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More folic acid needed to prevent birth defects

Mother holding baby's feet

Birth defects, such as spina bifida, may be greatly reduced if women significantly up their folic acid intake, beyond levels supplied by most public supplementation programmes, according to new research.

South Australian Health and Medical Research Institute (SAHMRI) researchers compared the effects in women of taking common iron-folic acid weekly supplements containing 0.4mg folic acid with supplements containing 2.8mg folic acid and found participants taking the larger dose reached a concentration of red blood cell folate associated with low neural tube defect risk.

The World Health Organization recommends menstruating women in countries where anaemia prevalence is higher than 20 per cent should take a weekly 2.8mg folic acid supplement, but most supplements being offered to women contain only 0.4mg.

The findings of the study of Malaysian women published in BMJ Global Health suggest the WHO recommendation of the higher dose is correct and would be associated with lower incidence of neural tube defects in babies.

Anaemia levels vary from country to country

There are many types of anaemia including those caused by iron deficiency and vitamin B12 and folate deficiency, and folic acid is the synthetic form of folate used in supplementation.

A folate deficiency can result in tiredness, breathlessness, faintness, headaches, palpitations, poor appetite, weight loss, impaired taste, diarrhoea, numbness and tingling in the hands and feet, muscle weakness and depression.

Adequate folate is essential in early pregnancy for spinal development in the baby and it is generally recommended women take a folic acid supplement from at least four weeks before conception and continue until 12 weeks after conception.

Anaemia prevalence in Malaysia is around 35.5 per cent in women, whereas places such as the UK, US, Australian and New Zealand have a prevalence that falls below the 20 per cent threshold for supplementation levels recommended by the WHO.

Cambodia, Maldives, Bangladesh and Myanmar are among the countries with the highest anaemia prevalence, ranging from 42.9 per cent to 64.3 per cent, according to journal PLoS One.

The global prevalence of anaemia for the general population is 24.8 per cent, which is above the 20 per cent threshold, according to WHO data.

In some places, such as the UK, Ireland and New Zealand, bread has been voluntarily fortified with folic acid and this is thought to have increased folate levels and lowered risk of neural tube defects.

Food sources of folate

Dietary sources of folate include green leafy vegetables, chicken liver, lamb’s fry, chickpeas, mussels, eggs, wholemeal bread and asparagus, to name just a few, but supplementation is still recommended prior to and during pregnancy.

The bottom line

The researchers say their findings show 2.8mg doses of folic acid should be made more widely available, to lower the risk of neural tube defects in babies.

For more on folic acid read: Ask the experts: Folic acid bread fortification and Ask the experts: How to get folic acid 

First published: Dec 2020

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