Mothers urged to take folic acid after congenital disorder rise

Expectant mothers are being urged to take folic acid after a worrying rise in congenital disorders linked to a deficiency of the diet supplement.

A study found there has been a rise in neural tube defects — mainly spina bifida and anencephaly, a condition where the foetus is missing parts of the brain and skull — in Ireland since the recession hit in 2009.

Leading obstetrician Michael Turner from the Centre for Human Reproduction at UCD has urged women to take the diet supplement strongly linked to preventing the congenital conditions before conception and during early pregnancy.

“There is at least one case a week,” said Prof Turner, professor of obstetrics and gynaecology at the Coombe Women and Infants University Hospital.

“The reason why it is so important is it is one of the few congenital malformations that is preventable. “The burden of disease on the child and on the family are enormous particularly with spina bifida where the child can be born severely handicapped and be limited in terms of its bladder function and ability to walk.”

More than 50 countries, including the US, have mandatory folic acid fortification in food such as flour, but the Irish government reversed a decision to introduce a similar system in 2008 because falling rates of neural tube defects were recorded during the early 2000s.

But the new report revealed that neural tube defects in Ireland rose from 70 cases in 2009 to 87 in 2011. The study from the UCD Centre for Human Reproduction and the HSE Eurocat Registers concluded that the recession could be having an impact on Irish women getting folic acid naturally in food like fruit and vegetables, especially in lower socioeconomic areas.

“The big concern I have as an obstetrician is that with all the austerity is that women who are socially disadvantaged have cut back on food that is nutritious and are going for cheap high calorie food and they may have cut back on taking their vitamin supplements as well,” said Prof Turner, one of the co-authors of the study. He said there is a “very strong” link between folic acid and the neural tube defects with the report stating it is established that up to 70% of neural tube defects are preventable through adequate intake of folic acid by the woman before conception.

He said: “It is about as strong scientific evidence as exists for anything.” He also stressed that the tablet form of folic acid is superior to folic acid from food as it is absorbed much better into the body. He said: “Most Irish diets, even if they take food that has folic acid added to it, it is not enough. Women would be foolish to depend on their diet alone.

“We are calling for a review of food fortifcation polices and a renewed public health campaign to promote preconceptual folic acid.”

The newly published study in the Journal of Public Health revealed that there were 236 neural tube defects linked to deficient maternal folic acid between 2009 and 2011. It also found the rate of neural tube defects was significantly higher among Irish mothers compared with non-Irish mothers, confirming the historic higher risk of Irish mothers of having an NTD-affected pregnancy, In the three years studied, there were 106 cases of anencephaly, 115 cases of spina bifida, and 15 cases of encephalocoele, which is a sac-like protrusion of the brain through the open skull.

It showed the rate for neural tube defects increased from 0.92 in every 1,000 births in 2009 to 1.17 in every 1,000 births in 2011, which is higher than the overall European rate of between 0.96 and 0.98 per 1,000 births. Prof Turner said Irish women need to realise it is vitally important to take folic acid to prevent the birth defects before and during early pregnancy. “In terms of the folic acid, women should be taking it for at least three months before they become pregnant and if they are obese or on anti-epileptic drugs or they have a history of spina bifida, they should be taking high=dose folic acid for three months beforehand.”

He said taking the supplement early in pregnancy “does work but doesn’t work as well”. He said: “If a women is even at risk of becoming pregnant she should be on her folic acid. It is quite interesting that a company in the United States actually put folic acid into the pill just in case the woman conceives while she is on the pill.”

The report revealed that the Government had planned on introducing a policy of mandatory folic acid food fortification in 2006 but it was abandoned in 2008 partly due to declining NTD rates in the previous years.


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