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Adding Folic Acid to Flour Lessens Congenital Malformations

A new study has found that adding folic acid to flour considerably reduces congenital malformations .

The study, conducted by Universit Laval's Department of Social and Preventive Medicine, has suggested that the addition of folic acid to flours has led to a 46 percent slump in the incidence of congenital neural tube deformation (mainly anencephaly and spina bifida) in Canada.

Such deformations either result in the child's death or in major health problems, including physical and learning disabilities.

The neural tube is the foundation of the embryo's nervous system. Poor development of the neural tube, which is sometimes due to a lack of folic acid, can lead to major health problems. Folic acid is found in green vegetables, fruit, whole grains, and meat. However, even a balanced diet is not able to provide sufficient folic acid for a pregnant mother and the child she is carrying.

In the U.S., fortification of many cereal products with folic acid became mandatory on January 1, 1998. On November 11, 1998, the Canadian government followed suit, requiring folic acid fortification of all types of white flour, enriched pasta, and cornmeal.

"Canada decided to add folic acid to all flour produced in the country because formation of the neural tube in embryos is particularly intense during the first four weeks of pregnancy, which is before a lot of women even know they're pregnant. Since half of Canadian pregnancies are unplanned and the human body can't store folic acid, it is better to integrate folic acid into the food chain than to focus exclusively on taking vitamin supplements," lead researcher, Dr. Philippe De Wals, said.

The study included live birth, stillbirths, and pregnancy terminations among women living in seven of the 10 Canadian provinces from 1993 to 2002. On the basis of published results for red-cell folate levels, the study period was divided into prefortification and full-fortification periods.

During the study period, a total of 2,446 children with neural-tube defects were recorded among 1.9 million births.

The researchers found that between 1993 and 1997, the incidence was 1.58 per 1,000 births. Between 2000 and 2002, the rate dropped 46 percent to 0.86. The biggest improvement occurred in the parts of Canada that had the highest rates of neural tube deformation before 1998-Newfoundland, Prince Edward Island, and Nova Scotia. In Qubec, the drop was also pronounced, but closer to the Canadian average.

Currently, only Canada, the United States, and Chile require that folic acid be added to flour. The success of this practice, as demonstrated by Dr. De Wals's team, could persuade other countries to follow suit.

The study is published in the New England Journal of Medicine.


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