Folic Acid Fortification a Success in Canada

Decrease in neural tube birth defects even more than seen in the U.S., study finds.

By Serena Gordon
HealthDay Reporter
Wednesday, July 11, 2007; 12:00 AM

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WEDNESDAY, July 11 (HealthDay News) -- After the Canadian government mandated the addition of folic acid to flour-based foods in 1998, the rate of neural tube birth defects dropped 46 percent, new research shows.

That tops the 28 percent reduction seen in such defects after a folic acid fortification program was implemented in the United States that same year.

"In the field of prevention, there have been a few clear triumphs of science and public health interventions -- immunization programs, when iodine was added to salt, and when vitamin D was added to milk. Now, we have another major victory in that we can prevent major and severe birth defects in children. Neural tube defects are a tragedy, and this is really a major public health victory," said study author Philippe De Wals, head of the department of social and preventive medicine at Laval University in Quebec. "All countries should adopt folic acid fortification."

The potential to prevent neural tube defects from occurring in the first place is why other countries have mandated the addition of folic acid to breads, cereals and pastas. Because folic acid -- a B vitamin -- is water-soluble, it doesn't collect in the body's tissues and isn't considered harmful to the general population. The only concern about additional folic acid is that it may mask symptoms of a vitamin B-12 deficiency in the elderly.

Beginning in 1998, the Canadian government began requiring folic acid fortification. According to the study, it's estimated that fortification added an average of about 150 micrograms of daily folic acid to each Canadians' diet. The recommended daily amount to prevent birth defects is 400 micrograms daily.

When the spinal cord or brain doesn't develop properly in early pregnancy, it's known as a neural tube defect. The most common neural tube defects are spina bifida and anecephaly. These birth defects affect about 3,000 American babies each year. Spina bifida occurs when the spinal column doesn't close properly and often results in lifelong disability. In anecephaly, the brain and skull bones don't form normally, and often part of the brain and skull is missing. These babies usually die soon after birth.