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Folic Acid Supplementation
De Wals P, Tairou F, Van Allen MI, et al. Reduction in Neural-Tube Defects after Folic Acid Fortification in Canada. New Engl J Med (July 12, 2007); 357:135-142. Full Text | PDF
Background. In 1998, folic acid fortification of a large variety of cereal products became mandatory in Canada.
Methods. The study population included live births, stillbirths, and terminations of pregnancies because of fetal anomalies among women residing in seven Canadian provinces from 1993 to 2002. On the basis of published results of testing of red-cell folate levels, the study period was divided into prefortification, partial-fortification, and full-fortification periods. We evaluated the relationship between baseline rates of neural-tube defects in each province and the magnitude of the decrease after fortification was implemented.
Results. A total of 2446 subjects with neural-tube defects were recorded among 1.9 million births. The prevalence of neural-tube defects decreased from 1.58 per 1000 births before fortification to 0.86 per 1000 births during the full-fortification period, a 46% reduction (95% confidence interval, 40 to 51). The magnitude of the decrease was proportional to the prefortification baseline rate in each province, and geographical differences almost disappeared after fortification began. The observed reduction in rate was greater for spina bifida (a decrease of 53%) than for anencephaly and encephalocele (decreases of 38% and 31%, respectively).
Conclusions. Food fortification with folic acid was associated with a significant reduction in the rate of neural-tube defects in Canada.
Comments. This study confirms the value of dietary folic acid supplementation during the preconception period to prevent neural tube defects in babies. In the United States and Canada, folate supplementation of flour and grain products has been mandated since 1997. Women of child-bearing age who are on “Low-carb” diets may be at increased of having babies with birth defects unless they are taking an additional supplement of this vitamin beginning in the preconception period. ABK
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