Add folic acid to food to ‘cut spina bif ida’

Leading obstetrician claims that one-third of cases could be prevented

ONE OF the country’s leading obstetricians believes mandatory folic acid fortification of food could reduce rates of congenital conditions such as spina bifida by a third.

Since landmark studies linked the supplement with the prevention of most cases of neural tube defects in 1993, women here have been urged to take folic acid. However, there has been no decline in rates of the serious birth conditions in the last two decades.

The congenital conditions – mainly spina bifida and anencephaly, where the foetus is missing parts of the brain and skull – are linked to the failure of the neural tube to close, which is normally complete by day 28 of pregnancy.

Women are advised to take folic acid, key to developing the baby’s spine and skull, for around six to eight weeks before pregnancy to get their folate levels up before the tube closes. But this often doesn’t happen as around half of pregnancies are unplanned. And a study has shown that most Irish women don’t begin taking the supplement until their pregnancy test is positive – which coincides with the closure of the neural tube.

New research published in the Irish Medical Journal shows the incidence of the birth conditions is not falling in Ireland, which, at 1.05 in every 1,000 births, is higher than the EU rate. The Irish study of the 288 pregnancies affected by neural tube defects from 2012 to 2015, found that almost two-thirds of women had information on folic acid supplementation but only three out of 10 women took the vitamin before conception.

Mandatory fortification with folic acid, mainly in bread and flour, has been introduced in more than 80 countries – but not in Ireland.

Professor Michael Turner, director of the UCD centre for human reproduction at Dublin’s Coombe hospital and co-author of the latest study, urged the Government to bring in mandatory fortification. He said this measure has dropped rates by 30% in the US and would have a huge effect in Ireland.

‘There are approximately 500 [children] in Ireland today with spina bifida. The mandatory fortification would prevent about a third of spina bifida cases.

‘In North America, where they have mandatory fortification, neural tube defect rates have fallen.’

While other factors are involved in around a third of cases, the study stated that two-thirds of the neural tube conditions are thought to be preventable by folic acid supplementation. There are two ways of tackling the problem. One is by food supplementation and the other

‘This measure would have a huge effect here’

is with fortification for primary prevention,’ he said.

‘The supplementation strategy hasn’t worked for two reasons. First of all, about half of pregnancies are unplanned and, even in women who are planning a pregnancy, they sometimes get pregnant before their folate levels have risen to an optimal level. You need to be taking the folic acid about six to eight weeks beforehand.’