Birth defects up after fall in folic-acid fortified food

A fall-off in foods fortified with folic acid has been linked with an increase in severe birth defects.

The Food Safety Authority of Ireland found the number and type of foods fortified with folic acid, as well as the amount added, had fluctuated in recent years.

The FSAI also found the incident rate of neural tube defects (NTDs), such as spina bifida and anencephaly, rose from 0.92 per 1,000 births in 2009 to 1.17 per 1,000 in 2011.

“It appears that the incidence of NTDs may be increasing again,” the authority warns in a report highlighting the need for women of childbearing age to have higher intakes of folic acid.

The report by the FSAI’s scientific committee found mandatory fortification of flour or bread with folic acid was more effective than voluntary fortification.

Taking folic acid, the synthetic form of the B vitamin known as folate, before conception and during the very early stages of pregnancy can prevent up to 70% of NTDs.

As well as mandatory fortification of bread and flour, women of childbearing age would be advised to take an additional 400 micrograms daily as a food supplement.

Voluntary fortification of foods would continue.

The authority’s chief specialist in public health nutrition, Dr Mary Flynn, said Irish women had a genetic predisposition to developing NTDs.

“There is conclusive scientific evidence linking low levels of folate with spina bifida and related birth defects and this is a major challenge given the low levels of folic acid in the Irish diet that needs to be addressed,” said Dr Flynn.

“By the time a woman finds she is pregnant, the neural tubes have already closed. They close within 21 to 28 days post-conception. So if a woman misses her period at 14 days, she might not get a pregnancy test for another week. Then it is too late.”

The report states voluntary fortification could be improved by providing guidance on voluntary fortification of selected food by manufacturers.

Compared to mandatory fortification, the approach had weaker evidence to support its possible effectiveness in further reducing rates of NTD-affected pregnancies from the current rate.

“We took a look at fortified foods on the market in 2015 and we found a lower amount compared to 2005/2006, so that could explain the drift upwards of NTDs,” said Dr Flynn.

The report also calls for the establishment of a comprehensive nationwide register of pregnancies affected by congenital birth defects.

More than 80 countries, including the US, Canada, and Australia, have introduced mandatory folic acid fortification of staple foods.