Folate during reproduction: the Canadian experience with folic acid fortification

Abstract

Folate has received international attention regarding its role in the risk-reduction of birth defects, specifically neural tube defects (NTDs). In 1998, health officials in Canada, like the United States, mandated the addition of folic acid to white flour and select grain products to increase the folate intake of reproductive-aged women. Subsequent to this initiative there has been an increase in blood folate concentrations in Canada and a 50% reduction in NTDs. Many countries, including Korea, have not mandated folic acid fortification of their food supply. Reasons vary but often include concern over the masking of vitamin B12 deficiency, a belief that folate intakes among womenare adequate, low priority relative to other domestic issues, and the philosophy that individuals have the right not to consume supplemental folic acid if they so choose. Prior to folic acid fortification of the food supply in Canada, the folate intakes of women were low, and their blood folate concentrations while not sufficiently low to produce overt signs of folate deficiency (eg. anemia) were inconsistent with a level known to reduce the risk of an NTD-affected pregnancy. The purpose of this article is to describe the role of folate during the periconceptional period, pregnancy, and during lactation. The rationale for, and history of recommending folic acid-containing supplements during the periconceptional period and pregnancy is described as is folic acid fortification of the food supply. The impact of folic acid fortification in Canada is discussed, and unresolved issues associated with this policy described. While the incidence of NTDs in Canada pre-folic acid fortification were seemingly higherthan that of Korea today, blood folate levels of Korean women are strikingly similar. We will briefly explore these parallels in an attempt to understand whether folic acid fortification of the food supply in Korea might be worth consideration

Folic Acid Fortification and Women’s Folate Levels in Selected Communities in Brazil - A First Look

“…However, women like the participants in our study comprise the group that fortification programs were designed to benefit. Our documentation of a large post- versus pre-fortification difference in folate status among OCPP participants adds importantly to the argument that a reduction in NTD occurrence post-fortification observed in Brazil [15] and other countries [11, 23–25] was mediated by a dramatic increase in folate status and decline in folate deficiency among high-risk women. Improving folate status in women of child-bearing age may have other benefits.…”

Role of maternal vitamins in programming health and chronic disease

“…Folic acid supplementation during the periconceptional period (%1 month prior and after conception) and maintained throughout pregnancy dramatically reduced the incidence of neural tube defects, 41 and mandatory folic acid fortification of cereal products since1998 has further contributed to a reduced prevalence of neural tube defects by up to 50%. 7 To build and preserve maternal stores and meet the needs of rapidly growing tissues, public health professionals recommend that all women of childbearing age under good compliance with their dietary recommendations receive a minimum of 400 mg of synthetic folic acid each day in addition to dietary folates (naturally occurring folates) obtained from a well-balanced diet or consumed as part of a multivitamin supplement. 8 The folic acid content of prenatal supplements ranges between 400 and 2000 mg, and women at risk of deficiency or poor compliance are advised by the Canadian Society of Obstetricians and Gynecologists to consume up to 12.5-fold (5000 mg/d) the RDA of folic acid for optimal protection against neural tube defects.…”

“…5,6 Methyl-group vitamins, such as folic acid, are active regulators in one-carbon metabolism, and increased consumption of these micronutrients has been proven an effective strategy for reducing adverse pregnancy outcomes, such as neural tube defects, in the offspring. 7 Thus, prenatal supplements are widely recommended before and during pregnancy because they are formatted specifically to meet the nutrient requirements of the mother and developing fetus, with particular emphasis on folic acid. 8 Folic acid amounts in prenatal supplements may range between 400 mg and 2000 mg, providing up to or beyond the recommended daily allowance (RDA) of 400 mg/d during pregnancy.…”

Usage of Potential Teratogenic Chemical Preparations among Mothers of Children Attending the Multidisciplinary Cleft Clinic at the Komfo Anokye Teaching Hospital, Ghana

“…Studies of vitamin supplementation with folate remain controversial [3,15] and recent studies of levels of folate receptor antibodies did not find any significant association with CLP [16]. Furthermore, food fortification programs using folic acid have shown detectable decreases in the rates of clefting in some studies [17,14]. Besides nutrients and toxins, other environmental exposures have been implicated for their possible roles in clefting.…”