March 18, 2002

Congenital anomalies, better known as ‘birth defects’, affect about 3% of newborns in Canada. That figure rises to about 7% over the first two years of life as previously undiagnosed conditions are discovered. While many congenital anomalies are treatable, some are not. The impact on families and individuals can be significant so it would be sensible, then, to take every possible precaution. One simple and effective step is for mothers-to-be to be taking in sufficient levels of folic acid.

One of the most common forms of congenital anomalies are neural tube defects, or NTDs. The neural tube forms in the embryo, then closes to later become the baby’s spinal cord, spine, brain and skull. An NTD occurs when the lower end of the neural tube fails to close properly. The most common of these is spina bifida. Another form is anencephaly which occurs when the brain fails to develop. Folate deficiency has also been associated with other serious birth defects of the heart, kidney, face and mouth.

There is now solid evidence that birth defects need not simply be a fact of life that must be accepted. Reducing the risk can be as simple as increasing the intake of the B-vitamin, folic acid, or folate in its naturally occurring form. It is a water soluble vitamin found in many foods but most prevalent in dark green, leafy vegetables, beans and legumes.

A developing fetus needs abundant folic acid very early in gestation, particularly during the first few weeks after conception. Ideally, a mother should be supplementing her diet with 0.4 mg of folic acid daily — a multivitamin containing that amount is the simplest way — for two to three months prior to conception. Unfortunately, many pregnancies are not planned. Worse, by the time a woman knows she’s pregnant, it’s already too late as the neural tube has already formed.

While good nutrition through a diet containing abundant fresh fruits and vegetables, along with a well-balanced intake of other representative food groups goes a long way towards preventing NTDs, diet alone is not enough to get the daily need. The prescription, then, is for women in their child-bearing years to be taking folic acid supplements.

Folic acid itself has few safety concerns for the general population. The primary concern is for anyone who may have an undiagnosed B12 deficiency since high levels of folate can mask the deficiency. Strict vegetarians can be prone to B12 deficiency so should take no more than 0.4 mg of folic supplements. For others, excess levels will simply be excreted in urine, just like excess vitamin C.

Taken at least one month before conception and throughout the first trimester, folic acid has been proven to reduce the risk for NTDs by 50-70%. Even women who are not planning to get pregnant should be supplementing their natural intake of folate. After all, every baby deserves the best chance it can have. Take folic acid now — so your body’s ready when you are.

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Call-out:
“Folate deficiency has also been associated with other serious birth defects of the heart, kidney, face and mouth.”