folic acid research shows promising results

Folate is a B vitamin naturally found in many everyday foods such as beans, nuts, and green leafy vegetables.  The synthetic form of folate, what most people know as “folic acid,” can be found in almost every type of multivitamin, as well as in enriched orange juice and fortified grain and bread products.  Folate and folic acid help with cell growth and cell regeneration—think thicker and faster growing hair and nails.  Additionally, folic acid plays an important role in preventing neural tube defects (NTDs), which are serious birth defects of the brain and spine.

That is why, out in the community, many people will refer to folic acid as “the pregnancy vitamin.”  For the average woman, her first introduction to folic acid will be when she becomes pregnant.  However, while folic acid supplementation is needed throughout a pregnancy, it is especially important in the earliest weeks.  The neural tube forms completely in just the first month after conception, often in the timeframe before a woman even knows she is pregnant.  So in order to reduce the risk of NTDs, women must actually begin to regularly take folic acid before they ever become pregnant.

As a result, all women of childbearing age are encouraged to consume 400mcg of folic acid every day in order to prevent neural tube defects in future pregnancies.  (A multivitamin with folic acid is often the easiest and most convenient method for achieving this recommendation.)  This has been the recommendation from the U.S. Preventive Services Task Force since 1996.  When adhered to, this level of supplementation has been shown to reduce the risk of NTDs by as much as 80%.  Yet, new research published in The British Medical Journal has the potential to either change or augment this long-held recommendation.

Using data from two existing folic acid population-based study trials, researchers aimed to determine if the concentration of folate in a mother’s red blood cells was linked to NTD formation. 

From the analysis of the data as well as other published literature, the authors were able to develop a model for predicting the estimated risk of a fetus developing an NTD based on folate concentration in a woman’s red blood cells.  The model in fact found a dose-response relationship between these two study factors.  This means that as folate concentrations rose, the risk of a fetus developing an NTD declined. 

Moreover, an optimal folate concentration range for preventing NTDs caused by folic acid deficiency was identified.  For example, when red blood cell folate concentration fell between 1000 and 1300 nanomoles per liter, the total risk of NTDs was approximately 6 per 10,000 births.  Comparatively, the lowest red blood cell concentrations recorded, 340 nmole/L, resulted in 48.8 per 10,000 births.  Gradual shifts in the number of NTDs observed were seen between these concentration levels as well.

These findings could have significant implications for preconception and prenatal health.  For example, the study’s authors reported that folic acid fortification of grain and bread products has put the majority of U.S. women, even those who do not take folic acid supplements, above the lowest ranges of red blood cell folate concentrations that are most associated with NTD risk.  However, there are likely many subpopulations of women who are still at risk for preventable NTDs.  And considering the overall poor adherence to daily folic acid supplementation among women in the preconception and interconception periods, and the fact that nearly half of all U.S. pregnancies are unplanned, a blood test that could identify low folate levels during these timeframes before a pregnancy may allow for targeted intervention.

Outside of the U.S., nationwide fortification programs are not commonplace, even though adherence to a daily regimen of folic acid supplementation is often just as weak as it is among U.S. women.  According to this study’s model, even when the red blood cell folate levels are shifted just marginally, especially among the groups with the lowest folate concentrations, significant declines in NTD risk can be seen.  This supports the positive impacts that can be achieved if more governments were to mandate grain and bread fortification.

This new research published in The British Medical Journal emphasizes the importance of folic acid supplementation for all women of childbearing years as well as highlights a new model for measuring risk of NTDs.  This new model could be used in the future on both micro and macro levels.  On the smaller scale, a simple blood test (depending on the cost) could become a part of routine women’s care to assess for folate deficiencies prior to pregnancy.  This information could be used by health care providers to target women with personally relevant messages about NTD risk and supplementation need.  On a global scale, this data supports large-scale folic acid fortification programs like the one implemented in the United States in 1996.  If even small shifts in folate concentration levels in the blood can produce significant reductions in NTD risk, then fortification of grain and bread products could improve the health and quality of life of many babies and their families.

To view the original study in The British Medical Journal, click here.

This article was written by Sarah S. Wright, Cape Fear Regional Coordinator.

 

Revised: September 15, 2014

This web site is designed for informational use only; it is not designed to give advice, diagnose, cure or treat any medical condition you may have. If you have any questions about your health, please contact your health care provider.