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Fortifying cereals, grains and flour with folic acid has not
protected against the risk of certain birth defects as much
as experts thought it would, a large, new study suggests. In
the late 1990s, health experts found that low folic acid
blood levels were linked to both birth defects. So, the U.S.
Food and Drug Administration mandated that cereal and grain
products be fortified with the B vitamin. To measure just
how effective that effort has been, investigators analyzed
1.3 million births across eight central California counties
over two decades. Between 1989 and 2010, there was an
average of about 88 cases of neural tube defects for every
100,000 births. But digging deeper, investigators found that
that risk had already started to decline before the 1997
fortification mandate. There was a risk drop of nearly 9
cases per 100,000 births every year between 1989 and 1996
alone, the researchers said. And that downward trend
actually slowed after fortification, dipping by 1.7 cases
for every 100,000 births annually between 1999 and 2010, the
study authors said. Study co-author said a number of
unexamined factors might have played a role in the trend,
including a notable rise in maternal obesity. "And we now
have to wonder if folic acid is the whole answer," he said.
"What we do know, however, is that this is not a message to
women that they should now do anything differently," he
stressed. "I certainly do not want to convey that folic acid
doesn't work. We're all very grateful that we found folic
acid a while back. And it works." That thought was seconded
by a public health analyst with the U.S. National Center on
Birth Defects and Developmental Disabilities, part of the
Centers for Disease Control and Prevention. "CDC researchers
have found that since folic acid fortification began in the
United States, about 1,300 babies are born each year without
a neural tube defect who might otherwise have been
affected," she said. "Folic acid has been shown to be
effective in preventing neural tube defects in randomized
control trials, community intervention programs and food
fortification programs," she added. The bottom line? "The
benefits of folic acid for the prevention of neural tube
defects are well-documented," public health analyst of CDC
said. "The CDC continues to recommend that, to reduce their
risk for a neural tube defect-affected pregnancy, women
capable of becoming pregnant should take 400 micrograms of
synthetic folic acid daily, from fortified foods or
supplements or a combination of the two, in addition to
consuming food with folate from a varied diet." Study
co-author and his colleagues reported their findings online
May 18 in the journal Birth Defects Research Part A.
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