Children's Health: Newborns benefit from folic acid fortification of cereals

A nationwide study suggests that fewer Canadian children are being born with birth defects of the brain and spinal cord thanks to fortification of cereal products with folic acid.

Folic acid is a B vitamin essential to the proper formation of the brain and spinal cord in early pregnancy. If the mother isn't getting enough folic acid, the fetus can develop so-called neural tube defects such as spina bifida. Folic acid fortification of cereal products became mandatory in Canada in 1998.

Dr. Philippe De Wals, director of the department of social and preventive medicine at Laval University in Quebec City, led a study examining incidence of neural tube defects in seven provinces from 1993 to 2002. There were 2,446 cases of neural tube defects among the 1.9 million births during the study period. The study group included live births, stillbirths and pregnancies terminated due to problems with the fetus.

Prior to fortification, the prevalence of neural tube defects was stable at 1.58 per 1,000 births from 1993 through 1997, despite Health Canada recommendations during this time that pregnant women take folic acid supplements. However, there was a 46 per cent decrease from 1998 to 2000, when incidence dropped to 0.86 cases per 1,000 births. That rate remained stable for the remainder of the study period.

The reduction in neural tube defects was most dramatic in areas that had higher rates initially, such as the eastern provinces. "That's a major scientific finding," De Wals says. "It also means that fortification in the world will have a much greater effect in the countries where there is a high prevalence rate of neural tube defects, as is the case in China, in some parts of India, in the U.K. and Ireland."

He adds that fortification may also be most beneficial to low-income people who have the poorest diets and are least likely to take supplements. "From an ethical and equity point of view, (fortification is) much more effective and much more interesting than to promote the use of supplements when you are planning your pregnancy, knowing that half of the pregnancies in Canada are unplanned," he says, although he continues to recommend supplements for women who are pregnant or trying to conceive.