Serious birth defects can be prevented with folic acid supplements and food enrichment

Folic acid is of vital importance to fetal development which is why pregnant women have a much higher need for this nutrient. Although the Danish health authorities recommend that pregnant take folic acid supplements, some get started too late and others forget to take their supplements. In other countries, it is common practice to enrich flour with folic acid but apparently, the added quantity is insufficient. According to a new British study, many pregnant women still don’t get enough folic acid, which increases their risk of giving birth to a baby with neural tube defects that can lead to severe disabilities. Lack of folic acid can also affect the child’s mental development. The British researchers therefore recommend adding more folic acid to fluor as a way of preventing the birth defects. It’s simple and inexpensive and would also be relevant for Denmark.

Folic acid (vitamin B9) is important for blood formation, energy levels, and growth. Pregnant women have an increased need for folic acid because the nutrient is important for the DNA synthesis in connection with fetal growth and development. Folic acid is also vital for proper closure of the child’s neural tube in the early stage of pregnancy.
Lack of folic acid can disrupt normal cell division in the fetus and result in brain damage or neural tube defects, which is when there is an incomplete closure of the neural tube. The problem normally occurs during the third or fourth week of pregnancy and may lead to severe disabilities, heart defects, or stillbirth. A folic acid deficiency during pregnancy may also result in low birth weight or overweight later in life.

• Every year, 300,000 children around the world develop severe birth defects as a result of neural tube defects.
• It is assumed that 80 percent of these cases are caused by lack of folic acid

Food enrichment plans must be improved and used more

In September 2021, the British government announced a plan to enrich bleached flour with folic aid as a way of preventing neural tube defects. This was in connection with an initiative that around 80 countries have already implemented since the 1990s. Now, a new study from the University College in London reveals that this enrichment scheme has only succeeded in preventing around 10 percent of neural tube defects because the amount of added folic acid is too low.
The scientists therefore see a unique chance for Great Britain to take the lead and show the world how to prevent neural tube defects effectively through optimal food enrichment. If all pregnant women get plenty of folic acid, it may prevent 80 percent of these tragic cases.
It was thought earlier that high doses of folic acid are neurotoxic, but the British scientists dismiss this notion by referring to other studies. It has also been said that high doses of folic acid can mask a vitamin B12 deficiency, but a B12 deficiency can easily be detected with a blood test. The British researchers therefore recommend increasing the added amount of folic acid from 0.2 micrograms to 1 mg per 100 grams of flour.
According to the new analysis, this optimization of the food enrichment would have prevented 6.7 million cases of neural tube defects in the period between 1992-2020.
The new British study is published in Journal of Medical Screening
According to an earlier Danish study from Århus University, scientists believe folic acid enrichment of flour would also be prudent in this country and call for swift action. Both the British and the Danish scientists still recommend that pregnant women take folic acid supplements.

Recommendations for folic acid for pregnant women

The officially recommended intake of folic acid during pregnancy is 400 micrograms daily, starting four weeks before conception and continuing at least 12 weeks into pregnancy, as this lowers the risk of giving birth to a child with neural tube defect. An earlier study that was presented to British psychologists in Brighton concluded that supplementation with folic acid throughout the entire pregnancy can boost the child’s psychological development, which is essential for the ability to tackle emotions and handle social relations.
Unfortunately, pregnancies are not planned and are discovered at a time where it is too late to start taking folic acid. Also, many pregnant women forget to take their supplement. Enrichment of foods is therefore the best option in many ways.

• Good sources of folic acid are spinach, avocado, beans and other vegetables, nuts, fruit, and liver
• The recommended intake level for adults is normally around 200 micrograms daily. Pregnant women, however, need at least 400 micrograms.

References

Nicholas J Wald. Folic acid and neural tube defects: Discovery, debate and the need for policy change. Journal of Medical Screening, 2022.

University College London. More folic acid in flour needed to prevent severe birth defects, researchers say. ScienceDaily August 22, 2022

Nutrition insight. Taking Folic Acid Throughout Pregnancy May Increase Children´s Emotional Intelligence. 12 May 2017

Wang G, et al. Associations of maternal pregnancy BMI and plasma folate concentrations with child metabolic health. JAMA Pediatrics. 2016

Queen Mary University of London. Upper intake of folate is invalid: Government urged to fortify flour with folic acid.

Wang G, el al. Associations of maternal pregnancy BMI and plasma folate concentrations with child metabolic health. JAMA Pediatrics. 2016

Kristian Sjøgren. Forskere: Put folinsyre i danske dagligvarer. Videnskab.dk 2015