Women urged to take folic acid before conceiving to avoid defects

A major public health campaign is urgently needed to remind women of the importance of taking folic acid to prevent birth defects, leading Irish obstetricians have advised.

The call has been made in response to research which shows a rise in the incidence of neural tube defects such as spina bifida, which are largely preventable through the intake of folic acid before and after conception.

Studies of women attending the Coombe women’s hospital show that as few as a quarter have taken folic acid before conception and that the numbers taking the supplement are declining.

Another recently published study has revealed a decline in the number of food products fortified with folic acid. This means women are less likely to consume the vitamin passively in their diet.

UCD professor of obstetrics at the Coombe Michael Turner said the Government's public health advice needed to be updated in the light of these findings.

“The message for women is that you shouldn’t wait until you are pregnant to take folic acid. Any woman who could get pregnant should be taking it.”

Immigrants

Women from poorer backgrounds as well as recent immigrants from eastern Europe are more likely to have low intakes of the vitamin, the research shows, possibly because they were missed by previous information campaigns.

Irish obstetricians first became concerned when paediatricians reported a rise in the number of operations they were carrying out on babies with spina bifida.

“This is a horrendous, lifelong health burden which is largely preventable, so we started to research why it was happening,” said Prof Turner, who is also the HSE clinical lead for obstetrics.

Prof Turner has raised the need for a new approach with the Department of Health and the HSE after the studies showed the apparently linked trends of falling folic acid intake and a 27 per cent rise in neural tube defects in two years.

He said there was a greater responsibility on Irish authorities to act because the resulting burden of illness is far greater than in other countries. As termination of most pregnancies is illegal, a far higher number of pregnancies involving birth defects result in live births. About one child a week is born with spina bifida, though most of these cases could be prevented through intake of supplements from three months before conception.

Prof Turner said austerity might be partly to blame, as people had less money for discretionary spending on higher-quality food products fortified with folic acid. The incidence of birth defects has also been found to be higher outside Dublin, as it is thought people in the capital spend more money on food.

UCD research fellow and obstetrician Aoife McKeating said low levels of folic acid supplementation were often found with unplanned pregnancies. “The risk of unplanned pregnancy is highest among women under the age of 20, who are unemployed or have a history of depression or domestic violence.”

Obese women, who are more likely to have an unplanned pregnancy, are advised to take a higher dose of folic acid. Just 2 per cent of obese patients in the Coombe were doing so.

Prof Turner’s advice is that all women who could potentially become pregnant, whether trying to conceive or not, should consider taking a folic acid supplement. One in three pregnancies was unplanned, he said.