modification of fortification itself, so that the risk for NTDs can be lowered further.

Along with NTDs, the study also looked at other birth defects, such as orofacial clefts, including cleft lip & palate, and gastroschisis. These defects are relatively simple to correct via surgical treatments, whereas NTDs like anencephaly and spina bifida have no treatment and cause lifelong disability. In the case of cleft lip and palate, fortification has played a positive role in decreasing these birth defects slightly, from 1.2 to 0.2 cases per 100,000 births per year. Cases of gastroschisis increased for the entire study period, but increased at a much slower rate after fortification.

 This image indicates the amount of Folic Acid needed before/during pregnancy in order to avoid Neural Tube Defects

Image Source: Envision

All in all, these findings add to the ongoing debate of how folic acid fortification can be modified to be more beneficial in the future. Some experts have suggested that fortification should be increased in food sources, so as to prevent more NTDs, whereas others are looking into further side effects of increased folic acid intake. As of now, folic acid intake is critical for normal pregnancy progression, but that intake amount may change based on future research findings. Thus, the amount of folic acid in the foods remains a topic of debate, but advice about folic acid intake for pregnancy remains the same: 400 micrograms of folic acid to prevent NTDs.

Feature Image Source: Ji kyungsoo

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