Strategies to increase folate/folic acid intake in women: an overview

Abstract

Supplementation with folic acid reduces the risk of neural tube defects (NTDs) and may also be associated with other health benefits in relation to cancer and vascular disease. There is strong support around the world for public health policies that encourage increased folic acid intake by women of childbearing age, especially daily intake of supplemental folic acid, to reduce the incidence of NTDs. Campaigns promoting the use of folic acid supplements are useful but many women remain unaware and many pregnancies are unplanned. They have therefore had a limited impact in the primary target group, namely women around the time of conception and in the early weeks of pregnancy. Studies suggest that only about 30% of women aged 18-45 years use folic acid periconceptionally, and among younger, less educated and poorer women, use is even less. It is estimated that the majority of women who take folic acid don't start until they know they are pregnant, and so miss the critical window (first 12 weeks) for the prevention of NTDs. It is therefore important that routes other than supplementation are considered. A European Unionfunded programme of work, 'Folate: from food to functionality and optimal health' (FolateFuncHealth, QLRT1-1999-00576 & QLRT-2001-2740, has contributed to this work and the findings were presented at a conference in Warsaw in 2004.

Nutrition in pregnancy

“…Furthermore, a recent study by Wald (2004) indicates that there is an inverse dose–response relationship between folate status and the risk of NTDs. This research emphasises the critical importance of folic acid supplementation before the time of conception, as once pregnancy is established, it is probably too late for folic acid to have a protective effect (Buttriss 2004). Wald has estimated that supplementation with 400 µg (0.4 mg) of folic acid per day results in a reduction in the incidence of NTDs of 36%.…”

Rye: the overlooked cereal

“…2005). Given concerns about current folate intakes (it being necessary for the prevention of neural tube defects in the developing embryo, for example, see http://www.sacn.gov.uk) (see Buttriss 2004; Stanner & Buttriss 2006), efforts have been made to enhance the folate content of rye bread through manipulation of the sourdough fermentation process and the choice of starter culture, given that some yeasts produce folate (thus increasing the levels present as a result of fermentation), whereas some lactic acid bacteria utilise folate (Kariluoto et al . 2005).…”

Time to reconsider a folic acid fortification policy in the UK

“…Evidence from randomised controlled trials that supplementing with folic acid reduces the risk of NTDs (MRC Vitamin Study Research Group 1991) has prompted governments around the world to recommend folic acid supplementation (400 µg/day) for women of childbearing age and those considering pregnancy. However, nationwide campaigns to date have had limited impact (Buttriss 2004b) and to reach almost all women in the very early stages of pregnancy, when a large proportion will be unaware that they are pregnant, folic acid fortification of a staple food has been advocated. In the UK, voluntary fortification of selected food types occurs ( e.g.…”